Search

Abstract: Peanut allergy is one of the commonest food allergies in children and has a low natural recovery rate. It is severe and possibly causes fatal anaphylaxis. Current treatment is limited to strict eviction which, although it prevents accidents, does not abate sensitization and the risk of recurrence remains. A risk of increased sensitization has been demonstrated for milk and egg allergy in a randomized study comparing eviction with an oral tolerance induction protocol. Trials evaluating injectable immunotherapy could only be conducted when recombinant allergens, mutated to remove decisive B cell epitopes, would become available. Induction of specific oral tolerance is possible in experimental models. Studies in allergic children whose allergy resolved spontaneously have showed immunological modifications involving Th1–Th2 balance and indicating the role of regulatory T-lymphocytes. However, the slow natural evolution of food allergy in children justifies a therapeutical intervention consisting in daily administration of increasing doses of the food to reach the amount normally eaten. This aims to trigger, or accelerate, immunological tolerance. Studies on egg, milk and wheat flour allergies have produced satisfactory results, indicating a possible application to peanut allergy. This paper summarizes the main facts concerning natural oral tolerance mechanisms, the development of food allergy and spontaneous recovery, before considering specific oral tolerance induction protocols. Criteria of selection of patients are discussed. Protocol implementation modalities are presented, including the increment of doses, the duration of the treatment, parameters for the specific monitoring and later prescription concerning maintenance doses. [Copyright &y& Elsevier]

Abstract: The realization of the TPO begin with a precise analysis from criteria ensuring the safety from the child. The paper specify the prerequisites (place of realization, venous access, environment, food preparation), the methodology of the OFC (open, simple or double blind manner) and the management of a reaction occurring during the OFC. [Copyright &y& Elsevier]

Abstract: Much attention is now being focused on foods from genetically modified plants because of the risk of allergenicity. No such risk has been reported for the first generation of GM plants made resistant to herbicides and insect larvae. Current experiments with hypoallergenic GM plants are reported and discussed in the present paper. The second generation of GM plants will improve the nutritional aspects of natural foods. Transgenic proteins could reach from 4 up to 8% of the total protein content in these foods. Any potential difference in allergenicity between second generation GM plants and the natural varieties must be examined with respect to the risk for food allergy caused by food products made from these plants and the risk for respiratory allergies in the people living near the crops caused by airborne pollen originating from the plants. WHO–FAO directives as well as the Codex Alimentarius proposals and the European Food Safety Authority (EFSA) guidelines recommend that transgenic proteins be screened for homology (by in silico study) and cross-reactivity with known allergens, as well as being examined carefully for modifications of host-plant proteomes. In vivo animal studies are also to be carried out to assess any potential immunogenicity. Lacking adequate safety data, the absence of potential allergenicity of transgenic plants cannot be ruled out. This is why data that do not meet the recommended safety criteria required for commercialization of GM plants do not allow us to rule out absolutely the risk that may be associated with products that are going to be commercialized. Therefore, it is essential that commercialized GM plants be monitored. We propose the establishment of public reference serum banks based on up-to-date WHO–FAO recommendations concerning the selection of sera according to precise criteria. We also propose establishing a system of allergovigilance linking national and European health and food safety agencies and a network of university hospital-based clinical and laboratory reference centres, together with a network of clinical allergists, responsible for the creation of the serum banks. Allergists working through these networks would be able to identify new sensitizations to transgenic foods in the population, just as they now identify new types of food allergies, which, in this case, would be GM foods. Such a project is now being established in France. [Copyright &y& Elsevier]

Abstract: Wheat isolates, used as binders and emulsifiers in the food industry, mainly in meat products, are neo-allergens resulting from deamidation of wheat gluten. In this paper, we describe cases of anaphylactic reactions caused by a wheat isolate occurring after eating pasta. Sensitivity to wheat isolate was demonstrated by positive skin tests and specific IgE reactivity to wheat isolate extract (20.1 KU/l, class 4), and also by detection and quantification of wheat isolate in pasta by immunoblotting and ELISA inhibition. [Copyright &y& Elsevier]

Abstract: It''s obvious that epinephrine should not be used for the treatment of generalized urticaria without hemodynamic perturbations. However, the purpose of this discussion is to defend epinephrine prescription (and not necessarily it''s administration) as possible first aid treatment in a very precise situation, which concern children with a history of generalized urticaria due to confirmed food allergy. This position was defined, after careful examination of scientific evidences in the literature, by the French “tripartite commission” and published under the title “Conditions to establish a project for individualized management at school of children at risk for food allergy emergencies” in 2003 in this journal. This paper resume the main points supporting this statement. [Copyright &y& Elsevier]