Bovine serum albumin immunization: a new risk of allergy during protocols for in vitro fertilization

Three patients having undergone protocols for in vitro fertilization (IVF) showed an allergic reaction suggesting seric disease 6 to 10 days after follicle aspiration. The responsibility of bovine serum albumin, present in the follicle-rinsing fluid and in the medium used for embryo culture was suspected. An immunological study was carried out, using two groups for comparison. Group 1: 7 controls. Group 2: 11 women having undergone IVF protocols without incident. Anti-BSA antibodies were present in low quantities in one or two subclasses of IgG and IgA in Group 1, and in several subclasses at higher levels in nine of 11 subjects from Group 2. The IgG4 response predominated 7 times out of 9. The antibody content gradually fell after the IVF attempt. An immune response predominated in the IgG1 in two patients. Skin test for the two fluids and BSA were positive only in the three patients. These results show the frequency of immunization to BSA induced through the ovarian and peritoneal pathways. Seric disease corresponds to a rise in IgG1. The association of a IgE-dependent sensitization is suspected. The authors suggest the possibility of an interference of these immune processes with implantation and propose the elimination of heterologous proteins from fluids. They also suggest that LH-RH analogues facilitate immune responses.     

Anesthetics responsible for anaphylactic shock. A French multicenter study

Combined allergological and anaesthetic consultations have been started in the last few years in eight French Teaching Hospitals so as to explore peranaesthetic anaphylactoid shocks. A survey was carried out in these centers in order to collect patients investigated with the same protocol, for the assessment of the incidence of anaphylaxis in France, as well as the involved drugs. Investigations were always carried out at least 6 to 8 weeks after the accident. The tests used to diagnose IgE-dependent anaphylaxis were skin tests (prick and intradermal tests, carried out in all eight centers), the radioimmunological assay of specific anti-quaternary ammonium IgE, together with an inhibition test with thiopentone and propofol (six centers), leukocyte histamine release (five centers) and human basophil degranulation tests (three centers) for those drugs for which no specific antibody assay exists. The collected data involved 1,240 patients, investigated within the last four years. Anaphylaxis was diagnosed in 821 patients (66.2%). Muscle relaxants were responsible in 668 cases (80% of cases of anaphylaxis). Suxamethonium was the main cause (54.3% of shocks due to muscle relaxants), followed by vecuronium (15.3%). General anaesthetics (hypnotics and benzodiazepines) were responsible for 9.2% of all cases of anaphylaxis opioids for 2.6%. There were only three cases of shock due to local anaesthetic agents. Latex and ethylene oxide are becoming increasingly involved. It would therefore seem mandatory to carry out after any anaphylactoid accident an assessment with sensitive and specific tests for anaphylaxis. Diagnosing anaphylaxis means that the involved drug should be used never again in that patient. Because muscle relaxants are by far the most involved drugs, anaesthetists should use them only when really required.     

Food allergies

Generally, environmental allergens are basically considered to include airborne allergens. Food however is an endogenous microenvironment which just as important, if not more so. This environment has undergone considerable modification over the past 30 years with the growing diversity of food proteins and by modifications of natural allergens related to techniques employed by the food and agriculture industry. These techniques can exacerbate the allergenecy properties of food or develop new allergens.     

Prevalence of peanut sensitization in a population of 4,737 subjects--an Allergo-Vigilance Network enquiry carried out in 2002

A total of 4,737 people consulting allergologists were routinely tested for peanut sensitization. The study involved 84 allergologists in the Allergo-Vigilance Network over a period of 30-60 consecutive days. Investigation procedures were identical. Results classified subjects into four groups according to the clinical history and prick-tests to common inhalants: group 1: subjects suspected of having a food allergy; group 2: subjects with ongoing atopic disease; group 3: subjects with an underlying predisposition to atopy, as showed by one or more positive results to prick-tests with airborne allergens; group 4: non atopic subjects. The sensitization rates were 22.7%, 8.7%, 4%, and 0.4% respectively. Assuming that 25% of the French population is allergic the rate of sensitization to peanut in the general population should be between 1% and 2.5%. Considering a ratio of 3.3 between sensitization and clinical allergy as plausible, the prevalence of peanut allergy could be 0.3% to 0.75% of the French population. This figure is lower than that for the UK, the US and Canada (0.8% to 1.5%). The correlation between the data in this study and those from previous epidemiological studies validates the methodology used in this type of enquiry. One of the aims of the Allergo-Vigilance Network set up in 2001 is to collect data from a large number of people. We present here the results of a study carried out in 2002 by 84 allergologists in the Allergo-Vigilance Network. The primary aim was to assess the prevalence of peanut sensitization in the French population seeking treatment for various allergic disorders. The second objective was to determine whether there was any difference in risk of peanut sensitization in people with ongoing atopic disease, in those with an underlying predisposition to atopy (shown by positive prick-tests) and finally in non atopic people.