[Where are we with oral immunotherapy for food allergy ?] / Allergologie-immunologie: Où en est-on avec l'immunothérapie orale dans l'allergie alimentaire ?

In allergology, food allergy is probably the problem to which medicine has brought the least therapeutic response so far. While oral immunotherapy for peanut, egg and milk is reserved for a few special cases and is not routinely recommended, apple desensitization for adult oral syndrome seems to bring some benefits in clinical practice, particularly in patients with restricted diet in fruits.

Dans le domaine de l'allergologie, l'allergie alimentaire est probablement la problématique à laquelle la médecine a apporté le moins de réponses thérapeutiques jusqu'ici. Alors que l'immunothérapie orale pour les cacahouètes, l'œuf et le lait est réservée à quelques cas particuliers et n'est pas recommandée de routine, la désensibilisation à la pomme lors de syndrome oral croisé chez l'adulte semble apporter certains bénéfices en pratique clinique, en particulier pour des patients dont le régime alimentaire en fruits est considérablement réduit.

Walking performances and muscle oxygen desaturation are increased after supervised exercise training in Takayasu arteritis: a case report and a review of the literature.

BACKGROUND: Takayasu arteritis (TAK) is a rare chronic inflammatory vasculitis predominantly affecting the aorta and its main branches. Takayasu arteritis has been shown to increase cardiovascular risk. Supervised exercise training (SET) is a well-recognized and effective therapeutic tool improving walking performances in patients with chronic atherosclerotic disease; however, the effects of SET, and the underlying mechanisms, remain poorly documented in TAK patients. CASE SUMMARY: We reviewed the literature and investigated the effects of a 12-week SET programme on walking performances, physical function, and calf muscle oxygen saturation (StO2; assessed by near-infrared spectroscopy) during exercise in a 28-year-old man with TAK and symptoms of arterial lower limb claudication. The literature review evidences only two recent publications suggesting that exercise training is effective and well-tolerated in patients with arteritis. The treadmill pain-free (+22%) and maximal (+273%) walking distance, 6-min walking distance (+66%), and physical function of lower extremities (+20%) following SET were significantly improved in our patient. Moreover, we observed a greater muscle oxygen desaturation (increased oxygen extraction) during exercise. DISCUSSION: Following SET, the increased oxygen extraction may be related to improved microvascular milieu leading to a better match between muscle oxygen supply and demand during exercise. These new results may contribute to mechanistic insights in peripheral adaptations following exercise training in TAK patients and may help to explain, at least partly, the increased walking performances. Although more studies are needed to better explore the impact of exercise training, these results suggest that exercise should be recommended in TAK patients.

[Food-dependent exercise-induced anaphylaxis : a stepwise diagnosis]. / Anaphylaxie alimentaire à l'effort : un diagnostic par étapes.

Food-dependent exercise-induced anaphylaxis (FDEIA) is a potentially severe food allergy. Physical exercise, NSAID, alcohol, infectious diseases and estrogens are recognized cofactors, able to reduce the amount of allergen needed to achieve a threshold for the induction of anaphylaxis. Various kinds of causative food but only a few responsible proteins have been identified. The best known is wheat ω5-gliadine. An oral food challenge remains the gold standard to prove the diagnosis. Its clinical application remains difficult and includes an allergen challenge, a cofactor challenge and a third step which integrates both of them in a single test. Gluten flour and NSAID + alcohol combination seem more efficient than respectively wheat flour and physical exercise in a provocation test condition.

L'anaphylaxie alimentaire à l'effort est une allergie alimentaire potentiellement sévère. L'exercice physique, les AINS, l'alcool, les infections et les œstrogènes sont des cofacteurs reconnus, capables de diminuer la quantité d'allergènes nécessaire à l'atteinte d'un seuil anaphylactique. Si le panel d'aliments incriminés est large, seules quelques protéines responsables ont été à ce jour identifiées. La plus connue est l'ω5-gliadine du blé. En cas d'incertitude diagnostique, un test de provocation est indiqué. Son application clinique reste difficile et inclut de tester l'allergène de manière isolée et le cofacteur puis d'intégrer les deux dans un même test. La farine de gluten et la combinaison AINS + alcool ont une sensibilité supérieure respectivement à la farine de blé et à l'exercice physique en situation de provocation.