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L'allergie Aux Piqûres De Moustiques Existe-T-Elle ?

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L'allergie Aux Piqûres De Moustiques Existe-T-Elle ? réalités pédiatriques 199_Février/Mars 2016 Revues générales Allergologie réalités pédiatriques # 199_Février/Mars 2016 Revues générales Allergologie L’allergie aux piqûres de moustiques existe-t-elle ? RÉSUMÉ : Une réaction locale (douleur, papule, érythème, prurit) est normale après une piqûre de moustique. Les jeunes enfants n’ayant pas encore acquis une tolérance naturelle sont les plus sensibles. En France, les réactions graves, systémiques, sont rares, mais la survenue d’une anaphylaxie doit faire rechercher une mastocytose. La conduite à tenir varie selon les spécialistes. Certains allergologues considèrent qu’en l’absence de réactions systémiques, une allergie IgE-dépendante peut être exclue, tandis que d’autres réalisent des tests cutanés et envisagent une allergie IgE-dépendante si ceux-ci sont positifs. Si le test cutané est positif, un anti-H1, une corticothérapie locale, des désinfectants sont indiqués. Le plus souvent, il n’y a pas d’indication à entreprendre une ITS, car les extraits sont mal standardisés ; mais certains ont obtenus de bons résultats avec les extraits actuels, en particulier sublinguaux. L’obtention d’allergènes de meilleure qualité pour le diagnostic et l’ITS est de nature à faire évoluer les indications de l’ITS. es moustiques ont un impact recombinants, ont relancé l’intérêt des médical important, car ils trans- allergologues pour la prise en charge mettent des maladies fréquentes de ces réactions. En effet, les allergolo- Let graves, en particulier le paludisme gues et les pédiatres sont de plus en plus et plusieurs arboviroses (fièvre jaune et souvent consultés pour des réactions dengue). L’objectif de cette revue est de cutanées gênantes, prurigineuses et répondre à la question souvent posée multiples, en particulier chez les jeunes aux médecins : “l’allergie aux mous- enfants et les personnes sensibles [1]. tiques existe-t-elle ?”. Leurs piqûres peuvent provoquer des réactions de type allergique habituellement bien Taxonomie moins sévères – donc moins étudiées [[ et moins connues – que celles qu’in- Les moustiques (angl. : mosquito), ou duisent les piqûres d’hyménoptères culicidés, sont une famille d’insectes ➞➞G. DUTAU (abeilles, guêpes, taons). La validité des classés dans l’ordre des diptères et le Allergologue – Pneumologue – Pédiatre extraits de corps totaux de moustiques sous-ordre des nématocères. Ils sont actuellement disponibles pour le dia- présents sur l’ensemble des terres émer- gnostic et l’ITS est discutée. gées de la planète (sauf l’Antarctique), dans les milieux forestiers, les savanes, Toutefois, des travaux récents concer- les zones urbaines, dès qu’une surface nant l’histoire naturelle de la sensibi- d’eau douce ou saumâtre est disponible, lisation, l’identification, une meilleure même peu abondante ou temporaire. connaissance des allergènes des mous- Ils sont abondants dans les régions tiques et la mise au point d’allergènes chaudes où ils se reproduisent en toutes 31 réalités pédiatriques # 199_Février/Mars 2016 Revues générales Allergologie saisons, mais ils ne sont pas rares dans les régions froides et tempérées où ils apparaissent pendant l’été. La classification de Schiner1 divise l’ordre des diptères en trois sous-ordres : les nématocères, qui comportent la familles des culicidés (moustiques), les brachycères qui comprend la famille des muscinés (mouches) et les orthoraphes dont les deux principales familles sont les tabanidés (taons) et des œstridés. Au sein des nématocères, on Fig. 1 : Différences concernant le prélèvement sanguin entre les insectes solénophages (moustiques) et telmophages (simulies). À gauche : le moustique prélève le sang directement dans un capillaire. À droite : la trouve les culicidés (Culex, Anopheles, simulie dilacère le derme avec création, ce qui entraîne la formation d’un lac sanguin où se fait le prélève- Stegomyia, Ædes, Phlebotomus) et ment (avec permission de l’auteur [1]). d’autres familles : simulidés (Silulium), tipulidés (Tipula), blépharocéridés, Le moustique-tigre (Ædes albopictus, face de l’eau, même dans les petites cécidomyidés (Miastor), chironomidés actuellement Stegomyia albopicta), ori- flaques, des récipients comme les (Chironomus spp., vers de vase), etc. ginaire d’Asie du Sud-Est, est l’espèce cache-pots, etc. Les larves éclosent la plus invasive dans le monde, présent au bout de 2 jours, respirant l’air exté- Les culicidés comportent de nom- dans 100 pays sur les cinq continents. rieur par leurs stigmates abdominaux. breuses espèces de moustiques qui pos- Il est vecteur du virus du chikungunya, Dépourvues de pates, leur extrémité sèdent les caractéristiques suivantes : de la dengue et, en zone tropicale, d’une céphalique est nette avec des yeux, antennes longues et fines à multiples trentaine de viroses dont l’encéphalite des antennes et des pièces buccales. articles ; ailes à écailles ; mâles à régime de Saint-Louis (États-Unis), proche de Au bout de 2 à 3 semaines, les larves végétarien se nourrissant surtout du l’encéphalite japonaise. deviennent des nymphes comme les nectar des fleurs ; femelles munies de chrysalides des papillons, ne se nour- longues pièces buccales en forme de Le moustique commun, Culex pipiens, rissant plus, immobiles à la surface de trompe rigide de type piqueur-suceur2 ne transmet pas de maladie. Il est res- l’eau. L’individu adulte sort alors de la (fig. 1). Ainsi constituées, les femelles ponsable d’une douleur au moment de chrysalide et s’envole3. piquent la peau de l’Homme et des la piqûre puis d’un petit érythème avec autres mammifères pour aspirer le papule et prurit responsable de grattage. sang nécessaire afin de nourrir leurs Certains individus – en particulier les Épidémiologie[et[ œufs. Dans le monde, on dénombre jeunes enfants (mais pas seulement) – facteurs[de[risque 3 543 espèces de moustiques réparties non encore devenus tolérants (désensibi- [[[ en 111 genres, toutes n’ayant pas la capa- lisés) à la suite de plusieurs piqûres, sont Une requête sur PubMed avec l’item cité de piquer l’homme ; 65 espèces sont gênés par l’importance des réactions “mosquito allergy” fournit 607 réfé- référencées en France métropolitaine. (locales étendues, régionales, multiples, rences, avec une augmentation du parfois systémiques). Les piqûres sont nombre des publications au cours des L’espèce de référence des culicidés est généralement multiples, influencées par 5 à 10 dernières années. Ædes (Stegomyia) ægypti L. (anophèle). divers facteurs (parfums, odeurs, cycle Certains moustiques transmettent des menstruel, fin de journée et nuit, temps 1. Quelques données maladies graves : paludisme (ano- chaud et orageux, etc.) épidémiologiques phèles), fièvre jaune (Stegomyia calo- pus), dengue (Ædes spp. dont Ædes Tous les moustiques (Culex spp., ano- La prévalence de l’allergie aux piqûres albopictus). phèles, Ædes spp.) pondent à la sur- de moustiques est mal connue bien que 1 http://www.cosmovisions.com/dipteres_classification.htm (consulté le 5 avril 2015). 2 La trompe du moustique femelle comporte : une gaine formée par la lèvre inférieure en forme de gouttière contenant 5 stylets (deux mandi- bules, deux mâchoires, un hypopharynx) ; une aiguille effilée, rigide et creuse (lèvre supérieure) occupant les bords de la gaine, qui communique directement avec I’œsophage et s’enfonce dans la peau en même temps que les stylets. 3 http://www.cosmovisions.com/dipteres_classification.htm (consulté le 5 avril 2015). 32 réalités pédiatriques # 199_Février/Mars 2016 les réactions de type allergique soient Réaction immédiate Réaction tardive fréquentes. Stade I 0 0 >>> Parmi 1 059 adultes vivant dans une (absence de sensibilisation) zone infestée de moustiques, Peng et al. Stade II 0 + [2] ont enregistré un pourcentage de 18 % de sensibilisations IgE-dépendantes à Stade III + + la salive de moustique. Les individus Stade IV + 0 susceptibles de présenter le plus sou- vent des réactions fréquentes et sévères Stade V (tolérance) 0 0 étaient : les employés civils et militaires non autochtones travaillant à l’extérieur Tableau I : Évolution naturelle des réactions allergiques cutanées aux piqûres de moustiques (avec permission de l’auteur [1]). dans les zones infestées par les mous- tiques ; les jeunes enfants ne bénéficiant importantes et surtout systémiques, dase. Cette allergie croisée constituerait pas ou peu d’une immunoprotection à type d’urticaire ou d’angiœdème. un terrain à risque de réactions sévères. maternelle. L’espèce Ædes albifasciatus est la plus commune en Argentine. >>> En Finlande, Brummer-Korvenkontio Symptômes[et[diagnostic et al. [3] ont constaté que la majorité Chez des individus jeunes, âgés de [[ des enfants présentaient des réactions moins de 20 ans, Tokura et al. [7] ont Les réactions aux piqûres de mous- locales immédiates et/ou retardées aux décrit sous le vocable “HMB-EBV-NK tiques sont habituellement locales, piqûres d’Ædes spp., que leurs réactions syndrome” une maladie associant : immédiates ou tardives, parfois sys- survenaient tôt dans l’enfance, puisqu’ils – une hypersensibilité aux piqûres de témiques. Les réactions allergiques devenaient ensuite rapidement tolérants moustiques (Hypersensitivity to mos- sont le plus souvent à la fois de type I (tableau I). En revanche, les enfants quito bites [HMB]) ; (IgE-dépendantes) et IV (à médiation islandais, vivant dans un pays dépourvu – des lésions cutanées bulleuses ou cellulaire) [1]. de moustiques hématophages, n’avaient nécrotiques ; pas d’anticorps contre la salive des – un syndrome lymphoprolifératif à 1. Réactions locales
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