title: Peanut-allergic patients in the MIRABEL survey: characteristics, allergists' dietary advice and lessons from real life.
abstract: BACKGROUND
  The MIRABEL survey is an observational study on peanut allergy in France, Belgium and Luxemburg. The objectives are to provide data on a large population, to analyse the consumer behaviour, to study the presence of peanut traces in pre-packed foods with/without precautionary allergen labelling (PAL), and to combine these data to quantify allergic risk and produce a cost/benefit analysis. This paper reports a real-life observatory of 785 patients (< 16y: 86%): medical characteristics, eliciting doses (ED) in real life and in oral food challenges (OFC), factors associated with severe reactions, allergist dietary advice and patients' anxiety regarding their allergy.
  
  
  METHODS
  Age and symptoms at diagnosis, route of exposure, comorbidities, allergy tests, ED (OFC/real life; mg peanut protein), dietary advice about PAL, and anxiety score were recorded.
  
  
  RESULTS
  Median age was 3 years; 85% were declared allergic. Severe/potentially severe reactions were reported in 30% of the allergic patients: serious systemic reaction (15%), laryngeal angioedema (8%), shock (4%) and acute asthma (3%); 66% had atopic dermatitis, 58% asthma. Median ara h 2 sIgE level was 11.5 kUA/L. Of the 278 OFCs, 225 were positive (median ED: 67.3 mg). Real-life ED was < 100 mg in 44.3%. Severe reactions were significantly more frequent in teenagers and adults (P = 0.004), asthmatic patients (P = 0.033), and patients who reacted to inhalation (P < 0.001). No significant association was found for OFC ED or ara h 2 sIgE. Factors associated with strict avoidance advice including PAL were OFC ED < 100 mg (P < 0.001), but not severe reaction history (P = 0.051) or asthma (P = 0.34). Anxiety was significantly associated with strict avoidance (P < 0.001).
  
  
  CONCLUSIONS
  Severe/potentially severe reactions, allergic comorbidities, and low EDs in real life are frequent in peanut-allergic patients. Asthma, teenage/adulthood and reaction to inhalation are associated with severe symptoms. PAL and criteria guiding dietary advice need to be improved.
authors.affiliation: CHU Lille, Pediatric Pulmonology and Allergy Department, hôpital Jeanne de Flandre, Lille, France.|Allergy Vigilance Network, Vandoeuvre les Nancy, France.
authors.forename: A
authors.initials: A
authors.lastname: Deschildre
authors.affiliation: Risk Assessment Department (DER), French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France.|French National Institute for Agricultural Research (INRA), Paris Institute of Technology for Life, Food and Environmental Sciences (AgroParisTech), UMR Economie Publique INRA-AgroParisTech, Paris, France.
authors.forename: C F
authors.initials: CF
authors.lastname: Elegbédé
authors.affiliation: Allergy Vigilance Network, Vandoeuvre les Nancy, France.|Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau, APHP; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Just
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman, Liège, Belgium.
authors.forename: O
authors.initials: O
authors.lastname: Bruyère
authors.affiliation: Allergy Vigilance Network, Vandoeuvre les Nancy, France.|Allergopôle, Clinique Saint-Luc, Bouge (Namur), Belgium.
authors.forename: X
authors.initials: X
authors.lastname: Van der Brempt
authors.affiliation: Risk Assessment Department (DER), French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France.
authors.forename: A
authors.initials: A
authors.lastname: Papadopoulos
authors.affiliation: Allergy Vigilance Network, Vandoeuvre les Nancy, France.|Allergy Department, Centre Hospitalier E Durkheïm, Epinal, France.
authors.forename: E
authors.initials: E
authors.lastname: Beaudouin
authors.affiliation: Allergy Vigilance Network, Vandoeuvre les Nancy, France.|Allergy Department, Centre Hospitalier E Durkheïm, Epinal, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Renaudin
authors.affiliation: Risk Assessment Department (DER), French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France.
authors.forename: A
authors.initials: A
authors.lastname: Crepet
authors.affiliation: Allergy Vigilance Network, Vandoeuvre les Nancy, France.|Allergy Department, Centre Hospitalier E Durkheïm, Epinal, France.|Lorraine University, Nancy, France.
authors.forename: D-A
authors.initials: DA
authors.lastname: Moneret-Vautrin
mesh_terms: D000293:Adolescent; D001530:Belgium / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003888:Desensitization, Immunologic; D004032:Diet; D037001:Directive Counseling; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008189:Luxembourg / Q000453:epidemiology; D008297:Male; D021183:Peanut Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011159:Population Surveillance; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D007073:Immunoglobulin E
keywords: diet; peanut allergy; real life; risk factor; severe reactions