FOOD ALLERGY & PEDIATRIC ASTHMA
MENARDO J.L
Hôpital Arnaud de Villeneuve, MONTPELLIER FRANCE
Traduction (partielle) en : | Anglais/English |  :-)

Food allergy can be a trigger in asthma. However, it appears to be a rare one which is usually involved in younger patients and particularly in children suffering from atopic dermatitis (1,2,3). Late phase reaction after double blind food challenges (DBFC) was looked for, but rarely found (3,4).

In food-allergic patients relating chest symptoms (cough and or wheezing) after a DBFC, a significant increase of airway hyperesponsiveness (BHR) can be observed in one half of the patients (5,6). Therefore, worsening of asthma through an increase of BHR appears possible, especially in infants who have more frequently positive food allergy tests than the older patients, even if a direct relationship between ingestion and symptoms is not obvious.

Food allergy tests are however not frequently positive in infants who suffer from recurrent wheezing (Fig1) (7,8). However some food allergens must always be tested in a wheezing infant even if the infant is excluselively breast fed since allergenic foods eaten by the mother can be transferred into the breast milk:

* cow’s milk (CM) and casein even if the child is exclusively fed with an hydrolysed CM formula, because number of these formulas still contain amount of allergenic peptides (9,10)
* soy if the infant receives soy based formulas (used as substitutes they are less expensive than CM hydrolysates), which can easily induce soy sensitization in high risk infants (11).
* egg which is the most frequent positive test in French infants suffering from atopic dermatitis (Fig 2) (12), and even if the child has never eaten any egg in his life, since DBFC can be positive (13).
* latex which in some conditions (infants suckling latex dummies) provoke sensitization (14) with possible cross-reactivities to other food allergens (15)
* peanut the allergens of which are absent in pure peanut oil but extensively cross react with soy allergens (16) and can be found in mother's breast milk (17) explaining possible severe reactions at the first exposure; they can cause fatal and near fatal anaphylaxis (18)

For the diagnosis, skin tests and specific IgE give comparable results which depend on the quality of the allergen that is tested, and are essentially relevant for egg, fish and CM which are well-defined (19). DBFC should only be performed in an hospital, where emergency care is immediately available, and therefore must be restricted to limited cases and in very selected conditions.

An elimination diet can be proposed in some conditions, and requires a clear improvement or a total remission within 10 days (19): otherwise, the diagnosis should be immediately reconsidered. It must be borne in mind that any diet can cause rapid deficiencies in infancy.

REFERENCES:

1) ONORATO J, MERLAND C., TERRAL C; MICHEL F.B., BOUSQUET J. Placebo-controlled double-blind food challenges in asthma J. Allergy Clin. Immunol. 1986,78, 1139-46

2) NOVEMBRE E., de MARTINO M., VIERUCCI A. Foods and respiratory allergy J. Allergy Clin. Immunol.1988, 81, 1059-65

3) SAMPSON H.A., JAMES J.M. Respiratory reactions induced by food allergen challenges in children with atopic dermatitis Pediatr. Allergy Immunol 1992, 3, 195-200

4) BOCK S.A. Respiratory reactions induced by food challenges in children with pulmonary diseases Pediatr. Allergy Immunol 1992, 3, 188-94

5) SILVERMANN M. WILSON N. 1986 Clinical physiology of food intolerance in asthma In C.E. Reed Editor. Proceedings of the Xll International Congress of Allergology and Clinical Immunology C.V. Mosby, St Louis, 457-62.

6) JAMES J.M; EIGENMANN P.A., EGGLESTON P.A., SAMPSON H.A. Airway reactivity changes in asthmatic patients undergoing blinded food challenges. Am. J. Respir. Crit. Care Med. 1996, 153, 597-603

7) PRICE G.W, HOGAN A.D., FARRIS A.H. et al Sensitization (IgE antibody) to food allergens in wheezing infants and children. J. Allergy Clin. Immunol. 1995,96,266-70

8) MENARDO J.L unpublished results

9) BUSINCO L. DREBORG S., EINARSSON R. et al: Hydrolysed cow’s milk formulae; allergenicity and use in treatment and prevention. An ESPACI position paper. Pediatr. Allergy Immunol 1993, 4, 101-11.

10) van BERESTEIJN E.C.H., MEIJER R.J.G.M., SCHMIDT D.G. Residual antigenicity of hypoallergenic infant formulas and the occurence of milk-specific IgE antibodies in patients with clinical allergy. J. Allergy Clin. Immunol.1995, 96, 365-74

11) KJELLMAN N-IM, JOHANSONN S.G.O. Soy versus cow’s milk in infants with a biparental history of atopic disease: development of atopic disease and immunoglobulins from birth to 4 years of age. Clin. Allergy 1979, 9 347-58.

12) MENARDO J.L unpublished results

13) CAFFARELLI C. , CAVAGNI G., GIORDANO S., STAPANE I., ROSSI C. Relationship between oral challenges with previously uningested egg and egg specific IgE antibodies and skin prick tests in infants with food allergy.J. Allergy Clin. Immunol.1995,95,1215-20

14) MAKINEN-KILJUNEN et al Lancet 1992, 339, 1608-9

15) RODRIGUEZ M. VEGA F., GARCIA N.T., PANIGO C.E.A Hypersensitivity to latex, chestnut, and banana Ann. Allergy 1993, 70, 31-4.

16) EIGENMANN P.A, BURKS A.W;, BANNON G.A., SAMPSON H.A. Identification of unique antigenic fractions of soy and peanut. (Abstr.) J. Allergy Clin. Immunol.1996,97, 1 (part 3): 582

17) De BOLT M.F.H., JOHANSEN K.M., YUNGINGER J.W. Secretion of peanut allergens in breast milk of nursing mothers (Abstr.) J. Allergy Clin. Immunol.1993,91, 1 (part 2): 342

18) SAMPSON H.A., MENDELSON L., ROSEN J.P. Fatal and near fatal anaphylactic reactions to food in children and adolescents. N. Engl. J. Med. 1992, 327, 380-4.

19) BRUIJNZEEL-KOOMEN C., ORTOLANI C, AAS K. et al Adverse reactions to food. Allergy 1995, 50, 623-35

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