L’allergie de l’enfant disparaît
généralementà l’âge adulte
Fausse rumeur
(N° 9 pour en savoir plus sur cet ouvrage
ou le commander...)

L’asthme, c’est psychologique
Fausse rumeur
(N° 24 pour en savoir plus sur cet ouvrage
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Les parents d’enfants allergiques ont souvent l’impression que les manifestations diminuent avec l’âge.

La majorité des allergies ne disparaît pas spontanément En raison d’un mode de fonctionnement particulier du système immunitaire, l’allergique fabrique des anticorps* appelés IgE, spécifiques d’un ou de plusieurs allergènes* (acariens*, graminées, chat…). La réaction allergique se déclenche à chaque fois que la personne allergique entre en contact avec son (ou ses) allergène(s).

L’allergie alimentaire guérit parfois La disparition à l’âge adulte de l’allergie au lait de vache ou à l’œuf est très fréquente. Ce phénomène s’explique par l’immaturité du système immunitaire du tout petit : en grandissant, son organisme peut, après une période d’éviction, à nouveau tolérer le lait ou l’œuf.

Pour ce qui concerne les autres allergies alimentaires :

Les manifestations allergiques respiratoires varient au cours du temps

Chez l’enfant, l’allergie est fréquemment la cause d’une gêne importante parce que les phénomènes allergiques sont souvent associés à des infections virales comme des rhinopharyngites à répétition avec écoulement nasal important. Quand il y a un asthme* associé, les épisodes de toux sont volontiers invalidants et les bronchites à répétition, sans fièvre, sont fréquentes. 

En grandissant, la gêne peut être masquée par la chronicité des symptômes, l’allergique s’y étant habitué peu à peu :

• La rhinite* se traduit par un nez bouché pouvant passer inaperçu de l’entourage qui a fini par s’y habituer également. Pourtant cet état entraîne une fatigue importante car l’obstruction nasale est à l’origine d’un sommeil peu récupérateur.
• L’asthme se manifeste par des gênes respiratoires à l’effort ou la nuit.
• L’enfant allergique a lui-même tendance à minimiser sa gêne. Pourtant celle-ci altère largement sa qualité de vie au quotidien.

Moins de 10 % des allergies respiratoires disparaissent spontanément. Un suivi et une prise en charge adaptés sont donc indispensables pour assurer une bonne qualité de vie, les traitements pouvant soit s’opposer aux manifestations allergiques (antihistaminiques, corticoïdes), soit modifier l ’histoire naturelle de l’allergie (éviction, désensibilisation).

Tout asthmatique ou parent d’asthmatique a pu constater que certaines émotions pouvaient entraîner une crise d’asthme. Cela conduit de nombreuses personnes à penser que l’asthme, c’est “dans la tête“. Cette idée peut induire des arrêts de traitement et une grande culpabilité de la part de l’asthmatique qui est désigné comme le responsable de ses crises.

L’asthme : une maladie inflammatoire le plus souvent d’origine allergique
L’asthme* est une maladie des bronches associée à l’allergie chez 80 à 90 % des enfants et chez une majorité d’adultes (50 à 60 %). ?

L’asthme peut se manifester de différentes façons :

L’asthme : une maladie difficile à accepter L’annonce du diagnostic d’asthme est souvent un moment difficile. Il entraîne la prescription de soins et de mesures préventives. Le traitement proposé est quotidien et, pour cette raison, semble souvent inadapté à l’asthmatique qui ne ressent de gêne qu’au moment des crises. L’asthme est ainsi souvent négligé et, en l’absence de traitement de fond, les gênes respiratoires sont de plus en plus fréquentes et la qualité de vie quotidienne tend à se détériorer : réveils nocturnes, impossibilité de faire des activités physiques, de travailler…

L’asthmatique subit son asthme et se marginalise à son insu. Le moindre facteur stimulant ses bronches très irritées, les émotions notamment, provoque une crise. Le contexte psychologique n’est donc pas à l’origine de l’asthme, mais traduit plus souvent un mauvais contrôle de celui-ci.

Réalités

• Les allergies au lait de vache et à l’œuf disparaissent souvent.
• Les autres allergies sont le plus souvent définitives, nécessitant un suivi et des traitements adaptés.  

Réalités

• Une émotion peut provoquer une crise d’asthme.
• La maladie asthmatique n’est pas d’origine psychologique. L’asthmatique, son entourage, ses parents notamment, n’ont aucune responsabilité dans la survenue de la maladie.
• Pour s’impliquer dans le traitement de sa maladie, l’asthmatique doit être conscient de l’atteinte organique au niveau des bronches.

Bibliographie
Demoly P, Casamar-Portales S. CDRom. RESIP. 2003.
Vervloet D, Magnan A. Flammarion. Paris 2003.

Bibliographie :
Godard Ph et coll. Masson 2000.
Salmeron S. Ed Médi-Text. Paris 2002.

Références (dont certains extraits Medline)

1. ANAES. Prise en charge de l’urticaire chronique. Janvier 2003.

2. Arshad SH et coll. Effect of environmental factors on the development of allergic disorders in infancy.
   J Allergy Clin Immunol 1993; 91 : 1042-50.
   http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1500628
   J Allergy Clin Immunol. 1992 Aug;90(2):235-41.
   Effect of environmental factors on the development of allergic disorders in infancy.
   Arshad SH, Hide DW.
   Clinical Allergy Research Unit, St. Mary's Hospital, Newport, Isle of Wight, U.K.
   A total of 1167 infants were followed for 1 year in a population-based prospective study to assess the effect of environmental factors on the development of allergic disorders. Some of these environmental factors are interdependent. Mothers who formula fed their infants smoked more often (p less than 0.001) and tended to belong to lower social classes (p less than 0.01). Logistic regression analysis was performed to adjust for these confounding variables. Maternal smoking adversely affected the prevalence of asthma (p = 0.003) defined as three or more separate episodes of wheezing and total allergy (p = 0.02). Infants in lower socioeconomic groups developed asthma significantly more often (p = 0.03) than infants born in higher socioeconomic groups. There was a nonsignificant trend for infants born in summer to develop asthma more than infants born in winter (p = 0.08). No effect of these factors was observed on eczema, food intolerance, or on the subgroup of infants with definite allergy (clinical disorder with positive skin prick test [SPT]). Exposure to animal dander did not influence the prevalence of clinical disorder, but positive SPT reaction to cat dander was more prevalent in infants who were exposed to cats and/or dogs (p = 0.04). Positive SPT to house dust mite occurred significantly more often in infants who were formula fed (p = 0.05). The environmental factors had a profound effect on the prevalence of asthma but not on other allergic disorders.
   PMID: 1500628 [PubMed - indexed for MEDLINE]

3. Balkrishnan R et coll Disease severity and associated family impact in childhood atopic dermatitis.
   Arch Dis Child. 2003 May;88(5):423-7.
   Balkrishnan R, Housman TS, Carroll C, Feldman SR, Fleischer AB.
   Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. rbalkris@wfubmc.edu
   AIM: To examine the association between childhood atopic dermatitis (AD) severity and family impact at baseline and after an intervention by a physician specialist, using validated measures of both severity and family impact. METHODS: Cross sectional self administered survey of parent-caregivers of 49 randomly selected children with AD; 35 parents were available for follow up. Family impact was measured using a modified AD Family Impact Scale completed by the parent-caregiver. The child's disease severity was measured using both the investigator's assessment via the Eczema Area and Severity Index (EASI) and the caregiver's assessment via the recently validated Self Assessment Eczema Area and Severity Index (SA-EASI). RESULTS: The parent-caregiver's assessment of severity of the child was the most significant correlate of the family impact of the child's AD (p = 0.65 at baseline and p = 0.38 at follow up). In multivariate regression models, the parent-caregiver's estimate of severity remained the single strongest predictor of family impact before and after receipt of dermatologist care, as well as the difference in impact between pre and post-dermatologist care. CONCLUSIONS: There is evidence to support the ability of parent-caregivers of children with AD to accurately determine severity of their child's AD; perceived severity is the driver of the family impact of this condition. Treatment of a child by a physician specialist is associated with reductions in both perceived severity, as well as family impact of this condition.
   PMID: 12716715 [PubMed - indexed for MEDLINE]

4. Bousquet J et coll De la dermatite atopique à l’asthme. Expansion Scientifique Française 2000 : 59-65.
   http://www.expansionscientifique.com/Session2004/Photos%20presentation/Presentation%20livres.htm

5. Braback L et coll Atopic sensitization and respiratory symptoms among Polish and Swedish school children.
   Clin Exp Allergy. 1994 Sep;24(9):826-35.
   Braback L, Breborowicz A, Dreborg S, Knutsson A, Pieklik H, Bjorksten B.
   Department of Paediatrics, Sundsvall Hospital, Sweden.
   Allergic sensitization and symptoms from the airways in relation to air pollution were compared in 10-12-year-old school children (n = 1113) from urban Konin in central Poland and both urban and rural parts of Sundsvall in northern Sweden. The measurements included parental questionnaires, skin-prick tests and serial peak flow measurements during 2 weeks with simultaneous monitoring of outdoor air pollutants. The skin-prick test technique was validated by IgE antibody determinations. The levels of common industrial pollutants, SO2 and smoke particles were much higher in Konin than in urban Sundsvall and the levels of NO2 were similar. Various respiratory symptoms were more often reported among school children in Konin (except for wheezing and diagnosed asthma). Multiple logistic regression analyses yielded the following increased odds ratios for children in Konin as compared with the reference group (rural Sundsvall): chest tightness and breathlessness 3.48 (95% confidence interval 2.08-5.82), exercise-induced coughing attacks 3.69 (95% confidence interval 1.68-8.10), recurrent episodes of common cold 2.79 (95% confidence interval 1.53-5.09) and prolonged cough 4.89 (95% confidence interval 2.59-9.23). In contrast, as compared with rural Sundsvall, the adjusted odds ratio for a positive skin-prick test was decreased in Konin, but increased in urban Sundsvall, 0.58 (95% confidence interval 0.37-0.91) and 1.67 (95% confidence interval 1.15-2.42) respectively. The study confirms that living in urban, as compared with rural areas, is associated with an increased prevalence of respiratory symptoms and sensitization to allergens. These differences could be explained by air pollution. Respiratory symptoms were more common in a similar urban group of Polish children who were exposed to even higher levels of air pollution. These children, however, had a much lower prevalence of sensitization to allergens, as compared with the Swedish children. This indicates that differences in lifestyle and standard of living between western Europe and a former socialist country influences the prevalence of atopy.
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6. De Blay F et coll. Éviction des allergènes : intérêts et limites. Rev fr Allergol Immunol Clin 2000; 40 : 367-71.
   Rev Mal Respir. 2000 Feb;17(1):29-39.
   [Elimination of airborne allergens from the household environment]
   http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10756554
   de Blay F, Casel S, Colas F, Spirlet F, Pauli G.

7. Déchamp C et coll. Nouveau cadre législatif de la pollution de l’air, nécessité de prise en compte de la pollution biologique de l’air par le pollen d’ambroisie. Rev fr Allergol 1998; 38 : 689-92.

8. Demoly P. Gènes de l’allergie respiratoire.
   Rev Pneumol Clin. 2003 Apr;59(2 Pt 1):67-75 [Respiratory allergic disease genes]
   Demoly P.
   Service des Maladies Respiratoires, INSERM U 454-IFR3, Hopital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier Cedex 5. demoly@montp.inserm.fr
   Asthma and atopy are polygenic diseases with an hereditary and an environmental component. Improvement in statistical and molecular tools has enabled the localization of a dozen chromosome regions bearing susceptibility genes: 1p32-34, 3q21, 5q31-33, 6p21-23, 11p15, 11q13, 12q14-24, 13q14-qter, 14q11, 17q11-21, 19q13 and 20p13. There are many candidate genes, particular the cluster of interleukin-4 genes (5q31-33), the major histocompatibility complex genes HLA D and the TNFalpha gene (6p21-23), the gene of the receptor B chain with strong affinity for IgE (11q13), the interferon-gamma gene (12q15-24), the genes of the alpha/gamma chains of the T receptor (14q11), the IL4 receptor gene (16p12), and the metalloprotease gene ADAM33 (20p13). Research will continue to define these genes more precisely or to recognize others and to apply this knowledge to therapeutic and diagnostic applications.
   PMID: 12843991 [PubMed - indexed for MEDLINE]

9. Demoly P et coll. Infections respiratoires et asthme. Ed. Léophonte P, Mouton Y. Repères sur les infections bronchopulmonaires. PIL, Paris 2001: p87-94.

10. Demoly P, Demoly MP. Peut-on prévenir l’allergie
    Eds. Arnaud Farnel, Paris 2001.
      

11. Demoly P et coll. ERASM, a pharmacoepidemiologic survey on management of intermittent allergic rhinitis in every day general medical practice in France. .
    Allergy. 2002 Jun;57(6):546-54.
    Demoly P, Allaert FA, Lecasble M; PRAGMA.
    Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, CHU de Montpellier, France.
    BACKGROUND: The actual management of intermittent allergic rhinitis is still little known about, despite the disease being very prevalent. We used a cross-sectional survey to address this issue in everyday general medical practice in France. METHODS: A total of 1321 general practitioners enrolled 3026 patients consulting for a spring exacerbation of allergic rhinitis. Both doctors and patients filled out a specific questionnaire on allergic rhinitis. RESULTS: These patients consulted their doctor two-and-a-half weeks, on average, after the onset of their symptoms. They were bothered for an average of six days per week (5.9 +/- 1.7 days) and for two months per year (8.7 +/- 7.7 weeks) by symptoms which largely exceed the ENT (ear, nose and throat) field, with ocular symptoms (51.7%), pharyngeal irritation (39.0%), cough (30.8%), or respiratory discomfort (17.9%). Of these patients 79.2% had some impairment of their professional life and 91.8% of their daily life. Fifty percent of patients knew to what allergens they were allergic; only 11.1% had additional laboratory tests and 10.3% had subsequent specialist consultation (for most this was with an allergologist). Prescribed drugs were oral antihistamines (92.4%) and nasal glucocorticosteroids (45.2%). Prescriptions were written for a duration of six weeks on average. Seventy-nine percent of patients considered that the information they had received was adequate and easy to understand, but 58.2% of patients would have liked more advice. Furthermore, only 54.7% followed their doctor's prescription scrupulously, and 44% used frequent self-medication. CONCLUSIONS: Intermittent allergic rhinitis is a real health problem because of its increasing prevalence, the induction of impaired quality of life and loss of performance, especially at work. General practitioners play a major role in this disorder; they make the diagnosis, start the treatment, give the relevant information, and monitor most of the patients.
    PMID: 12028122 [PubMed - indexed for MEDLINE]

12. Demoly P, Bousquet J. La rhinite allergique. John Libbey Eurotext, Paris 2002.

13. Demoly P, Portales-Casamar S. CDRom Encyclopédique d’Allergologie. RESIP 2002.

14. Devalia JL et coll. Effect of nitrogen dioxide on synthesis of inflammatory cytokines expressed by human bronchial epithelial cells in vitro.
    Am J Respir Cell Mol Biol. 1993 Sep;9(3):271-8.
    Devalia JL, Campbell AM, Sapsford RJ, Rusznak C, Quint D, Godard P, Bousquet J, Davies RJ.
    Department of Respiratory Medicine, St. Bartholomew's Hospital, London, United Kingdom.
    Although studies of nitrogen dioxide (NO2) inhalation, in both animals and humans, have demonstrated that this agent can cause epithelial cell damage and inflammation of the airway epithelium, the mechanisms underlying these effects are not well understood. We have cultured human bronchial epithelial cells, as explant cultures from surgical tissue, and studied these firstly from their ability to constitutively synthesize specific proinflammatory cytokines and then investigated the effect of exposure to NO2 on the generation of these cytokines. Constitutive synthesis of cytokines was evaluated by analysis of both the expression of the mRNA for interleukin (IL)-1 beta, IL-4, IL-8, granulocyte/macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma), by the polymerase chain reaction (PCR), and by immunocytochemical staining for the presence of cell-associated IL-1 beta, IL-8, GM-CSF, TNF-alpha, and IFN-gamma, using specific monoclonal and polyclonal antibodies directed towards these cytokines. Release of IL-4, IL-8, GM-CSF, TNF-alpha, and IFN-gamma following exposure to 5% CO2 in air or 400 ppb and 800 ppb NO2 for 6 h was investigated by enzyme-linked immunosorbent assay. PCR demonstrated that the human bronchial epithelial cells expressed the mRNA for IL-1 beta, IL-8, GM-CSF, and TNF-alpha but not for IL-4 and IFN-gamma. Immunocytochemical staining confirmed the presence of endogenous IL-1 beta, IL-8, GM-CSF, and TNF-alpha.(ABSTRACT TRUNCATED AT 250 WORDS)
    PMID: 8398164 [PubMed - indexed for MEDLINE]

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    Référence: 583489 ISBN 2-225-83489-X Nb. de pages: 328 pages

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OUVRAGES MEDI-TEXT Editions

Collection Sabinus Santé

• Asthme : savoir utile ! Dr Sergio SALMERON
• Cancer du sein : savoir utile ! Pr Jacques ROUËSSÉ, Dr Étienne BRAIN, Dr Frédérique CVITKOVIC
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Collection P’tits boudoux & Santé

• Les œufs n'aiment pas Margaux (Margaux a une allergie alimentaire) Dr Martine HERVÉ-GUILLOT, Dr Nadia LAHLOU
• Des nuits sèches pour Victor (Victor fait pipi au lit) Dr Henri LOTTMANN, Dr Nadia LAHLOU  

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