Quoi de neuf en allergologie pédiatrique en 2011 ? Anaphylaxie, allergie alimentaire, médicamenteuse et aux venins d’insectes (une revue de la littérature internationale 2011)

Abstract

Several studies confirm that, in children with anaphylaxis, the use of epinephrine is not adequate, not only by the patients themselves (self-administration) but also in the emergency rooms, and suggest measures to improve the early use of epinephrine. Prevalence of food allergy, including severe anaphylaxis, is high and constantly increasing. However, 30 to 50% of food sensitizations diagnosed by means of skin and/or biological testing are not associated to allergy and need challenge tests to assess their relevance. In children tolerant to boiled milk or cooked egg, daily consumption of these foods accelerates tolerance acquisition to crude milk and non-cooked egg. Several protocols of desensitization/tolerance induction to egg, milk and peanut are presented, with promising results. Several studies, including two studies in several thousands of children, clearly show that only 10 to 15% of children with suspected drug allergy are really hypersensitive to the drugs. Risk of drug hypersensitivity increases with the earliness and the severity of the reactions. Thus, it is suggested that diagnosis should be primarily based on challenge tests in children reporting non-immediate and non-severe reactions, to avoid unnecessary skin testing. Immediate-type hypersensitivity to toxoid vaccines resolves with time, and this spontaneous recovery may allow booster full-strength injections of the vaccines in most children. Finally, although they are usually tolerated by egg- and milk-allergic children, (injective) drugs and biological substances produced on milk or egg derivatives may be contaminated by proteins and induce anaphylactic reactions.