"Diverses études ont clairement montré que la DS par voie SC modifiait favorablement la « marche atopique » lorsqu'elle était initiée précocement chez des enfants atteints de rhinite/ rhinoconjonctivite liée à une mono-ou pauci-sensibilisation allergénique. Holt et al.  se sont proposé d'étudier les possibles effets préventifs de la DS sublinguale chez des enfants à risque atopique élevé, sur la base de leurs antécédents familiaux et personnels (DA associée à une sensibilisation alimentaire, mais sans sensibilisation aux aéro-allergènes). Pour ce faire, 200 nourrissons à risque ont été inclus dans une étude prospective en double insu versus placebo. "
[Show abstract][Hide abstract] ABSTRACT: Food allergy risk is increased in children with gastroesophageal reflux, and even more increased when these children are treated by anti-acids. Most children with suspected food allergy are not allergic to foods. Thus, a well-conducted allergological work-up is necessary to avoid familial anxiety and food evictions that may be harmful for the children. Frequent consultations at the allergist's office are associated with a better identification of severity and a better emergency treatment of anaphylactic reactions by the parents. Specialized 24 h/24 helplines and educational support provided during activity holidays are associated with a significant benefit on management of food-induced anaphylaxis by the parents and the children themselves. Finally, reactivity to wheat may vary according to the wheat-containing foods administered to the children, and children tolerant to wheat cereal biscuits may react to other wheat-containing foods such as bread or pasta. If many children report suspected allergic reactions to drugs, only a few of these children are truly suffering from drug hypersensitivity, except for children reporting reactions to non-opioid analgesics, antipyretics and non-steroidal anti-inflammatory drugs. Once more, it is shown that drug challenges should be performed at home and prolonged in children reporting non-immediate reactions, at the risk of underdiagnosing drug hypersensitivity. Finally, hymenoptera venom immunotherapy is efficient in children, and its efficacity persists during 7–8 years at least.
Revue Française d'Allergologie 09/2014; 54(5). DOI:10.1016/j.reval.2014.01.002 · 0.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The practice of administering sublingual immunotherapy for respiratory allergy is gaining more and more diffusion worldwide as a consequence of the robust demonstration of clinical efficacy and safety provided by recent high-powered and well-designed studies, confirming for individual seasonal allergens the results of previous metanalyses in adult and pediatric populations. Preliminary evidence derives from recent rigorous trials on perennial allergens, like house dust mites, and specifically designed studies addressed the benefits on asthma. Emerging research suggests that SLIT may have a future role in other allergic conditions such as atopic dermatitis, food, latex and venom allergy. Efforts to develop a safer and more effective SLIT for inhalant allergens have led to the development of allergoids, recombinant allergens and formulations with adjuvants and substances targeting antigens to dendritic cells that possess a crucial role in initiating immune responses. The high degree of variation in the evaluation of clinical effects and immunological changes requires further studies to identify the candidate patients to SLIT and biomarkers of short and long term efficacy. Appropriate management strategies are urgently needed to overcome the barriers to SLIT compliance.
Allergology International 12/2013; 62(4):415-23. DOI:10.2332/allergolint.13-RAI-0627 · 2.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Allergen-specific Immunotherapy (AIT) is a well-documented etiological therapy for IgE-mediated rhinitis and asthma and it is the only treatment strategy able to alter the natural history of the diseases. This review aims at focusing some real-life aspects of AIT. In spite of the high level of evidence for efficacy and safety reached by AIT and the continuously improving quality of allergenic extracts, it is estimated that, with regional variations, less than 5% of European children with AR are treated with AIT. The number of AIT prescriptions is decreasing in these last years in all Europe. The adherence to the treatment is quite low today either for SCIT or for SLIT. The results of clinical trials shouldn't be referred to AIT in general but rather to the specific product utilized. There is the need for a closer cooperation among allergists with other specialties in order to optimize the assessment of allergic patients and of AIT.
European annals of allergy and clinical immunology 12/2013; 45(6):187-92.
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