Background: Peanut allergy (PA) is an IgE-mediated food allergy with variable clinical outcomes. Mild-to-severe symptoms affect various organs and, often, the gastrointestinal tract. The role of intestine-derived IgE antibodies in gastrointestinal PA symptoms is poorly understood. Objective: This study aimed to examine fecal IgE responses in PA as a novel approach to patient endotyping. Methods: Feces and serum samples were collected from peanut-allergic and healthy children (n=26) to identify IgE and cytokines using multiplex assays. Shotgun metagenomics DNA sequencing and allergen database comparisons made it possible to identify microbial peptides with homology to known allergens. Results: Compared to controls, fecal IgE signatures showed broad diversity and increased levels for 13 allergens, including food, venom, contact, and respiratory allergens (P<.01-.0001). Overall, fecal IgE patterns were negatively correlated compared to sera IgE patterns in PA patients, with the greatest differences recorded for peanut allergens (P<.0001). For 83% of the allergens recognized by fecal IgE, we found bacterial homologs from PA patients’ gut microbiome (eg, thaumatin-like protein Acinetobacter baumannii vs Act d 2, 109/124 aa identical). Compared to controls, PA patients had higher levels of fecal IgA, IL-22, and auto-IgE binding to their own fecal proteins (P<.001). Finally,levels of fecal IgE correlated with abdominal pain scores (P<.0001), suggesting a link between local IgE production and clinical outcomes. Conclusion: Fecal IgE release from the intestinal mucosa could be an underlying mechanism of severe abdominal pain through the association between leaky gut epithelia and anticommensal TH2 responses in PA.

La consommation des légumineuses a augmenté ces deux dernières décennies avec comme conséquence l’augmentation de la prévalence des anaphylaxies alimentaires à cette famille d’aliments : l’arachide étant le principal responsable. Quelques études rapportent une réactivité croisée in vivo entre l’arachide et certaines légumineuses, notamment le lupin et le fenugrec. Déterminer la prévalence de la sensibilisation aux légumineuses autres que l’arachide chez les enfants allergiques à l’arachide et évaluer la pertinence de cette sensibilisation vis-à-vis du risque allergique. Ont été inclus tous les enfants présentant une allergie avérée à l’arachide suivis entre le 1er janvier 2017 et le 29 février 2020 dans le service d’allergologie pédiatrique au CHRU de Nancy pour lesquels la consommation ou la sensibilisation à au moins une autre légumineuse était documentée. Les données ont été collectées de façon rétrospective concernant la consommation, les tests cutanés, le dosage des IgE spécifiques, les réactions allergiques inaugurales et les tests de provocation orale pour chaque légumineuse explorée. Parmi les 195 enfants allergiques à l’arachide inclus, 122 avait une sensibilisation à au moins une autre légumineuse (63,9 %). Les sensibilisations étaient plus fréquemment retrouvées pour le fenugrec (66,3 %), la lentille (42,2 %), le soja (39,9 %) et le lupin (34,2 %). Parmi les 122 enfants sensibilisés, 34 avaient une allergie confirmée à au moins une autre légumineuse (27,9 % soit 17,4 % de la population étudiée), dont 6 enfants avec une allergie à plusieurs légumineuses (4,9 %). Lupin, pois et lentilles étaient les principaux allergènes responsables. Près de la moitié des réactions allergiques aux autres légumineuses que l’arachide étaient sévères (score d’Astier ≥ 3). Près de deux tiers des enfants allergiques à l’arachide sont sensibilisés à au moins une autre légumineuse et en cas d’allergie confirmée, près de la moitié ont présenté des réactions anaphylactiques sévères. Ces résultats soulignent l’importance de l’exploration systématique de la sensibilisation et de la tolérance des différentes légumineuses chez les enfants allergiques à l’arachide.

In recent decades, the prevalence of allergic diseases has increased dramatically, and food allergy plays a key part in this increase. The prevalence of food allergy is about 4% in adults and 6-8% in children. Legumes are among the key classes of food responsible for IgE-mediated allergic reactions, especially severe food anaphylaxis. The Labeling Directive (UE 1169/2011) requires manufacturers to declare three legumes: peanut, soy and lupin. Allergic reactions provoked by peas are common in early childhood in legume allergy, especially with green peas and split peas in our countries. The binomial denomination of pea is Pisum sativum. Two major allergens from the 7S-gobulin family have been identified in pea: a vicilin-like protein, Pis s 1, and a convicilin, Pis s 2. Recently, pea has been used as an ingredient in various processed foods. Commercial pea proteins, extracted from yellow dry dehulled pea and containing more than 80% of proteins, are used by manufacturers for their emulsifying and gelling properties in minced meat products, drinks, baked goods and other applications as substitutes for gluten and for animal protein. The allergenic risk of these pea derivatives is poorly known and should be evaluated. (C) 2019 Elsevier Masson SAS. All rights reserved.

Déterminer l’état de sensibilisation à la moisissure Alternaria chez des patients consultant en allergologie pour rhinite, asthme et ou conjonctivite au Maghreb et en Afrique.Étude prospective incluant 156 patients présentant une symptomatologie allergique (rhinite, asthme ou conjonctivite) âgés de 3 à 65 ans, chez qui il a été recherché par « prick-test » la sensibilisation cutanée à Alternaria.Le sexe ratio était de 0,77. L’âge moyen était de 25,24 + 16,4 ans. Les principaux motifs de consultation étaient prurit nasal (97,4 %), écoulement nasal (82,7 %), obstruction nasale (72,4 %), toux (64,1 %) et prurit oculaire (50,6 %). La sensibilisation à Alternaria était retrouvée dans 24,3 %. La sensibilisation à Alternaria augmente avec l’âge (p < 0,01), elle était corrélée à la conjonctivite. Chez les patients sensibilisés à Alternaria les facteurs déclenchant retrouvés étaient l’habitat humide et la moisissure. Les facteurs climatiques associés étaient humidité, vent, froid, pluie et chaleur (p < 0,05).La sensibilisation cutanée à Alternaria est modérément fréquente et varie selon les pays. Elle est liée à l’âge.To determine the state of health in patients consulting in allergology for rhinitis, asthma and conjunctivitis in the Maghreb and Africa.A prospective study in 156 patients presenting allergic symptoms (rhinitis, asthma or conjunctivitis), patients aged 3 to 65 years, with screening by prick-test.The sex ratio was 0.77. The average age was 25.24 + 16.4 years. The main reasons for consultation were nasal pruritus (97.4 %), nasal discharge (82.7 %), nasal obstruction (72.4 %), cough (64.1 %) and eye pruritus (50.6 %). Sensitization to Alternaria was found in 24.3 %. This sensitization increased with age (P < 0.01) and was correlated with conjunctivitis. In Alternaria-sensitized patients, the triggers found were damp habitat and mold. Associated climatic factors comprised: humidity, ventilation, cold, rain and heat (P < 0.05).Cutaneous sensitivity to Alternaria is fairly frequent and varies by country. It is age-related.

BackgroundFish is one of the most allergenic foods. While clinical cross-reactivity among different fishes is a widely accepted feature of fish allergy, associations with other food allergies are not well understood. This study aims at analyzing the relevance of clinical cross-reactivity between fish and chicken meat in patients with allergy to chicken meat without sensitization to hen's eggs.MethodsPatients with food allergy to fish and chicken meat (n = 29) or chicken meat only (n = 7) were recruited. IgE-reactive chicken proteins were identified (Edman, MS analysis) and quantified (ELISA). Allergens were used in IgE ELISA and skin testing.ResultsChicken parvalbumin and two new allergens, aldolase and enolase, were identified at 12, 40, and 50 kDa, respectively. They were recognized by sIgE of 61%, 75%, and 83% of all patient sera which were in the majority of the cases positive for the fish homologues as well. Fish and chicken meat allergens were highly cross-reactive while high inhibition rates with fish or chicken allergens correlated with the patients' primary sensitization to fish or chicken. In cooked or roasted foods, enolase and aldolase were detectable in chicken breast while parvalbumin was detectable in chicken legs and wings.ConclusionsFish and chicken meat are cross-reactive foods; both fish-allergic and chicken meat-allergic patients might be at risk of developing a food allergy to chicken meat or to fish, respectively. This clinical phenomenon is proposed to be termed fish-chicken syndrome' with cross-reactive allergens involved being parvalbumins, enolases, and aldolases.

Study objective. - The aim of this study was to investigate the added value of using a panel of fish allergens in component-resolved diagnosis of fish-allergic patients.Patients and methods. - Sixty-two patients were diagnosed as being allergic to fish by clinical history and with positive skin prick-tests and specific IgE to fish extracts (cod, salmon and tuna). Allergen-specific IgE levels to fish parvalbumin, enolase, aldolase and gelatin were quantified by Elisa.Results. - Forty-five of the patients were sensitized to parvalbumin. Among the cod parvalbumin-sensitized patients, 50% were also sensitized to both enolase and aldolase. Of the patients with positive skin tests to salmon and to tuna (75.6% and 67.6%, respectively), isolated sensitization to parvalbumin was observed. Mean levels of specific IgE to cod and enolase parvalbumin were positively correlated with the severity of the patients' clinical symptoms; this was not the case for cod aldolase. Patients were clustered into three groups according to their parvalbumin-specific IgEreactivity. In the first group, the 36 patients who were sensitized to three different fish reported mild to severe symptoms; their symptoms were correlated with the presence of IgE to total cod extract and to cod parvalbumin. The second group of 9 mono-sensitized patients had only minor symptoms of fish allergy, most often to salmon; their symptoms were positively correlated with specific IgE levels of salmon extract and cod parvalbumin-specific IgE. The third group consisted of 17 patients who were sensitized to a small number of fish; they had moderate to severe symptoms. While this group of patients had no detectable parvalbumin-specific IgE, 70.6% of them were found to have IgE specific for fish aldolase, enolase or gelatin; in this group, the presence of IgE specific for cod was rarely observed.Conclusion. The use of a panel with a number of allergenic fish proteins may contribute to the improvement of the diagnosis of fish allergy. Specific sensitization profiles appear to be associated with certain profiles of clinical symptoms. (C) 2014 Elsevier Masson SAS. All rights reserved.

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.

SummaryBackgroundThe majority of fish‐allergic patients are sensitized to parvalbumin, known to be the cause of important IgE cross‐reactivity among fish species. Little is known about the importance of fish allergens other than parvalbumin.ObjectiveThe aim of this study was to characterize hitherto undefined fish allergens in three commonly consumed fish species, cod, salmon and tuna, and to evaluate their importance for in vitro IgE‐diagnosis in addition to parvalbumin and fish gelatin.MethodsSixty‐two patients were diagnosed by clinical history, skin prick tests and specific IgE to fish extracts. Two new fish allergens from cod, salmon and tuna were identified by microsequencing. These proteins were characterized by immunoblot, ELISA and mediator release assay. Purified parvalbumin, enolase, aldolase and fish gelatin were used for quantification of specific IgE in ELISA.ResultsParvalbumin and two other allergens of 50 and 40 kDa were detected in IgE‐immunoblots of cod, salmon and tuna extracts by most patient sera. The 50 and 40 kDa proteins were identified as beta‐enolase and fructose‐bisphosphate aldolase A respectively. Both purified enzymes showed allergenic activity in the mediator release assay. Indeed, 72.6% of the patients were sensitized to parvalbumin, 20% of these had specific IgE to salmon parvalbumin only. IgE to enolases were found in 62.9% (0.5–95.0 kUA/L), to aldolases in 50.0% (0.4‐26.0 kUA/L) and to fish gelatin in 19.3% (0.4–20.0 kUA/L) of the patients. Inter‐species cross‐reactivity, even though limited, was found for enolases and aldolases by IgE‐inhibition ELISA.Conclusions and Clinical RelevanceFish enolase and aldolase have been identified as important new fish allergens. In fish allergy diagnosis, IgE to enolase and aldolase are especially relevant when IgE to parvalbumin are absent.

Wheat isolates are neoallergens of food industry, resulting from wheat gluten deamidation. They are used as emulsifiers and found mainly in cooked meats. Food allergy to wheat isolates represents 1.15% of severe food anaphylaxis. Patients can eat native wheat flour and other cereals without any problem. Diagnosis is based on symptoms, ingestion of cooked meat, positivity of wheat isolate skin-prick test and absence of sensitization to wheat flour and gluten. Wheat isolates avoidance is very restrictive in the absence of specific labeling. (C) 2012 Elsevier Masson SAS. All rights reserved.