Three peanut-allergic/sensitized phenotypes with gender difference.

BACKGROUND: Peanut-allergic reactions are heterogeneous ranging from mild symptoms to anaphylaxis. OBJECTIVE: Identify peanut-allergic/sensitized phenotypes to personalize patient management. METHODS: A combined factor and cluster analysis was used to study the phenotypes of 696 patients diagnosed with peanut sensitization and enrolled in the MIRABEL survey. The method was first applied to the 247 patients with an oral food challenge (OFC). It was then applied to the 449 patients without OFC to confirm the findings in an independent population. RESULTS: Three independent clusters emerged from the OFC subgroup. Cluster 1, 'Severe peanut allergy with little allergic multi-morbidity' (123 subjects), had the highest proportion of patients with positive OFC (92%), a medium level of peanut protein inducing a positive OFC (235 mg), lower percentage of allergic multi-morbidity (2% asthma plus atopic dermatitis (A + AD), no cases of A + AD + multiple food allergies (MFA)). Cluster 2, 'Severe peanut allergy with frequent allergic multi-morbidity' (62 subjects), had a high proportion of patients with positive OFC (85%) with the lowest level of peanut protein inducing a positive OFC (112 mg), 89% allergic subjects, 100% with allergic multi-morbidity (A + AD) and 84% with A + AD + MFA. Cluster 3, 'Mild peanut-allergic/sensitized phenotype' (62 subjects), had the lowest mean age, the lowest proportion of patients with positive OFC (53%) with a high level of peanut protein inducing a positive OFC (770 mg), a low percentage of allergic multi-morbidity (48% A + AD + MFA). The two severe peanut-allergic phenotypes were more frequent in girls. The same clusters were found in the subgroup of patients without OFC. CONCLUSION & CLINICAL RELEVANCE: Besides the classic markers associated with lower threshold doses of OFC (such as SPT and rAra h 2), allergic multi-morbidity and female gender should also be taken into account to better adapt the progressive dosage of provocation tests.

Peanut-allergic patients in the MIRABEL survey: characteristics, allergists' dietary advice and lessons from real life.

BACKGROUND: The MIRABEL survey is an observational study on peanut allergy in France, Belgium and Luxemburg. The objectives are to provide data on a large population, to analyse the consumer behaviour, to study the presence of peanut traces in pre-packed foods with/without precautionary allergen labelling (PAL), and to combine these data to quantify allergic risk and produce a cost/benefit analysis. This paper reports a real-life observatory of 785 patients (< 16y: 86%): medical characteristics, eliciting doses (ED) in real life and in oral food challenges (OFC), factors associated with severe reactions, allergist dietary advice and patients' anxiety regarding their allergy. METHODS: Age and symptoms at diagnosis, route of exposure, comorbidities, allergy tests, ED (OFC/real life; mg peanut protein), dietary advice about PAL, and anxiety score were recorded. RESULTS: Median age was 3 years; 85% were declared allergic. Severe/potentially severe reactions were reported in 30% of the allergic patients: serious systemic reaction (15%), laryngeal angioedema (8%), shock (4%) and acute asthma (3%); 66% had atopic dermatitis, 58% asthma. Median ara h 2 sIgE level was 11.5 kUA/L. Of the 278 OFCs, 225 were positive (median ED: 67.3 mg). Real-life ED was < 100 mg in 44.3%. Severe reactions were significantly more frequent in teenagers and adults (P = 0.004), asthmatic patients (P = 0.033), and patients who reacted to inhalation (P < 0.001). No significant association was found for OFC ED or ara h 2 sIgE. Factors associated with strict avoidance advice including PAL were OFC ED < 100 mg (P < 0.001), but not severe reaction history (P = 0.051) or asthma (P = 0.34). Anxiety was significantly associated with strict avoidance (P < 0.001). CONCLUSION AND CLINICAL RELEVANCE: Severe/potentially severe reactions, allergic comorbidities, and low EDs in real life are frequent in peanut-allergic patients. Asthma, teenage/adulthood and reaction to inhalation are associated with severe symptoms. PAL and criteria guiding dietary advice need to be improved.

Dietary patterns in the French adult population: a study from the second French national cross-sectional dietary survey (INCA2) (2006-2007).

Identification and characterisation of dietary patterns are needed to define public health policies to promote better food behaviours. The aim of this study was to identify the major dietary patterns in the French adult population and to determine their main demographic, socio-economic, nutritional and environmental characteristics. Dietary patterns were defined from food consumption data collected in the second French national cross-sectional dietary survey (2006-2007). Non-negative-matrix factorisation method, followed by a cluster analysis, was implemented to derive the dietary patterns. Logistic regressions were then used to determine their main demographic and socio-economic characteristics. Finally, nutritional profiles and contaminant exposure levels of dietary patterns were compared using ANOVA. Seven dietary patterns, with specific food consumption behaviours, were identified: 'Small eater', 'Health conscious', 'Mediterranean', 'Sweet and processed', 'Traditional', 'Snacker' and 'Basic consumer'. For instance, the Health-conscious pattern was characterised by a high consumption of low-fat and light products. Individuals belonging to this pattern were likely to be older and to have a better nutritional profile than the overall population, but were more exposed to many contaminants. Conversely, individuals of Snacker pattern were likely to be younger, consumed more highly processed foods, had a nutrient-poor profile but were exposed to a limited number of food contaminants. The study identified main dietary patterns in the French adult population with distinct food behaviours and specific demographic, socio-economic, nutritional and environmental features. Paradoxically, for better dietary patterns, potential health risks cannot be ruled out. Therefore, this study demonstrated the need to conduct a risk-benefit analysis to define efficient public health policies regarding diet.

Mirabel: an integrated project for risk and cost/benefit analysis of peanut allergy.

Food allergy is a major public health issue. However, no regulatory measures exist when allergens are present at trace levels and the different risk components are poorly described. Thus, knowledge on exposure components such as the allergens present in foods and the consumption behaviour of allergic consumers and models to estimate the related risk need to be enriched. Mirabel proposes for the first time studying each risk component using an integrated approach in order to improve the quality of life of the allergic population. Field surveys were conducted in order to fill in the current gaps in unintentional allergen traces in food, allergic consumers' food behaviour, threshold doses of allergic reaction, allergy symptoms and severity. The aim is also to propose methodological and operational tools to quantify allergic risk, to test management scenarios and to produce a cost/benefit analysis. Medical data on the peanut allergies of 785 patients were collected in the MIRABEL survey and 443 patients answered the food consumption questionnaire. The population surveyed was mostly paediatric - 86% were children under 16 years of age, with a high percentage of males (60%). This project will generate tangible results on peanut allergen exposure and risk which could be used in future risk assessment work and particularly to provide science-based guidance to set up concentration limits for peanut traces on packages.

Identification of the main pesticide residue mixtures to which the French population is exposed.

Owing to the intensive use of pesticides and their potential persistence in the environment, various pesticide residues can be found in the diet. Consumers are therefore exposed to complex pesticide mixtures which may have combined adverse effects on human health. By modelling food exposure to multiple pesticides, this paper aims to determine the main mixtures to which the general population is exposed in France. Dietary exposure of 3337 individuals from the INCA2 French national consumption survey was assessed for 79 pesticide residues, based on results of the 2006 French food monitoring programmes. Individuals were divided into groups with similar patterns of co-exposure using the clustering ability of a Bayesian nonparametric model. In the 5 groups of individuals with the highest exposure, mixtures are formed by pairs of pesticides with correlations above 0.7. Seven mixtures of 2-6 pesticides each were characterised. We identified the commodities that contributed the most to exposure. Pesticide mixtures can either be components of a single plant protection product applied together on the same crop or be from separate products that are consumed together during a meal. Of the 25 pesticides forming the mixtures, two--DDT and Dieldrin--are known persistent organic pollutants. The approach developed is generic and can be applied to all types of substances found in the diet in order to characterise the mixtures that should be studied first because of their adverse effects on health.

Mass balance approach to assess the impact of cadmium decrease in mineral phosphate fertilizers on health risk: The case-study of French agricultural soils.

Cadmium is a ubiquitous and highly toxic contaminant that can cause serious adverse effects. The European Food Safety Authority (EFSA) and the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) have shown that the risk related to food contamination by cadmium cannot be ruled out in Europe and France. Fertilizing material is one of the main sources of cadmium contamination in the food chain on which regulators can play to reduce cadmium exposure in the population. The aim of this work was to develop a mass-balance approach integrating the various environmental sources of cadmium to estimate the effects of a decrease in cadmium concentrations in crop fertilizers on dietary exposure and on the health risk. This approach led to a predictive model that can be used as a decision-making tool. Representative and protective fertilization scenarios associated with controlled cadmium levels in mineral phosphate fertilizers were simulated and converted into cadmium fluxes. Cadmium inputs from industrial mineral phosphate fertilizers were then compared with cadmium brought by the application of manure, sewage sludge and farm anaerobic digest, at the levels typical of French agricultural practices. Regardless of the fertilizer and scenario used, a flux lower than 2 g Cd.ha-1.year-1 reduces both the accumulation in soils and the transfer of cadmium in the food chain. It corresponds to a cadmium content of 20 mg.kg P2O5-1 or less in mineral phosphate fertilizers. Modelling the transfer of cadmium from the soil to consumed food made it possible to propose cadmium limits in fertilizers applied in France. In a global context of ecological transition to promote human health, this research will help risk managers and public authorities in the regulatory decision-making process for the reduction of environmental cadmium contamination and human exposure.

To which mixtures are French pregnant women mainly exposed? A combination of the second French total diet study with the EDEN and ELFE cohort studies.

Pregnant women and their unborn child are exposed to a large number of substances during pregnancy. Some of these substances may cross the placenta, resulting in exposure of the foetus. There is growing evidence that certain substances could interact to produce a mixture effect. It is therefore essential to identify the main mixtures mothers are exposed to. This study aimed to identify the major mixtures French pregnant women included in EDEN and ELFE cohorts were exposed to, on the basis of the 441 substances analysed in the second French total diet study. Exposure systems and the composition of substances were identified from co-exposures using sparse non-negative matrix under-approximation to generate the main mixtures. Individuals were clustered to define clusters with similar co-exposure profiles. Six clusters associated with eight mixtures were identified. For example in ELFE, cluster 2 comprising 10% of the population was characterised by mixtures "Pest-1" mainly contains pesticides and "TE-F-PAH″ contains trace elements, furans and polycyclic aromatic hydrocarbons. Five other clusters were also described with their associated mixtures. Similar results were observed for EDEN. This study helps to prioritise mixtures for which it is crucial to investigate possible toxicological effects and to recommend epidemiological studies concerning health effects.

To which chemical mixtures is the French population exposed? Mixture identification from the second French Total Diet Study.

Through their diet, humans are exposed to a wide range of substances with possible adverse effects. Total diet studies (TDS) assess exposure and risk for many single substances or mixtures from the same chemical family. This research aims to identify from 440 substances in the second French TDS, the major mixtures to which the French population is exposed and their associated diet. Firstly, substances with a contamination value over the detection limit were selected. Secondly, consumption systems comprising major consumed foods were identified using non-negative matrix factorisation and combined with concentration levels to form the main mixture. Thirdly, individuals were clustered to identify "diet clusters" with similar consumption patterns and co-exposure profiles. Six main consumption systems and their associated mixtures were identified. For example, a mixture of ten pesticides, six trace elements and bisphenol A was identified. Exposure to this mixture is related to fruit and vegetables consumed by a diet cluster comprising 62% of women with a mean age of 51 years. Six other clusters are described with their associated diets and mixtures. Cluster co-exposures were compared to the whole population. This work helps prioritise mixtures for which it is crucial to investigate possible toxicological effects.

Polyelectrolyte complexes via desalting mixtures of hyaluronic acid and chitosan-Physicochemical study and structural analysis.

Polyelectrolyte complexes (PECs) were prepared from Chitosan (CS) and Hyaluronic Acid (HYA) homogeneous mixtures of aqueous solutions. The method consisted of preparing a homogeneous mixture of the two polysaccharides via charge screening at high salt concentrations. Then, the mixture was dialyzed, leading to the controlled self-assembly of the two polyelectrolytes. Critical parameters like the chitosan degree of acetylation (DA) and molar mass (Mw), the residual salt concentration and the molar charge ratio r=nNH3(+) (CS)/nCOO(-) (HYA) accounted for the transition from homogeneous aqueous solutions to colloidal suspensions (r=0.1) or gel coacervates (r=0.5). The influence of the DA and Mw of CS was evaluated by visual observations, light scattering and rheological measurements. For low values of r, Small Angle X-ray Scattering (SAXS) experiments revealed that the HYA nanostructure was weakly affected by the presence of PECs. On the contrary, the structure was impacted when increasing r, revealing a heterogeneous aggregate morphology with ladder-like chain interactions.

Probabilistic exposure assessment to food chemicals based on extreme value theory. Application to heavy metals from fish and sea products.

This paper presents new statistical methods in the field of exposure assessment. We focus on the estimation of the probability for the exposure to exceed a fixed safe level such as the provisional tolerable weekly intake (PTWI), when both consumption data and contamination data are independently available. Various calculations of exposure are proposed and compared. For many contaminants, PTWI belongs to the exposure tail distribution, which suggests the use of extreme value theory (EVT) to evaluate the risk. Our approach consists in modelling the exposure tail by a Pareto type distribution characterized by a Pareto index which may be seen as a measure of the risk of exceeding the PTWI. Using propositions by EVT specialists, we correct the bias of the usual Hill estimator to accurately estimate this risk index. We compare the results with an empirical plug-in method and show that the Pareto adjustment is relevant and efficient when exposure is low compared to the PTWI while the plug-in method should be used when exposure is higher. To illustrate our approach, we present some exposure assessment for heavy metals (lead, cadmium, mercury) via sea product consumption.

The PERICLES research program: an integrated approach to characterize the combined effects of mixtures of pesticide residues to which the French population is exposed.

Due to the broad spectrum of pesticide usages, consumers are exposed to mixtures of residues, which may have combined effects on human health. The PERICLES research program aims to test the potential combined effects of pesticide mixtures, which are likely to occur through dietary exposure. The co-exposure of the French general population to 79 pesticide residues present in the diet was first assessed. A Bayesian nonparametric model was then applied to define the main mixtures to which the French general population is simultaneously and most heavily exposed. Seven mixtures made of two to six pesticides were identified from the exposure assessment. An in vitro approach was used for investigating the toxicological effects of these mixtures and their corresponding individual compounds, using a panel of cellular models, i.e. primary rat and human hepatocytes, liver, intestine, kidney, colon and brain human cell lines. A set of cell functions and corresponding end-points were monitored such as cytotoxicity, real-time cell impedance, genotoxicity, oxidative stress, apoptosis and PXR nuclear receptor transactivation. The mixtures were tested in equimolar concentrations. Among the seven mixtures, two appeared highly cytotoxic, five activated PXR and depending on the assay one or two were genotoxic. In some experiments, the mixture effect was quantitatively different from the effect expected from the addition concept. The PERICLES program shows that, for the most pesticides mixtures to which the French general population is exposed, the toxic effects observed on human cells cannot be easily predicted based on the toxic potential of each compound. Consequently, additional studies should be carried on in order to more accurately define the mixtures of chemicals to which the consumers are exposed, as well as to improve the investigation, prediction and monitoring of their potential human health effects.

Management options to reduce exposure to methyl mercury through the consumption of fish and fishery products by the French population.

This paper presents an updated assessment of exposure in France to methyl mercury through the consumption of fish and fishery products, and proposes several management scenarios which could reduce this exposure through changes to fish contamination levels or fish consumption patterns. The exposure model was applied in line with previous methodological results [Tressou, J., Crépet, A., Bertail, P., Feinberg, M.H., Leblanc J.Ch., 2004a. Probabilistic exposure assessment to food chemicals based on extreme value theory: application to heavy metals from fish and sea products. Food Chem. Toxicol. 42, 1349-1358; Tressou, J., Leblanc, J.Ch., Feinberg, M., Bertail, P., 2004b. Statistical methodology to evaluate food exposure to a contaminant and influence of sanitary limits: application to ochratoxin A. Regul. Toxicol. Pharmacol. 40, 252-263] so as to obtain a realistic estimate of probability and confidence intervals (95% CI) concerning French consumers exposed to levels exceeding the revised fixed provisional tolerable weekly intake (PTWI) for methyl mercury of 1.6 microg/week/kg of body weight, established by the Joint FAO/WHO Expert Committee on Food Additives in 2003. The results showed that young children aged between 3 and 6 years old or 7 and 10 years old, and women of childbearing age were at the risk groups. With respect to these groups and according to the fish consumers patterns (consumers of predatory fish only or consumers of predatory and nonpredatory fish), the results suggested that strategies to diminish MeHg exposure by reducing the amount of predatory fish consumed would be more efficient in significantly decreasing the probability of exceeding the PTWI than the implementation of international standards.