G. Kanny

Epidemiology of life‐threatening and lethal anaphylaxis: a review

Severe anaphylaxis is a systemic reaction affecting two or more organs or systems and is due to the release of active mediators from mast cells and basophils. A four‐grade classification routinely places ‘severe’ anaphylaxis in grades 3 and 4 (death could be graded as grade 5). Studies are underway to determine the prevalence of severe and lethal anaphylaxis in different populations and the relative frequencies of food, drug, latex and Hymenoptera anaphylaxis. These studies will also analyse the risk arising from the lack of preventive measures applied in schools (personalized management protocols) and from the insufficient use of self‐injected adrenalin. Allergy‐related conditions may account for 0.2–1% of emergency consultations. Severe anaphylaxis affects 1–3 per 10u2003000 people, but for the United States and Australia figures are even higher. It is estimated to cause death in 0.65–2% of patients, i.e. 1–3 per million people. An increased prevalence has been revealed by monitoring hospitalized populations by reference to the international classification of disease (ICD) codes. The relative frequency of aetiological factors of allergy (food, drugs, insects and latex) varies in different studies. Food, drug and Hymenoptera allergies are potentially lethal. The risk of food‐mediated anaphylaxis can be assessed from the number of personalized management protocols in French schools: 0.065%. Another means of assessment may be the rate of adrenalin prescriptions. However, an overestimation of the anaphylaxis risk may result from this method (0.95% of Canadian children). Data from the literature leads to several possibilities. First, a definition of severe anaphylaxis should be agreed. Secondly, prospective, multicentre enquiries, using ICD codes, should be implemented. Moreover, the high number of anaphylaxis cases for which the aetiology is not identified, and the variation in aetiology in the published series, indicate that a closer cooperation between emergency specialists and allergists is essential.

Cross-allergenicity of peanut and lupine: the risk of lupine allergy in patients allergic to peanuts.

BACKGROUNDnPeanut allergy is common, but cross-allergy between legumes is rare. Proteins from Lupinus albus are increasingly eaten in the form of seeds or additives to wheat flour. The risk of cross-allergenicity is still insufficiently known.nnnOBJECTIVEnWe sought to study the risk of cross-allergy to lupine in patients allergic to peanut and to study lupine allergenicity.nnnMETHODSnTwenty-four patients allergic to peanuts were studied by means of skin prick tests with native lupine flour from Lupinus albus. Double-blind oral challenge tests were performed with lupine flour and peanut in 8 of these patients. Specific IgEs were assayed for peanut, lupine flour, and pollen in 6 sera. RAST inhibition tests for lupine pollen by peanut were performed on 4 of these sera. Peanut and lupine flour immunoblots were carried out for 6 sera, and crossed immunoblot inhibitions for peanut by lupine flour and lupine flour by peanut were carried out for 2 sera.nnnRESULTSnThe skin prick test responses with lupine flour were positive in 11 (44%) subjects. The challenge test responses were positive in 7 of 8 subjects at the same doses as with peanut. The major lupine flour allergen (molecular mass, 43 kd) is present in peanuts. The RAST inhibition and immunoblot tests indicated cross-reactivity of peanut with the lupine flour and pollen.nnnCONCLUSIONSnThe risk of crossed peanut-lupine allergy is high, contrary to the risk with other legumes. The inclusion of 10% lupine flour in wheat flour without mandatory labeling makes lupine a hidden allergen, presenting a major risk of cross-reaction in subjects already allergic to peanut products. A high sensitizing potential can also be postulated for this legume.

Identification of oleosins as major allergens in sesame seed allergic patients.

Background:u2002 The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem‐FEIA. The reasons for this negativity are unknown.

Anaphylaxis to pork kidney is related to IgE antibodies specific for galactose-alpha-1,3-galactose

Carbohydrate‐specific IgE antibodies present on nonprimate mammalian proteins were incriminated recently in delayed meat anaphylaxis. The aim of this study was to explore whether anaphylaxis to mammalian kidney is also associated with galactose‐α‐1,3‐galactose (αGal)‐specific IgE.

Prospective study of mustard allergy: first study with double-blind placebo-controlled food challenge trials (24 cases)

Background: Mustard allergy accounts for 1.1% of food allergies in children. However, double‐blind placebo‐controlled food challenge trials (DB PCFCs) have not yet been proposed.

Probiotics may be unsafe in infants allergic to cow's milk.

Differences in the intestinal microflora of atopic and nonatopic infants have been shown; atopic children have fewer bifidobacteria and lactobacilli (1–3). Beneficial immunoregulatory effects of probiotic flora have been confirmed by preventive and therapeutic studies with probiotics in infants at high risk of atopy and in those presenting with cow’s milk allergy (CMA) and atopic eczema/dermatitis syndrome (AEDS) (3, 4). We report a case supporting the hypothesis that residual milk proteins at risk of reactogenicity may be present in different probiotic brands that are marketed as health supplement products. A 11-month-old infant, with AEDS and CMA was fed an aminoacid formula (Neocate ; SHS International Ltd, Liverpool, UK). He presented with Escherichia coli colitis, so a probiotic (Bacilor ; Lab Lyocentre, Aurillac, France) was prescribed. Within 15 min, he presented with generalized erythema and laryngeal discomfort. A prick-test to Bacilor was positive, as was a prick-test to milk (Table 1). Three other children, aged from 3 to 10 years, with persistent milk allergy were tested to three probiotic brands: Bacilor , Imgalt (Lab Jaldes, Gigean, France) and Ditopy (Lab Ducray, Boulogne, France). The prick-tests were positive to Bacilor and Imgalt (Table 1). Bacilor contains only Lactobacillus casei, of the rhamnosus variety, Imgalt also has L. rhamnosus, L. acidophilus, Bifidobacterium bifidum and B. longum, Ditopy contains L. rhamnosus and L. acidophilus. The manufacturers of these preparations were questioned about the medium used for the growth of these strains: the medium used for Bacilor and Imgalt flora includes lactoserum proteins and casein. No control tests for residual milk proteins are carried out on thesemedicinal products. The culture medium of Ditopy flora is hydrolyzed soy protein. The immediate clinical reaction in the infant, as well as positive-prick tests in these four children, support the hypothesis of residual milk proteins, the level of contamination being clinically relevant in somemilk allergic infants, at risk of anaphylaxis (5). Despite previous encouraging results, therapeutic results of probiotics were not particularly marked in a recent study (6, 7). No information was provided about the culture medium. In the event of marked allergy to milk proteins, ingestion of probiotics containing small amounts of residual milk proteins could explain sustained AEDS.

Réactions anaphylactoïdes et cutanées tardives aux produits de contraste iodés : état actuel de la question - évolution des idées

Resume Propos.xa0– Revue actualisee des accidents aux produits iodes de contraste, de leurs mecanismes, des moyens de diagnostic et de la prevention. Les produits iodes de contraste ioniques et non ioniques sont responsables de reactions indesirables, de mecanisme variable. Toutefois, les reactions anaphylactoides bien identifiees par l’elevation de la tryptase serique sont parmi les reactions les plus severes. L’utilisation de non-ioniques ne diminue pas la frequence de l’anaphylaxie. La premedication par corticoides et antihistaminique est inefficace pour prevenir l’anaphylaxie. Les reactions cutanees tardives, de connaissance recente, reconnaissent frequemment un mecanisme d’hypersensibilite retardee. Les facteurs de risque des reactions anaphylactoides sont les accidents anterieurs aux produits iodes de contraste, les cardiomyopathies, les betabloquants, l’asthme, l’atopie. Le sexe feminin et l’âge sont des facteurs de gravite. Actualite et points forts.xa0– Le mecanisme anaphylactique peut etre affirme par des tests cutanes et l’identification d’IgE specifiques. L’hypersensibilite retardee peut etre etablie par epicutaneoreactions et par immunohistologie de biopsie cutanee. Perspectives et projets.xa0– Un bilan allergologique est conseille en cas de reaction anterieure a un produit iode de contraste. Dans l’urgence, une alternative utilisant les sels de gadolinium peut etre utile. Les autres facteurs de risque incitent a la conjonction d’une premedication et de l’utilisation d’un produit iode non ionique et monomerique. L’augmentation de prevalence de l’anaphylaxie est a craindre avec l’utilisation de molecules divalentes.

Le risque d'asthme aigu grave à la farine de lupin associé à l'allergie à l'arachide

Resume Laddition de farine de lupin ( Lupinus albus ), recemment autorisee en France dans lalimentation humaine, comporte un risque de reaction croisee avec larachide. Nous rapportons un cas dasthme aigu grave au lupin survenu chez une patiente allergique a larachide. Exegese Notre patiente presente une allergie severe a larachide se manifestant par un asthme aigu grave. Les prick-tests a la farine de lupin crue et cuite sont positifs. Le taux des IgE specifiques a la farine de lupin (Allerbio, France) est eleve. Le test de provocation orale induit lapparition dun asthme aigu grave a la dose de 965 mg de farine de lupin, quantite qui peut etre contenue dans 100 g de pain. Conclusion Cette observation souligne le haut risque allergique du lupin chez les patients allergiques a larachide. II convient, avant dautoriser lintroduction dun nouvel aliment, devaluer son potentiel allergenique et dinstaurer un systeme dallergovigilance pour apprecier lacceptabilite allergologique des nouveaux aliments.

The economic costs of severe anaphylaxis in France: an inquiry carried out by the Allergy Vigilance Network.

Background:u2002 The prevalence of severe anaphylaxis, between 1 and 3 per 10u2003000, has increased sharply over recent years, with a rate of lethality of 1%. The economic burden is unknown.

Original article: The economic costs of severe anaphylaxis in France: an inquiry carried out by the Allergy Vigilance Network

Background:u2002 The prevalence of severe anaphylaxis, between 1 and 3 per 10u2003000, has increased sharply over recent years, with a rate of lethality of 1%. The economic burden is unknown.