Anaphylaxie au pignon de pin: à propos de vingt cas déclarés au Réseau Allergo-Vigilance

Le pignon de pin est la graine du pin parasol (Pinus pinea), retrouvé en Europe occidentale et en Afrique du Nord. Il est de plus en plus utilisé dans l’alimentation, souvent sous forme masquée. L’allergie au pignon de pin est rare, mais sa fréquence augmente progressivement. Elle est souvent sévère avec engagement du pronostic vital. Nous rapportons ici une série de 20 cas d’anaphylaxie au pignon de pin rapportés au Réseau Allergo Vigilance de 2002 à 2013. Il s’agit de la plus grande série de cas publiée. Ces cas concernaient des enfants et des adultes jeunes, majoritairement de sexe masculin (13/20). Tous les cas étaient sévères (anaphylaxie de grade II ou III), étaient survenus immédiatement après consommation de pignon de pin, et nécessitaient l’intervention d’une équipe d’urgence. L’adrénaline était utilisée 11 fois sur 20. Le pignon de pin était sous forme masquée dans l’alimentation dans 14 cas. Dans 10 cas, la sensibilisation au pignon de pin était isolée et dans 5 cas, elle s’accompagnait d’une sensibilisation à l’arachide. La série confirme que l’allergie au pignon de pin est rare mais potentiellement très sévère. Le plus souvent l’allergène est masqué dans l’alimentation. Les cas de monosensibilisation sont les plus fréquents. Des cas de cosensibilisation avec les fruits à coques, la cacahuète, le pollen de pin ou l’armoise ont été décrits mais aucune allergie croisée n’a été prouvée à ce jour. Les protéines allergéniques responsables de l’allergie au pignon de pin restent indéterminées

Serotonin reuptake inhibitors improve muscle stem cell function and muscle regeneration in male mice

Abstract Serotonin reuptake inhibitor antidepressants such as fluoxetine are widely used to treat mood disorders. The mechanisms of action include an increase in extracellular level of serotonin, neurogenesis, and growth of vessels in the brain. We investigated whether fluoxetine could have broader peripheral regenerative properties. Following prolonged administration of fluoxetine in male mice, we showed that fluoxetine increases the number of muscle stem cells and muscle angiogenesis, associated with positive changes in skeletal muscle function. Fluoxetine also improved skeletal muscle regeneration after single and multiples injuries with an increased muscle stem cells pool and vessel density associated with reduced fibrotic lesions and inflammation. Mice devoid of peripheral serotonin treated with fluoxetine did not exhibit beneficial effects during muscle regeneration. Specifically, pharmacological, and genetic inactivation of the 5-HT1B subtype serotonin receptor also abolished the enhanced regenerative process induced by fluoxetine. We highlight here a regenerative property of serotonin on skeletal muscle

Heat treatments applied to egg product have a rather low impact on in vivo allergenicity, despite significant changes in protein digestibility and antigenicity

Egg products represent 15 to 50% of egg consumption in Europe depending on the country. For microbiological safety reasons, thermal treatments are applied to egg products. Liquid egg products are pasteurized for 2 to 6 min around 56°C (egg white) or 68°C (for whole egg and yolk); egg white powders are dry-heated up to several weeks from 60 to 80°C. The effects of these treatments on egg functional properties have been widely studied, but what about egg protein digestibility or allergenicity? The aim of our study was to investigate the effect of a wide range of pasteurization rates (on liquid whole egg) and dry heating rates (on egg white powder) on the in vitro digestibility, antigenicity and allergenicity of egg proteins.Pasteurization of liquid whole egg up to 10 min at 60°C, improved protein in vitro digestibility and decreased ovomucoïd antigenicity. Conversely, pasteurization up to 10 min at 66°C decreased protein in vitro digestibility and lysozyme antigenicity, but increased drastically ovotransferrin antigenicity. However pasteurization (6 min at 66°C) had a limited impact on the prick test (PT) reactivity of most children. Dry heating of egg white powder, from 1 to 10 days at 60°C, improved protein in vitro digestibility and slightly decreased lysozyme antigenicity. But dry heating over 1 day at 80°C or 90°C decreased protein in vitro digestibility and lysozyme antigenicity, while drastically increased ovotransferrin antigenicity. Dry heating of egg white powder up to 7 days at 80°C had a limited impact on egg allergy tested in mice

Technological advances in egg product processing with reference to allergenicity

Egg is a widely used ingredient in many food products all around the world. It is indeed a major source of high quality proteins and essential nutrients and provides many desirable functional attributes such as foaming, emulsifying, gelling, colouring, and flavouring. However, hen’s egg is also one of the most frequent allergenic foods, particularly in childhood, affecting 1.6 to 3.2 % of young children in Europe.Egg products represent 15 to 50% of egg consumption in Europe depending on the country. For microbiological safety reasons, thermal treatments are applied to egg products. Liquid egg products are thus pasteurized for 2 to 6 min between 56°C (for egg white) and 68°C (for whole egg and yolk), whereas egg white powders are dry-heated up to several weeks between 60 and 80°C. The effects of these treatments on egg functional properties have been widely studied; this is not the case for egg protein digestibility or allergenicity. The aim of our study was thus to investigate the effect of a wide range of pasteurization rates (on liquid whole egg) or dry heating rates (on egg white powder) on the in vitro digestibility, antigenicity and allergenicity of egg proteins.Liquid whole egg was pasteurized from 2 to 6 min between 60°C and 66°C, and egg white powder was dry heated from 1 to 10 days between 60°C and 90°C. In vitro digestion of samples was performed using a model that mimics successive gastric and duodenal stages of digestion in the adult human. The degree of hydrolysis was quantified by OPA method at the end of each stage, and the SDS PAGE pattern was followed throughout the in vitro digestion. Ovomucoïd, ovotransferrin and lysozyme antigenicity was tested by inhibition ELISA with specific monoclonal antibodies. Liquid whole egg allergenicity was investigated in 54 egg-allergic children by skin prick testing and IgE-binding pattern to egg proteins was determined by indirect ELISA. Egg white powder allergenicity was tested on mice sensitized and challenged through oral route by measuring plasmatic histamine concentration, specific and total IgE and IgG levels, and cytokine concentration in spleen cell culture supernatants.Pasteurization of liquid whole egg, from 4 to 10 min at 60°C, improved protein in vitro digestibility and decreased ovomucoïd antigenicity, but did not significantly change ovotransferrin and lysozyme antigenicity. Conversely, pasteurization from 4 to 10 min at 66°C decreased protein in vitro digestibility and lysozyme antigenicity, but increased drastically ovotransferrin antigenicity. Pasteurization (6 min at 66°C) had a limited impact on the prick test (PT) reactivity of most children. However, two main classes of patients were obtained from PT diameter variations: for 34 children, pasteurization had no impact on PT reactivity, whereas for 20 children, pasteurization significantly decreased reactivity. A large effect was even found for 4 children who had null PT with pasteurized liquid whole egg. No correlation was found between patterns of IgE-binding to egg proteins and patterns of PT-reactivity as a function of pasteurization.Dry heating of egg white powder, from 1 to 10 days at 60°C, improved protein in vitro digestibility and slightly decreased lysozyme antigenicity. On the other hand, dry heating over 1 day at 80°C or 90°C decreased protein in vitro digestibility and lysozyme antigenicity, but drastically increased ovotransferrin antigenicity. Dry heating of egg white powder up to 7 days at 80°C had a limited impact on egg allergy tested in mice. No significant effect was found on histamine concentration, or specific and total IgE and IgG levels. Only a significant decrease of IL4 cytokine concentration was observed for mice groups fed with dry heated powders.Heat treatments applied to egg products thus have, in most cases, a rather low impact on in vivo allergenicity, despite significant changes in protein digestibility and antigenicity

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial

AIMS: The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS: Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS: For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications