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Abstract: Peanut allergy is one of the commonest food allergies in children and has a low natural recovery rate. It is severe and possibly causes fatal anaphylaxis. Current treatment is limited to strict eviction which, although it prevents accidents, does not abate sensitization and the risk of recurrence remains. A risk of increased sensitization has been demonstrated for milk and egg allergy in a randomized study comparing eviction with an oral tolerance induction protocol. Trials evaluating injectable immunotherapy could only be conducted when recombinant allergens, mutated to remove decisive B cell epitopes, would become available. Induction of specific oral tolerance is possible in experimental models. Studies in allergic children whose allergy resolved spontaneously have showed immunological modifications involving Th1–Th2 balance and indicating the role of regulatory T-lymphocytes. However, the slow natural evolution of food allergy in children justifies a therapeutical intervention consisting in daily administration of increasing doses of the food to reach the amount normally eaten. This aims to trigger, or accelerate, immunological tolerance. Studies on egg, milk and wheat flour allergies have produced satisfactory results, indicating a possible application to peanut allergy. This paper summarizes the main facts concerning natural oral tolerance mechanisms, the development of food allergy and spontaneous recovery, before considering specific oral tolerance induction protocols. Criteria of selection of patients are discussed. Protocol implementation modalities are presented, including the increment of doses, the duration of the treatment, parameters for the specific monitoring and later prescription concerning maintenance doses. [Copyright &y& Elsevier]

Abstract: The realization of the TPO begin with a precise analysis from criteria ensuring the safety from the child. The paper specify the prerequisites (place of realization, venous access, environment, food preparation), the methodology of the OFC (open, simple or double blind manner) and the management of a reaction occurring during the OFC. [Copyright &y& Elsevier]

Abstract: Wheat isolates, used as binders and emulsifiers in the food industry, mainly in meat products, are neo-allergens resulting from deamidation of wheat gluten. In this paper, we describe cases of anaphylactic reactions caused by a wheat isolate occurring after eating pasta. Sensitivity to wheat isolate was demonstrated by positive skin tests and specific IgE reactivity to wheat isolate extract (20.1 KU/l, class 4), and also by detection and quantification of wheat isolate in pasta by immunoblotting and ELISA inhibition. [Copyright &y& Elsevier]

Abstract: It''s obvious that epinephrine should not be used for the treatment of generalized urticaria without hemodynamic perturbations. However, the purpose of this discussion is to defend epinephrine prescription (and not necessarily it''s administration) as possible first aid treatment in a very precise situation, which concern children with a history of generalized urticaria due to confirmed food allergy. This position was defined, after careful examination of scientific evidences in the literature, by the French “tripartite commission” and published under the title “Conditions to establish a project for individualized management at school of children at risk for food allergy emergencies” in 2003 in this journal. This paper resume the main points supporting this statement. [Copyright &y& Elsevier]