L’allergie à l’arachide est un problème de santé publique dans les pays industrialisés par sa fréquence et sa sévérité. L’immunothérapie orale (ITO) est une alternative thérapeutique à l’éviction alimentaire dans le but de diminuer le risque de réaction en cas d’ingestion accidentelle. Le but de notre étude est d’évaluer l’efficacité de l’ITO à l’arachide chez l’enfant et d’identifier des facteurs prédictifs d’efficacité. Tous les enfants allergiques à l’arachide ayant débuté une ITO à l’arachide avant le 1er septembre 2016 ont été inclus dans 3 centres d’allergologie en Lorraine (Nancy, Verdun et Épinal), utilisant les mêmes protocoles d’ITO établis par le Pr Moneret-Vautrin. Nous avons défini l’efficacité selon trois critères : la tolérance quotidienne de 2 g d’arachide, la diminution des IgE spécifiques (sIgE) r Ara h2, et dans un sous-groupe la négativité du test de provocation orale (TPO) à la dose de 15 g d’arachide. Parmi les 139 enfants inclus (âge médian : 9,8 ans), 85,6 % consommaient 2 g d’arachide par jour à la fin de la phase d’augmentation des doses et 38,8 % d’entre eux avaient diminué de moitié leurs sIgE r Ara h2 à 18 mois de protocole. Avoir une co-allergie aux anacardiacées était un facteur prédictif de diminution des sIgE r Ara h2 à 18 mois de protocole (OR = 6,3 [1,5–25,8]). Le TPO, réalisé chez 39 enfants (22,3 %) après 3 mois d’arrêt d’ITO, était négatif dans 79,5 % des cas. La tolérance quotidienne de 2 g d’arachide par une majorité des patients est un point fort avec une diminution potentielle du risque de réaction allergique en cas d’ingestion accidentelle. Par ailleurs, les enfants allergiques aux anacardiacées semblent présenter une meilleure réponse biologique à l’ITO, ce qui correspond peut-être à un phénotype particulier. La tolérance de 2 g d’arachide a été acquise par la majorité des patients. La tolérance à long terme, évaluée dans une sous-population, a été acquise dans plus de trois quarts des cas. Une co-allergie aux anacardiacées semble être un facteur prédictif d’efficacité, ce qui soulève la question de phénotypes particuliers pour lesquels il y aurait plus de bénéfice à proposer une ITO.

Aim. - The Lorraine and Champagne Ardenne Allergology Network (Allergolor) set up a system in 2006 whose aim was to improve the response of the medical emergency service (SAMU) to calls from patients with symptoms of severe anaphylaxis. This pre-alert system is based on records stored in SAMU centers that respond to phone calls to the medical emergency number 15. This study reviews the use and relevance of this pre-alert system by means of a retrospective survey of SAMU centers in Lorraine.Methods. - Information on cards concerning patients at high risk of anaphylaxis was sent to SAMU centers by the Allergolor network. Patients dialing 15 (the SAMU phone number) were then recognized as being in the system by identification of their telephone number. We collected the data on the use of this pre-alert system by the 4 SAMUs in Lorraine (Meurthe and Moselle, Moselle, Meuse and Vosges) over a 5-year period and made a descriptive analysis of the management of patients presenting with symptoms of severe anaphylaxis and how this action met the recommendations of the French SAMU and also the recommendations of the Academy of Medicine.Results. - One hundred and fifty cards concerning 132 patients had been sent from the Allergolor network to the Lorraine SAMUs; data on 55 of the 150 cards were incomplete and 43 of the cards had not been entered in the SAMU software. Since the pre-alert system was introduced, the number of patients reported has been falling. Over the 5-year period, there were only 7 calls, 2 of which were from one of the 7 individuals; thus only 6 cards had been used. The symptoms reported included 4 from individuals with cutaneous reactions, 2 with laryngeal edema and 1 with post prandial malaise. The response in 6 out of the 7 cases was in line with the French SAMU's 2009 recommendations and also with the measures recommended by the Academy of Medicine, with 5 cases that met both sets of recommendations.Conclusion. - The number of new cases of severe anaphylaxis in Lorraine is estimated to be 100 a year, leading to an estimated reporting rate of 27 % (132/500) over a 5-year period. The present evaluation enabled us to measure the performance of the system and to suggest some possible improvements. The failure to pass on or take account of patients' cards by the SAMUs will be improved. Harmonization of the recommendations for dealing with anaphylaxis is necessary. (C) 2013 Elsevier Masson SAS. All rights reserved.

Exclusion diets can induce nutritional disorders in certain patients suffering from food allergies (FA). Among children, the most frequently involved foods often represent the major sources of nutrition, especially if cow's milk or gluten is involved during infancy, and the risk of nutritional deficiency increases with Multiple FA. These food exclusion diets could induce different kinds of nutrition deficiencies: lack of energy, nutrients, vitamins, and mineral substances. The feeding of these children should be conscientiously followed, and the consumption of different dietetic products, especially Substitution infant formulas or guarantied "allergen free" foods should be carefully controlled. Quantitative nutritional adequacy should be regularly assessed and alimentary equilibrium must be respected. The diet prescription and its follow-up should be based on the joint knowledge of the allergist and the dietician. Adult FA mostly concerns vegetable allergens and therefore poses few nutritional deficiency problems except, with the exception of

Twenty-two cases of severe anaphytaxis associated with buckwhear (fagopyrum esculentum) were declared by the AllergyVigilance Network between 2002 and 2006: 13 females and 9 males (mean age: 30 years). The prevalence of buckwheat anaphylaxis out of 489 cases of food anaphylaxis was 4.5%. Symptoms were anaphylactic shock (11 cases), serious systemic reactions (7 cases), laryngeal angioedema (3 cases) and pre-lethal (or sub-lethal?) acute asthma (1 case). Anaphylaxis was induced by oral challenge in one patient. 77% patients were in hospital from several hours up to four days, but epinephrine was used in only 40% of cases. Half the people suffered repeated episodes. In four cases, buckwheat flour was a masked allergen. The authors list all kinds of food that might contain buckwheat (eviction died on www.cicbaa.org). They underline the relationship between frequent buckwheat consumption and the prevalence of allergy. They emphasize that there is no compulsory labelling.

The case of a 64 y.o. female is reported. She experienced formerly four anaphylactic shocks. Two shocks occurred after ingestion of pork and beef meat. Any food allergy to animal proteins was discarded. A high degree of sensitivity to penicillin G was proved by a positive prick test to penicillin G 1 Ul/ml, which induced a systemic reaction. RAST to penicillin G was class 4. The leucocyte histamine release test showed a high level of spontaneous histamine release. A double blind, placebo controlled, oral challenge with penicillin mixed to milk induced wheezing and a fall of blood pressure at the cumulative dose of 20 Ul. The hypothesis of food induced anaphylaxis, linked to penicillin residues in meats, is highly plausible. The significance of the phenomenon of spontaneous histamine release is discussed. It might point to frequent ingestions of hidden penicillin residues in the diet.