Bibliographic updates

The Monthly choice
March  2015
Claude MOLINA* & Jacques GAYRAUD**

1.   Prevention of peanut allergy through early consumption
2.   Asthma and Exercice-induced-bronchoconstriction in Athletes
3.   Eczema and  Environment
4.   Phenotypes of wheezing and asthma in children
5.   Occupational Anaphylaxis

1.   Prevention of peanut allergy through early consumption

G.Du Toit et al  NEJM 2015 26 Feb 372 803-813 & R.S.Gruchalla and  H.A Sampson 875-877Edito.
Theme: Food Allergy - Peanut
Key words: Peanut allergy - Early consumption

The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy (approximately 70 to 80%) among children at high risk and modulated immune responses to peanuts: this is the result of a randomized prospective trial conducted in London among 530 infants followed during 60 months. These compelling findings suggest new forthcoming guidelines in the management of Peanut-Allergy, the frequency of which is increasing and alarming.

2.   Asthma and Exercice-induced-bronchoconstriction (EIB) in Athletes
L.P Boulet et P.M.O’Byrne : NEJM 372 7 12 Fev 2014  641-648
Theme: Asthma
Key words: Asthma – Exercice inuced bronchoconstriction

Intense exercise in athletes impose demands on the cardiorespiratory system and accounts for increase prevalence of various respiratory ailments such as asthma and rhinitis and transient narrowing of the airways that occurs among athletes who may not have a diagnosis of asthma or even have any respiratory symptoms.  The complex mechanism of this EIB has not been established with certainty. The diagnosis based on history requires also documentation on variable airway obstruction, by broncho-provocation tests (β2 agonists, metacholine) or eucapnic voluntary hyperpnea. The treatment must minimize the deleterious effects of exercise, mandatory to allow optimal performance. Non pharmacologic and pharmacotherapy are detailed, largely based on expert opinion. Adherence to anti-doping regulations regarding asthma drugs are important for competitive athletes.

In a closer approach, Belgian authors ( S.F Seys et al Allergy Vol 70 2015 2 187-194) demonstrate increased presence of damage-associated molecular patterns in the sputum of non asthmatic athletes, particularly elite swimmers who presented after exercise-induced bronchonstriction, biomarkers of  airways epithelial damage,in sputum,  predominance of neutrophils in the airways and release of inflammatory cytokines, molecular signature of airways alterations.

3.   Eczéma (E) and Environment

T.Tsakok et al / The Lancet 26 Feb 2015 385 special issue 59
Theme: Skin allergy - Eczema
Key words: Eczema – Environment – ISAAC2 study – Damp – Mould – Socio economic factors

In a cross-sectional study of ISAAC phase 2, among 46 051 children aged 8-12 years, from 20 countries, the authors suggest an association between childhood eczema symptoms and damp housing conditions, which may be causal. Modification to home environment to reduced damp and mould could be harnessed to improve or even prevent this debilitating disease.

In a similar approach, J.I.Silverberg (Ped.All.Immun. 2015 26 54-61)  analyzing data from 3049 children and adolescents ages 8-19 years from the  2005-2006 National American Survey,  observe that children with atopic dermatitis have lower body mass index due to malnutrition with low bone mineral density and belong to  Hispanic ethnicity.

So indoor pollution and socio-economic factors play a role in the onset of eczema in children.

4.   Phenotypes of wheezing and asthma in children : Lessons from cohort studies
J.Just et al Ped.All.Immun 21 Fev 2015.accepted articles
Theme: Respiratory allergy - Asthma
Key words: Asthma phenotypes - Wheezing

Phenotyping asthma by multivariate and unsupervised analyses allow to describe three wheeze types in children of pre-school age:
The mild episodic viral wheeze with a good prognosis
The multi-trigger atopic wheeze, more prevalent in boys with poor prognosis
The severe non-atopic wheeze, more prevalent in girls, the prognosis of which depends of the time of onset (early or late) of allergic expression.
Further studies are mandatory to better define wheezing phenotypes, and to find non invasive biological markers, in order to prevent the risk of developing severe asthma.

5.   Occupational Anaphylaxis (OA)
A.Siracusa et al Allergy 2015 70 141-152
Theme: Occupational allergy
Key words: Hymenoptera venom – Latex

Hymenoptera stings and now, more rarely natural rubber latex are the commonest triggers of OA. Other triggers include food, medications, insect/mammal/snake bites and chemicals. Underlying mechanism is usually IgE mediated, less frequently non allergic. Some aspects of exposure, (route, frequency, type of allergens) may account for the variability of symptoms. After identification of the trigger, prevention is based on removal from further exposure. Immunotherapy is recommended only for OA due to Hymenoptera stings.

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Last updated 14 July 2015