[Food protein-induced enterocolitis syndrome]. / Syndrome d'entérocolite induite par les protéines alimentaires.

A little known pathology, increasingly diagnosed. Late vomiting after food intake predominate. An insidious chronic form, an explosive acute form. A clinical diagnosis of a typical story, reproducible. Milk and soy often involved, sometimes unusual foods.

[Food allergy in children, when evoke? What tests?]. / Allergie alimentaire de l'enfant, quand l'évoquer ? Quels tests? Signes cutanés et digestifs prédominent.

Food allergy in children, when evoke ? What tests ? Food allergy is an adverse reaction to food proteins by immunological mechanisms (IgE mediated or non-IgE mediated). Signs can affect many organs, but skin and digestive symptoms remain the predominant manifestations in children. Some allergens are responsible for most food allergies in children. Diagnosis is based on standardized investigations including above all the history which is confirmed by skin testing, specific IgE and food challenge.

Allergie alimentaire de l'enfant, quand l'évoquer ? Quels tests? L'allergie alimentaire correspond à une réaction anormale aux protéines alimentaires liée à un mécanisme immunologique (médié ou non par les immunoglobulines de type E). Les signes peuvent toucher de nombreux organes, mais les manifestations cutanées et digestives prédominent chez l'enfant. Quelques allergènes sont responsables de la plupart des allergies alimentaires de l'enfant. Le diagnostic repose sur des investigations standardisées comprenant avant tout l'anamnèse, qui est confortée par des tests cutanés, un dosage des IgE spécifiques et parfois un test de provocation par voie orale.

[How reintroduce food in an allergic child]. / Comment réintroduire les aliments chez un enfant allergique ? Si l'allergie perdure, l'induction d'une tolérance immunitaire est possible dans certains cas.

How reintroduce food in an allergic child. Many food allergies heal when the child grows. The management is very different, if the allergy recognizes a non-IgE-mediated mechanism or IgE-mediated. In case of food allergy with non-IgE mediated mechanism reintroduction can sometimes be gradual at home. If IgE mediated allergy, monitoring the size of the prick tests screw the evolution of specific IgE indicates the appropriate time for the practice of a food challenge. If the allergy persists over time, oral immunotherapy is an important change in the food allergy treatment paradigm. However, to date, the recommendations advise against the practice outside of research protocols. Two exceptions are discussed: some allergies not IgE mediated and egg or cow's milk cooked immunotherapy.

Comment réintroduire les aliments chez un enfant allergique. Bon nombre d'allergies alimentaires guérissent quand l'enfant grandit. La prise en charge est très différente, si l'allergie reconnaît un mécanisme médié ou non médié par les immunoglobulines de type E (IgE). En cas d'allergie alimentaire non médiée par les IgE, la réintroduction peut parfois se faire progressivement au domicile. En cas d'allergie médiée par les IgE, le suivi de la taille des réponses aux prick-tests vis-à-vis de l'aliment et l'évolution du taux des IgE spécifiques indiquent le moment opportun pour la pratique d'un test de provocation par voie orale. Si l'allergie perdure avec le temps, l'immunothérapie orale aux aliments est un important changement dans le paradigme du traitement de l'allergie alimentaire. Néanmoins, à ce jour, les recommandations déconseillent de la pratiquer en dehors de protocoles de recherche. Deux exceptions sont discutées : certaines allergies non médiées par les IgE et l'immunothérapie à l'oeuf ou au lait de vache cuits.

Specificity of IgE antibodies from patients allergic to goat's milk and tolerant to cow's milk determined with plasmin-derived peptides of bovine and caprine ß-caseins.

SCOPE: Despite a sequence homology of 90% between bovine and caprine ß-caseins (CN), IgE antibodies from patients allergic to goat's milk (GM), but tolerant to cow's milk (CM), recognize caprine ß-CN without cross-reacting with bovine ß-CN. We investigated this lack of cross-reactivity by evaluating the IgE-reactivity toward peptides isolated from plasmin hydolysates of bovine and caprine ß-CN. METHODS AND RESULTS: The IgE-binding capacity of plasmin-derived peptides was evaluated with sera from 10 CM-allergic patients and 12 GM-allergic/CM-tolerant patients. In CM-allergic patients, IgE reactivity of caprine fragments (f29-107) and (f108-207), but not (f1-28), was similar to that of the bovine counterparts. In contrast, all bovine fragments were poorly recognized by IgE antibodies from GM-allergic/CM-tolerant patients. The peptide (f29-107) was generally the most immunoreactive fragment of caprine ß-CN. By using synthetic peptides, the immunodominant IgE-binding epitope recognized by most GM-allergic/CM-tolerant patients was located in the caprine domain 49-79. CONCLUSION: The restricted specificity of the IgE response toward the caprine ß-CN in GM-allergic/CM-tolerant patients is mainly directed against the domain 49-79, which differs from its bovine counterpart by only three amino acid substitutions.

Long-term safety of fluticasone propionate and nedocromil sodium on bone in children with asthma.

OBJECTIVE: Inhaled corticosteroids are recommended as first-line therapy for pediatric asthma. However, few controlled long-term studies have investigated their effect on bone mineral density (BMD) and growth. METHODS: Children who were aged 6 to 14 years and had persistent asthma were randomized to 24 months' treatment with fluticasone propionate (FP) 200 micro g/d or nedocromil sodium (NS) 8 mg/d (if uncontrolled, maximum doses of 400 micro g/d and 16 mg/d, respectively). BMD was assessed blind and analyzed at a central facility on the basis of dual-energy x-ray absorptiometry measurements of the lumbar spine and femoral neck at months 0, 6, 12, and 24. Height was measured at months 0, 12, and 24. Efficacy parameters (lung function, asthma control, occurrence of exacerbations) were measured every 3 months. RESULTS: In total, 174 children were randomized to treatment (87 received FP, and 87 received NS). At month 24, the adjusted mean percentage increase in lumbar spine BMD was 11.6% in the FP group compared with 10.4% in NS-treated children (95% confidence interval for treatment difference: -0.7% to 3.1%). The corresponding increases in femoral neck BMD were 8.9% and 8.5%, respectively. There was no significant difference in growth between the 2 groups: adjusted mean growth rates were 6.1 cm/y with FP and 5.8 cm/y with NS. FP was significantly superior for every efficacy parameter investigated and was similarly well tolerated as NS. CONCLUSIONS: The long-term effects of FP and NS on BMD accrual and growth are similar among children with asthma. The benefit:risk ratio of FP may be considered superior to that of NS.