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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]

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: 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]

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]

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]