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Résumé L’enfant multi-allergique réagit à au moins deux allergies, alimentaires et/ou respiratoires ; c’est souvent un enfant présentant plusieurs comorbidités atopiques (dermatite atopique, rhinite allergique, asthme). D’où vient-il ? L’héritabilité de l’allergie est évidente. Outre les déficits en filaggrine, de très nombreux polymorphismes génétiques sont surreprésentés chez les patients allergiques. Mais la génétique n’explique pas tout ; l’environnement moderne urbanisé, caractérisé par une diminution de l’exposition antigénique aux agents infectieux (quasi-disparition des helminthes) et aux substances biologiques environnementales (aliments, antigènes atmosphériques…), participe de l’allergie. Des modifications épigénétiques, transmissibles de génération en génération, en réponse à ce nouvel environnement, sont également constatées chez les patients allergiques. L’environnement, directement, ou par modifications épigénétiques, peut orienter le système immunitaire du fœtus et du nouveau-né prédisposé génétiquement vers un profil allergique Th2. Qui est-il ? Et que devient-il ? La trajectoire de l’enfant multi-allergique débute souvent avec une dermatite atopique. L’altération de la barrière cutanée facilite la multi-sensibilisation ou allergie précoce et sévère, vis-à-vis d’allergènes alimentaires puis respiratoires. Cet enfant vit dans un environnement intérieur riche en allergènes pro-inflammatoires, et notamment en moisissures. L’asthme sera volontiers précoce et sévère avec exacerbations et altération de la fonction respiratoire, et perdurera chez le grand enfant et l’adulte. Cet enfant multi-allergique s’inscrit dans « la marche atopique » qui va de la dermatite atopique du nourrisson à la rhinite et l’asthme de l’adulte. The multi-allergic child is a child who presents with two or more allergies; he is often an atopic child, with other atopic comorbidities (atopic dermatitis, allergic rhinitis, asthma). Where does he come from? The heritability of the allergy is obvious; filaggrin mutations are well known, but numerous other genetic polymorphisms may be over-represented in allergic children. Modern urban environments are characterized by the paucity of infectious microorganisms and, particularly, the lack of helminths and low antigenic biodiversity (foods, inhalants antigens…), and these factors can play a key role in the development of allergic diseases. Epigenetic changes which are passed on from generation to generation, when observed in allergic patients, may enable them to adapt to such new environments. Thus, the environment, directly or by epigenetic changes, can program the immune system of fetuses and newborn babies with a particular genetic background towards a Th2 allergic pattern. Who is this child? What is his future? From the start, the multi-allergic child may have an atopic dermatitis and a skin deficiency which can lead to early and severe poly-sensitization or food allergy, and later on to a respiratory allergy. He may live in a pro-inflammatory indoor environment which is full of molds. He may have an early and severe asthma, with exacerbations leading to a decline in lung function, and asthma that continues on into childhood and adulthood. This multi-allergic child is part of “the atopic march”, which begins with an infant's atopic dermatitis and eventually leads to an adult with asthma and rhinitis. [ABSTRACT FROM AUTHOR]

Résumé: Les allergies alimentaires concernent 5 à 6 % des enfants. Le risque est l’accident anaphylactique par ingestion accidentelle de l’allergène, risque que l’enfant et sa famille doivent apprendre à éviter et à traiter. L’éducation thérapeutique est primordiale pour les y aider limitant la socialisation et en majorant l’anxiété, l’allergie alimentaire affecte significativement la qualité de vie de ces enfants. En l’absence de traitement curatif, l’amélioration de la qualité de vie est l’un des principaux objectifs de la prise en charge de ces enfants. À notre connaissance, l’influence de l’éducation thérapeutique sur la qualité de vie de ces enfants et leur famille n’a jamais été évaluée. Le GRETAA (Groupe de réflexion en éducation thérapeutique de l’allergie alimentaire) avec le soutien de la Société française d’allergologie, se propose d’effectuer une étude prospective, dont l’objectif principal est d’évaluer l’impact à 1 an de l’éducation thérapeutique sur la qualité de vie des enfants de 8 à 12ans atteints d’allergie alimentaire IgE médiée. [ABSTRACT FROM AUTHOR]

Résumé: La prévalence des allergies alimentaires sévères de l’enfant est en augmentation ces dernières années. L’intérêt de l’éducation thérapeutique (ETP) dans la prise en charge des allergies alimentaires n’est plus à démontrer et plusieurs programmes d’ETP dans ce domaine, validés par les ARS, existent en France à l’heure actuelle. Le Groupe de réflexion en ETP dans l’allergie alimentaire (GRETAA), s’appuyant sur les recommandations de la HAS en matière d’ETP, contribue à structurer la démarche éducative dans l’allergie alimentaire, dans le but d’harmoniser les pratiques. Après avoir écrit le référentiel de compétences à acquérir par les patients et leur famille, proposé différents outils éducatifs pour les apprentissages, le GRETAA s’est interrogé sur les modalités d’évaluation de l’ETP en allergie alimentaire. Il a précisé les critères sur lesquels devait porter l’évaluation et validé des outils spécifiques permettant d’évaluer chacun de ces critères afin de proposer une démarche d’évaluation commune à toutes les équipes investies dans l’ETP en allergie alimentaire. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Asthma in children is not the most important indication for an exercise test. However, one might recommend a cardiopulmonary exercise test systematically in the follow-up of patients with severe asthma when there is persistent bronchial obstruction, when an asthmatic child complains of dyspnoea on exertion, or when the child`s physical activity is limited. This test could be used to assess exercise tolerance, ventilatory adaptations, and the need for exercise training. Follow-up and evaluation of this training could be through a field exercise test (shuttle test or walk test). Moreover, the diagnosis of childhood asthma is frequently based only on symptoms suggestive of exercise-induced asthma. When the clinical features or a bronchodilatator test are not diagnostic, analysis of symptoms occurring during an exercise test can establish the diagnosis. The exercise test is thus a method that provides the time and intensity necessary to trigger exercise-induced bronchospasm. [Copyright &y& Elsevier]

Abstract: Allergic hypersensitivity reactions occurring during anaesthesia are a major cause of concern, since these reactions remain unpredictable and may be life-threatening for the patient. Neuromuscular blocking agents, latex and antibiotics are the three agents most frequently involved in these reactions. A systematic allergoanaesthetic screening after every peri-anaesthetic incident is clearly warranted, both to avoid the patient''s having a reaction during any subsequent anaesthesia and to obtain additional epidemiological data that can be used to improve the future management of all anaesthesia procedures. This allergy screening includes standardized laboratory and skin test procedures, with verification of the concordance between the clinical history and the test results. Atopic infants and those having had multiple surgical interventions are at risk for allergic reactions to latex. In the case of children with spina-bifida, strict latex avoidance measures must be followed systematically, beginning with the first intervention. [Copyright &y& Elsevier]

Abstract: We report a case of a young man with an allergy to latex who developed anaphylactic shock during anaesthesia for renal transplantation. All anaesthetic agents used before the episode were tested as potential allergens and only latex was shown to be positive. It appears that latex contamination in the graft was the cause since no materials containing latex were used during the operation. We feel it essential that donor organs should be removed in a totally latex – free environment. Such conditions will remove the risk of anaphylactic shock at the point of reperfusion of the transplant. [Copyright &y& Elsevier]

Introduction Garçon de 9 ans ayant eu 2 épisodes allergiques (dont 1 anaphylactique) en 2011 au décours de prises de haricots verts qui ont conduit au diagnostic. Malgré l’éviction de cet allergène, cet enfant a présenté de nombreuses réactions allergiques ± sévères, souvent au décours de repas, parfois avec un cofacteur « sport » associé ; souvent après prise de cacahuètes. Un test ISAC a montré une positivité pour le pollen de graminées, le chat, rOle e 1 et deux LTP (rAra h 9, nJug r 3). L’objectif est de déterminer si dans le haricot vert, seule la LTP est impliquée. Méthodes Un immunoblot haricot vert, arachide et rAra h 9 a été réalisé afin d’explorer son profil allergénique vis-à-vis du haricot vert, de l’arachide et des LTPs. Puis les réactivités croisées in vitro ont été visualisées par immunoblot inhibitions. Résultats L’ immunoblot réalisé montre une bande IgE réactive spécifique sur l’extrait d’arachide, et une bande IgE réactive spécifique vers 10 kDa sur les deux extraits d’haricots verts, crus et cuits. Dans l’extrait de haricots verts cuits, une deuxième bande IgE réactive apparaît de façon spécifique. La protéine rAra h 9 est également reconnue par les IgE du patient. Les immunoblot inhibitions réalisés mettent en évidence la présence d’une réactivité croisée entre les protéines de haricot vert et les protéines d’arachide. Discussion Le patient est sensibilisé à deux protéines de haricot vert : une protéine d’environ 10 kDa (vraisemblablement une LTP) et une protéine de 60 kDa. Ces IgE dirigées contre des protéines de haricot vert semblent spécifiques du haricot vert puisque le patient consomme les autres légumineuses sans problème. On observe aussi la présence d’IgE dirigées contre des protéines d’arachide d’environ 70 kDa mais pas autour de 10 kDa, taille attendue pour Ara h 9. Cette absence peut s’expliquer par sa faible abondance et par la procédure d’extraction suivie. Conclusion Actuellement le régime d’éviction ne concerne que le haricot vert et le haricot beurre. Les réactions allergiques sans prise de haricot vert sont possiblement dues à un syndrome LTP. Le patient mange très régulièrement de l’arachide pour maintenir sa tolérance et a été mis sous Cétirizine pour « calmer » la réactivité. [ABSTRACT FROM AUTHOR]

Among a child out of ten is asthmatic. School absenteeism is frequent, due to an insufficient control of asthma. This insufficient control is especially evident at school where the usual risk factors of asthma are present. Allergenic risk with animals danders carried by other children, or regular practice of sports, are difficult situations for the asthmatic child. Controlling asthma, informing school and communicating with teachers, using the individualized care project, should avoid this absenteeism, which is responsible of school backwardness and difficulties in choosing careers. [Copyright &y& Elsevier]

Allergic-like reactions to paracetamol (acetaminophen) are rare. Paracetamol allergic and non-allergic hypersensitivity has been diagnosed in a few patients with skin and/or respiratory symptoms, immediate and accelerated urticaria and angiœdema especially. Most patients with hypersensitivity to paracetamol reacted also to anti-inflammatory drugs (i.e. acetyl-salicylic acid), suggesting that their reactions resulted from a non-allergic hypersensitivity. However, anaphylactic reactions, and potentially harmful toxidermias (i.e. acute generalised exanthematic pustulosis) have been related to specific paracetamol allergic hypersensitivity, with tolerance to anti-inflammatory drugs. [Copyright &y& Elsevier]

Semi-late and late responses are obtained in intradermal and patch-tests in patients with non-immediate reactions to betalactams. We compared responses in intradermal and patch-tests in 69 children with suspected betalactam hypersensitivity. Responses in skin tests were assessed at 20 min (immediate), 6–8 h (semi-late), 48–72 h (late), and at the 6–7th day (hyper-late). Oral challenges were performed with betalactams that gave negative responses in skin tests. Positive responses in skin tests and oral challenge diagnosed non-immediate betalactam hypersensitivity in two children with delayed hypersensitivity to clavulanic acid (positive challenge with amoxicillin associated with clavulanic acid, and negative responses in skin tests and challenge with amoxicillin alone), one child with serum sickness-like disease to cefatrizine (hyper-late response in patch-test), and one child with acute generalized exanthematous pustulosis to amoxicillin (hyper-late responses in intradermal and patch-tests). In these children, responses in skin tests and challenge with other betalactams in the same class and other classes were negative. Thus, although the number of children with positive responses in patch-tests is low, our results suggest that patch-tests with betalactams have a good diagnostic value in children with severe non-immediate reactions such as serum sickness-like disease and potentially harmful toxidermias. They also confirm that most reactions resulting from a non-immediate hypersensitivity to betalactams are highly specific for the suspected drugs, with most patients tolerant to other betalactams. [Copyright &y& Elsevier]

Abstract: Asthma and other allergic conditions are priority research subjects because they are major public health problems world-wide. The management of severe allergic asthma has benefited from the development of a new class of drugs, anti-IgE antibodies (omalizumab). Other molecules being studied in adult asthmatics include monoclonal antibodies and fusion proteins whose action is to block bronchial inflammation at different levels. Considerable progress has been made in the understanding of the genesis of asthma and allergy. It appears that the early years of life have a fundamental importance in the natural history of allergic diseases and, in particular, of asthma; this makes it important to act early on the process, that is, from the earliest age possible. Specific immunotherapy, by injection or sublingually, may have a positive effect on the natural history of allergy, making it possible to predict the development of new sensitivities and reduce the risk of developing asthma. The coming years will probably reveal which therapeutic measures will be effective in preserving the respiratory capital of the asthmatic infant. [Copyright &y& Elsevier]

Atopic dermatitis (AD) is a very common chronic inflammatory skin disease in childhood, often the first step in the atopic march. It seems justified to look for a food or a respiratory allergy, being worsening or responsible for the AD. At infant age, some clinical features are consistent with a food allergy: a severe AD, with an early onset, uncontrolled by topical corticosteroids, and a history of immediate-type reactions. As sensitization to food allergens is very common (positive skin prick-test, atopy patch-test or specific IgE), the role of food allergens in worsening AD is difficult to affirm. So, it could be necessary to ask the advice of an allergist, to avoid unnecessary elimination diets. At older age, exposure to aeroallergens cans worsen AD. Looking for an aeroallergen allergy can help to choose the specific immunotherapy, which clinical efficacy on AD seems interesting., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Allergic rhinitis (AR) is a common IgE dependent disorder. AR is maybe one of the steps of the allergic march, which starts with atopic dermatitis and food allergy and includes atopic asthma. AR and asthma are frequently associated. AR is frequently under-diagnosed and undertreated although it affects quality of life and school performance. Management of AR depends on its severity and will associate environmental control (best guided by environmental investigation and skin testing of specific IgE antibodies), pharmacotherapy (with antihistamines and intranasal corticosteroids as first line drugs). At present allergen immunotherapy is considered in patients with severe AR, insufficiently controlled by pharmacotherapy and who demonstrate specific IgE antibodies to relevant allergens. Sublingual immunotherapy is well tolerated. Only immunotherapy with the right allergens has the potential to alter the natural history of the allergic march, by preventing the development of new allergen sensitizations and reducing the risk for the subsequent development of asthma. This fact might extend the indications of specific allergen immunotherapy. Patients (and parents) education is of utmost importance in the management of allergic disorders., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

In France patients with cystic fibrosis benefit from a multidisciplinary follow-up in Cystic Fibrosis Centres. In this follow-up, despite the numerous therapeutic benefits of exercise in this disease, little emphasis is placed on the promotion of physical activity. The aim of this article is to improve this aspect of management, giving advice from a working group of experts, based on the medical literature and clinical experience. These proposals include quantification of physical activity, evaluation of exercise, training and rehabilitation programs and finally, modification of behaviour to include physical activity in the overall cystic fibrosis treatment strategy. It is intended to set up multicentre studies to evaluate the impact of these proposals., (Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: We aimed to confirm that children who have survived bronchopulmonary dysplasia (BPD) display lower ventilation during exercise than healthy children, and to determine whether alveolar hypoventilation associated with exercise-induced hypoxemia occurred in these children., Methods: Twenty children with BPD (birth weight 1441+/-523 g [mean +/- SD], gestational age 31+2.3 weeks), aged 7 to 14 years, and 18 matched healthy children, born at term, performed resting pulmonary function and cardiopulmonary incremental exercise tests. Arterialized capillary blood gases were measured at rest and at maximal exercise in the BPD group., Results: The BPD group showed moderate expiratory airflow limitation and hyperinflation. Maximal oxygen uptake and ventilatory threshold were similar in the two groups. The BPD group displayed ventilatory limitation on exercise, with greater use of the ventilatory reserve (p<0.01), lower maximal ventilation (p<0.01), tidal volume (p=0.01). Changes in ventilation (p<0.0001) and tidal volume (p=0.003) during exercise were significantly smaller in the BPD group than in controls, at similar submaximal workloads. At peak exercise, we observed hypoxemia in 12 BPD children (60%). In the subgroup with hypoxemia, a significant increase in PaCO2 (p=0.01) was measured at peak exercise, showing alveolar hypoventilation sustained by the lower tidal volume., Conclusions: Despite normal maximal aerobic performance, BPD children showed ventilatory limitation on exercise, frequently with hypoxemia and alveolar hypoventilation. Despite an improvement in their pulmonary condition, continued follow-up by cardiopulmonary exercise testing, is strongly recommended.

Cardiopulmonary exercise test is a new respiratory functional test used for sick children. It demonstrates the integrated response of all the systems involved in exercise (especially cardiac and respiratory ones) and consequently evaluates exercise adaptations during chronic disease. This dynamic test assesses exercise tolerance, and so quality of life more objectively than a resting test. Values measured (especially oxygen uptake and ventilatory threshold) are quantifiable and reproducible, allowing the follow-up of a disease and the initiation and individualization of exercise training. Moreover, it is also useful for diagnosis and assessment of abnormal symptoms during exercise (as dyspnea), especially abnormalities that are undetectable during rest. The six-minute walk test, the step test and the shuttle test are rapid, simple and low-cost field tests that give adequate information on the daily physical performance (walking, climbing stairs, or running) of the sick child. They allow a closed follow-up, especially during an exercise training period. However, only the cardio-pulmonary exercise test can allow the physical practise in sick children, eliminating the contra-indications.

Introduction: Neonatal screening for cystic fibrosis (CF) leads to early dedicated specialist care for all patients., Background: Pulmonary function tests (PFT) are mandatory for routine monitoring of CF patients. The aim of this article is to review the current guidelines for PFTs in CF, particularly the type of test, the age and the clinical status of the patient., Viewpoint: The regular use of spirometry is generally accepted. Many other tests are used but their clinical value in the routine follow-up of CF patients remains to be established., Conclusion: Further efforts should be made to evaluate the value of PFTs in CF, particularly in very young children.

We report a case of a young man with an allergy to latex who developed anaphylactic shock during anaesthesia for renal transplantation. All anaesthetic agents used before the episode were tested as potential allergens and only latex was shown to be positive. It appears that latex contamination in the graft was the cause since no materials containing latex were used during the operation. We feel it essential that donor organs should be removed in a totally latex-free environment. Such conditions will remove the risk of anaphylactic shock at the point of reperfusion of the transplant.

Among a child out of ten is asthmatic. School absenteeism is frequent, due to an insufficient control of asthma. This insufficient control is especially evident at school where the usual risk factors of asthma are present. Allergenic risk with animals danders carried by other children, or regular practice of sports, are difficult situations for the asthmatic child. Controlling asthma, informing school and communicating with teachers, using the individualized care project, should avoid this absenteeism, which is responsible of school backwardness and difficulties in choosing careers.

Skin tests represent a major tool in the diagnosis of IgE mediated-allergy. The main indication is the measure of atopy during infancy and early childhood, as a predictive factor of the development of asthma. When atopic eczema is present, skin testing can provide a diagnosis of food allergy. Skin tests are easily done, without absolute contraindications. The epidemiological knowledge helps to choose the allergens to test. The skin-prick test method is well standardized and must be rigorous because of the hyporeactivity of the infant skin. Results are always confounded with positive and negative control solutions. The interpretation of pricks tests must be careful, standing out a clinical allergy (when clinical allergic symptoms are presents) from a sensitization (atopy). The predictive value of a positive skin test is discussed: predisposition to asthma, association with severe asthma, predisposition to acute bronchiolitis during an epidemic of respiratory virus. A positive skin test to food allergen would predict a later pneumallergen sensitization.