ZZ2L9UJT

1180

28 octobre 2020 12:28

5 novembre 2020 18:57

Résumé Les allergies aux fruits sont fréquentes, représentant pour les fruits de Rosacées 14 % des allergies rapportées et 5 % pour les fruits croisant avec le latex. Elles peuvent être liées à une sensibilisation primaire aux pollens ou isolées. Le concept d’allergie aux fruits est complexe pour le praticien en raison des difficultés de définition du fruit variable selon les classifications, l’évaluation du risque d’allergie croisée et les particularités des expressions cliniques de l’allergie alimentaire en fonction des allergènes impliqués. Cette mise au point précise les définitions botanique, culinaire et allergologique du fruit, les principales familles d’allergènes responsables d’allergies alimentaires, les particularités cliniques, diagnostiques et thérapeutiques de l’allergie aux fruits. La sensibilisation peut survenir par sensibilisation respiratoire (réactivité croisée pollens-fruits) ou par sensibilisation primaire aux fruits par voie digestive ou par contact. Les épitopes végétaux peuvent être continus ou discontinus. Le comportement thermique des allergènes, leur résistance à la digestion, leur stabilité en milieu acide permettent de caractériser leur risque. L’allergénicité varie souvent avec le cultivar, le mode de conservation, les technologies agro-alimentaires utilisées (cuisson, appertisation, fermentation, texturisation, hydrolyse, filtration…). Le diagnostic s’établit sur la base d’un algorithme basé sur l’anamnèse, les prick tests aux aliments natifs, la recherche d’IgE spécifiques, le test de réintroduction. Il convient de souligner l’importance d’utiliser les aliments natifs pour la réalisation des tests cutanés en raison de la sensibilité particulière des allergènes végétaux à la dénaturation. Le traitement se base sur l’éviction des fruits incriminés. Des essais d’immunothérapie aux allergènes de fruits sont à l’étude. Les protocoles de tolérance utilisant des fruits à différents temps de cuisson sont prometteurs pour les allergènes thermolabiles. Fruit allergies are frequent, representing for Rosaceae fruits 14 % of reported allergies and 5 % for fruits crossing with latex. They can be linked to a primary sensitization to pollens or isolated. The concept of fruit allergy is complex for the practitioner because of the difficulties in defining the fruit, variable according to classifications, the evaluation of the risk of cross-allergy and the particularities of the clinical expressions of a food allergy according to the allergens involved. This review specifies the botanical, culinary and allergological definitions of fruit, the main families of allergens responsible for food allergies, and the clinical, diagnostic and therapeutic particularities of fruit allergy. Sensitization can occur by respiratory sensitization (pollen-fruit cross-reactivity) or by primary sensitization to fruit by the digestive tract or by contact. Plant epitopes may be continuous or discontinuous. The thermal behaviour of allergens, their resistance to digestion and their stability in an acidic environment makes it possible to characterise their risk. Allergenicity often varies with the cultivar, the method of preservation, the food processing technologies used (cooking, canning, fermentation, texturisation, hydrolysis, filtration, etc.). The diagnosis is established on the basis of an algorithm based on anamnesis, prick-tests with native foods, the search for the specific IgE, the reintroduction test. The importance of using native foods for skin testing should be stressed because of the particular sensitivity of plant allergens to denaturation. The treatment is based on the removal of the offending fruit. Immunotherapy trials with fruit allergens are under study. Tolerance protocols using fruits at different cooking times are promising for thermolabile allergens.

Abstract Fruit allergies are frequent, representing for Rosaceae fruits 14% of reported allergies and 5% for fruits crossing with latex. They can be linked to a primary sensitization to pollens or isolated. The concept of fruit allergy is complex for the practitioner because of the difficulties in defining the variable fruit according to the classifications, the evaluation of the risk of cross-allergy and the particularities of the clinical expressions of food allergy according to the allergens involved. This development specifies the botanical, culinary and allergological definitions of the fruit, the main families of allergens responsible for food allergies, the clinical, diagnostic and therapeutic particularities of fruit allergy. Sensitization can occur by respiratory sensitization (pollen-fruit cross-reactivity) or by primary sensitization to fruit by the digestive tract or by contact. Plant epitopes may be continuous or discontinuous. The thermal behaviour of allergens, their resistance to digestion, their stability in acidic environment allow to characterize their risk. The allergenicity often varies with the cultivar, the method of conservation, the food processing technologies used (cooking, canning, fermentation, texturization, hydrolysis, filtration ...). The diagnosis is established on the basis of an algorithm based on the anamnesis, prick tests with native foods, the search for specific IgE, the reintroduction test. It is important to underline the importance of using native foods for skin tests because of the particular sensitivity of plant allergens to denaturation. The treatment is based on the removal of the offending fruit. Immunotherapy trials with fruit allergens are under study. Tolerance protocols using fruits at different cooking times are promising for thermolabile allergens. Fruit allergies are frequent, representing for Rosaceae fruits 14% of reported allergies and 5% for fruits crossing with latex. They can be linked to a primary sensitization to pollens or isolated. The concept of fruit allergy is complex for the practitioner because of the difficulties in defining the fruit, variable according to classifications, the evaluation of the risk of cross-allergy and the particularities of the clinical expressions of a food allergy according to the allergens involved. This review specifies the botanical, culinary and allergological definitions of fruit, the main families of allergens responsible for food allergies, and the clinical, diagnostic and therapeutic particularities of fruit allergy. Sensitization can occur by respiratory sensitization (pollen-fruit cross-reactivity) or by primary sensitization to fruit by the digestive tract or by contact. Plant epitopes may be continuous or discontinuous. The thermal behaviour of allergens, their resistance to digestion and their stability in an acidic environment makes it possible to characterise their risk. Allergenicity often varies with the cultivar, the method of preservation, the food processing technologies used (cooking, canning, fermentation, texturization, hydrolysis, filtration, etc.). The diagnosis is established on the basis of an algorithm based on anamnesis, prick-tests with native foods, the search for the specific IgE, the reintroduction test. The importance of using native foods for skin testing should be stressed because of the particular sensitivity of plant allergens to denaturation. The treatment is based on the removal of the offending fruit. Immunotherapy trials with fruit allergens are under study. Tolerance protocols using fruits at different cooking times are promising for thermolabile allergens.

None

• AB - Non-spécifique
• FREDO santé humaine
• fruit
• syndrome oral
• vegetal allergens

• allergie alimentaire
• allergènes végétaux
• food allergy
• oral syndrome
• pollen food cross-reactivity
• réactivité croisée pollen aliment

Revue Française d'Allergologie

September 30, 2020

30 septembre 2020

10.1016/j.reval.2020.08.002 Le DOI est une URL unique de référencement d'une publication. Il est donc plus fiable et permanent qu'une URL classique

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