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Vandœuvre-lès-Nancy, France

Moneret-Vautrin D.-A.,Center Hospitalier rkheim | Papadopoulos A.,Anses | Beaumont P.,avenue Gambetta | Menetrey C.,Limoges University Hospital Center | And 4 more authors.
Revue Francaise d'Allergologie | Year: 2012

The MIRABEL project deals with peanut allergy in order to make the connection between medical data including the reactive dose and the food consumptions of the patients. The two aims of the pilot study are to characterize the profile of peanut allergy in France and the feasibility of the study. Sixty-one paediatric cases have been collected from June to September 2011. The age ranges from 1 and 11. years. The median of sensitization is 1.5. year and for the first clinical symptoms: 3. years. Atopy is detected in 95.1% of cases. Tree nut allergy is associated in 47.5% of cases, legume allergy in 36.4% of cases. The route is ingestion (84.6%), contact with the skin (28.8%), and inhalation (5.8%). The median of the amount of peanut eliciting reactions is 102. mg. The median of the cumulative reactive dose (CRD) determined by oral challenges is 109. mg. A strict avoidance, needing to read the labels, is prescribed in 32.2% of cases. It is based on a low CRD (median: 24. mg, range: 4.7-109. mg). Half of the patients sent back the questionnaire for their consumptions. The feasibility of the study is confirmed. © 2012 Elsevier Masson SAS.

Lefevre S.,University of Lorraine | Jacquenet S.,Genclis SAS | Kanny G.,University of Lorraine | Kanny G.,Nancy University Hospital Center
Revue Francaise d'Allergologie | Year: 2016

Allergy due to peanuts is a frequent food allergy, involving about 1% of the population. It is a potentially severe allergy, usually persistent and having a strong impact on the quality of life of the patients and their entourage. The diagnosis is based on the clinical history, the results of skin tests plus serum assays for peanut-specific IgEs and its allergens. Confirmation of the diagnosis is established by a double-blind, placebo-controlled oral provocation test. Based on a review of the literature, we evaluated the place of different tests used in the diagnostic workup and we propose a decisional algorithm for food allergy due to peanuts. The suspicion of this allergy is established on the basis of a compatible clinical history and a positive skin prick-test to peanut (either a real peanut or a peanut extract). The diagnostic algorithm depends on the initial level of IgE specific for rAra h2 and rAra h6, which if positive, establishes the diagnosis of food allergy due to peanuts with a sensibility of 98% and a specificity of 96%. If the results are negative, then IgE assays for rAra h1and rAra h3 and subsequently for rAra h9 are justified. The presence of anti-rAra h8 IgE is a sign of the existence of cross-reactivity with pollens. A repeat oral introduction test may be done, following the PRACTALL consensus recommendations. This allows us to determine the level of reactivity, to implement an avoidance regime, to follow the evolution of the food allergy and to define the details of a dietary regimen. © 2015 Elsevier Masson SAS.

Luyasu S.,Service de Reanimation medicale | Hougardy N.,Laboratoire Of Biologie Clinique | Hasdenteufel F.,Nancy University Hospital Center | Jacquenet S.,Genclis SAS | And 3 more authors.
Revue de Medecine Interne | Year: 2011

Introduction: Despite the occurrence of a severe allergic reaction including an anaphylactic shock, a drug may remain essential and impossible to replace. This may be the case of insulin in a diabetic patient. We describe the case of an anaphylactic shock to human insulin in whom a desensitization protocol was successfully achieved. Case report: A 50-year-old type 2 diabetic man presented one year after initiation of the insulin therapy an anaphylactic shock following the subcutaneous administration of a human insulin containing protamine (Insulatard®). A desensitization protocol to human insulin was performed and allowed to use two human insulin analogues containing no protamine (asparte and glargine), with a two-year event-free follow-up. Positive skin tests with insulin and protamine, and the presence of insulin specific IgE were evidenced of an IgE-mediated mechanism. Desensitization was monitored by skin tests, Maunsell's test, measurement of specific IgE and IgG4, and the basophil activation test. The decrease of basophil sensitivity to insulin is an early marker for tolerance induction. Conclusion: The effectiveness of the desensitization to human insulin underlines the importance to define the modalities of such desensitization protocol and of the monitoring of the tolerance induction. © 2010 Société nationale française de médecine interne (SNFMI).

Morisset M.,University of Lorraine | Richard C.,Genclis SAS | Astier C.,University of Lorraine | Jacquenet S.,Genclis SAS | And 8 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2012

Background: Carbohydrate-specific IgE antibodies present on nonprimate mammalian proteins were incriminated recently in delayed meat anaphylaxis. The aim of this study was to explore whether anaphylaxis to mammalian kidney is also associated with galactose-α-1,3-galactose (αGal)-specific IgE. Methods: Fourteen patients with anaphylaxis to pork or beef kidney underwent prick tests to meat and kidney. Some patients also underwent skin tests to Erbitux® (cetuximab). IgE antibodies to αGal, swine urine proteins, beef and pork meat, serum albumin proteins, cat, and rFel d 1 were measured by ImmunoCAP®. The αGal levels were estimated in meats and kidney by ELISA inhibition assay. Cross-reactivity between αGal and pork kidney was studied with the ImmunoCAP® inhibition assay. Results: Among the 14 patients, 12 presented with anaphylactic shock. Reactions occurred within 2 h from exposure in 67% of patients. Associated risk factors were observed in 10 cases, and alcohol was the main cofactor. Three patients underwent an oral challenge to pork kidney, and anaphylaxis occurred after ingestion of small quantities (1-2 g). Prick tests to kidney were positive in 54% of patients. All tested patients showed positive skin tests to Erbitux®. All patients tested positive for IgE to αGal, with levels ranging from 0.4 to 294 kU/l. IgE binding to αGal was inhibited by raw pork kidney extract (mean, 77%; range, 55-87%), which showed a high amount of αGal determinants. Conclusions: Pork or beef kidney anaphylaxis is related to αGal IgE. Its peculiar severity could be due to an elevated content of αGal epitopes in kidney. © 2012 John Wiley & Sons A/S.

Paris C.,Nancy University Hospital Center | Paris C.,University of Lorraine | Herin F.,French Institute of Health and Medical Research | Herin F.,University Paul Sabatier | And 11 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2016

Background Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder. Methods Patients were investigated in the occupational disease department and, according to their symptoms, underwent pulmonary function testing, methacholine challenge, specific inhalation challenge to argan powder, skin prick tests, and immunoblotting analysis. Results We report three cases of occupational asthma to argan powder and a probable case of rhinitis. Fifteen argan proteins were recognized by the patients' IgE. Identification of proteins, cross-reactions to nuts, and ELISA inhibition tests suggested that some argan allergens can cross-react in vitro with hazelnut allergens, including 11S globulin and vicilin. Conclusion High-level exposure to argan powder should be considered to be a potential cause of IgE-mediated allergy, and workers handling argan powder should be carefully investigated. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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