Food allergy: the limits of the elimination diet
For parents of allergic children, the total eviction of the offending food is hard to live. It is replaced by a regime based on the tolerance of each child. Warning, this reintroduction should be supervised by an allergist. The research hopes to cure these allergies tomorrow by promoting tolerance gradually.
Congress met in Paris in late April1, allergists French discussed the limits of the “sacrosanct” strict elimination diet and research ways to address food allergies.
1. The limits of strict avoidance diets
For many years, the strict eviction food was the only way to prevent and treat food allergy.However, as allergists, this method has some limitations. ”The risk of accidental reintroduction, the careful examination of the composition of food … have a considerable impact on quality of life of the patient but also his family,” said Dr. Marie-Christine Castelain, allergist, chief of allergy Hospital St. Vincent de Paul in Lille 2.
Since 2006, a study française3 stressed this alteration of the quality of family and social life of the patient, plus a greater risk on re-entry incident, the appearance of food phobias and anxiety complicating the reintroduction of the food involved. ”We also know that a strict elimination diet does not help the healing – Some food allergies disappear naturally – and may even aggravate the allergy, facilitating the emergence of new sensitizations and lowering the threshold reactogenic initial dose from which the allergy occurs “we said Dr. Fabienne Rance, a pediatric allergist at the Children’s Hospital of CHU Toulouse4.
2. Food allergy: No reintroduction without consultation!
Does this mean an end with the elimination diet? ”We recently presented the end of the elimination diet as a scoop. Yet for several years, allergists recommend instead a scheme based on the initial tolerance of each patient,” we said Fabienne Rance.
Beware the reservations against the strict elimination diet does not mean that parents can reintroduce the allergen without control! Food allergies are among the purveyors of serious reactions (malaise, anaphylactic shock …). ”Food allergy is identified as part of a standardized diagnosis, which includes inter alia the definition of the dose at which the allergy occurs. It is usually around 1 gram but it varies from one individual to another, “says Dr. Fabienne Rance. It is from this dose that will define the allergist with parents and support the regime appropriate.
3. Healing tomorrow food allergies by desensitizing
If the controlled reintroduction is recommended not to aggravate food allergies, will there be tomorrow treated by desensitization? Today, desensitization also called specific immunotherapy is the only cure for allergy sufferers gradually habituating them to substances that cause allergic reactions in them. But this support is limited to bee venom allergy, wasp and some aeroallergens (mites, pollens from grasses, herbaceous and tree). ”Induction of tolerance should be limited to a search box. I repeat: do not parents play the sorcerer’s apprentice. Currently, several teams are currently working on this line of research with mixed results” we said Dr.Fabienne Rance.
A sublingual desensitization to cow’s milk is underway at several teams in France for children with persistent allergy to cow’s milk, with encouraging preliminary results. At the 2009 Congress of Clinical Investigation Circle in Biological and Food Allergy (CICBAA), Prof. Moneret-Vautrin has presented results on the efficacy and safety of a protocol of tolerance arachide4. In 2009, twenty patients were desensitized to peanuts, having presented many allergic reactions, especially breathing during the protocol (80%) but with few problems, however upon returning home (0, 7%) 5. ”Our team also works in Toulouse to desensitization via the sublingual route. But all these studies are preliminary at this time. While carrying a real hope, they will still take some time” moderates Dr. Fabienne Rance.
The advantage of this avenue of research and sliding strict avoidance diets to regimes based on the tolerance of each patient also imply certain constraints: the completion of the initial threshold of tolerance, acceptance of new modes of treatment, whereas one is in foreclosure for years rigorous (overcoming his fear of the return), the constraints related to the continuation of a regular dose of tolerance back home, the risks of these protocols support a severe reaction at home … There are many points that underscore the importance of a rigorous follow-allergic patients, in particular through the implementation of a therapeutic education of helping children and their parents better understand disease.
Tags: Allergy, food allergy