According to the authors, the article by Zopf and colleagues reflects the current state of knowledge about food intolerances on the basis of national guidelines and recognized databases. However, in many aspects the article does not reflect allergological guidelines or current knowledge. One example is the whole area of non-immunologically mediated food intolerances (non-allergic food intolerances): the authors include in this category intolerances with extremely varied underlying pathomechanisms and report an overall prevalence of 15–20%. The summary does not reflect the current terminology used by the European Academy of Allergy and Clinical Immunology (EAACI) and implicates a wrong impression for readers with regard to the clinical relevance of the listed intolerances.


Although the reported prevalence of 15% for lactose intolerance is correct, the prevalence of intolerances to additives is much lower, at less than 1%. Individual additives are even less clinically relevant.


Intolerance to salicylates has not been confirmed for ingestion via food but primarily after administration as a medical drug (for example, in ASS intolerance).


The so called histamine intolerance is attributed to a deficiency of the histamine-degrading enzymes diaminoxidase (DAO) and, possibly, histamine-N-methyltransferase (HNMT). Such deficiencies have been reported in the literature in individual cases, but it is not known whether symptoms after oral ingestion of small amounts of histamine are caused by such animpaired histamine breakdown. A pathology with a genetic enzyme deficiency of diaminoxidase, such as is reported in Table 1, has not been confirmed.

/pdf/correspondence-letter-to-the-editor-clinical-relevance-456xryh1qf.pdf

Correspondence (letter to the editor): Clinical Relevance

Anti-NMDA receptor encephalitis. The disorder, the diagnosis and the immunobiology.

Catatonia and the immune system: a review

Objective: To precisely describe the initial psychiatric presentation of patients with anti-NMDA receptor (NMDAR) antibodies encephalitis (anti-NMDAR encephalitis) to identify potential clues enhancing its early diagnosis. Methods: We retrospectively studied the French Reference Centre medical records of every adult patient with anti-NMDAR encephalitis to specify the patients9 initial psychiatric symptoms leading to hospitalization in a psychiatric department and the reasons underlying the diagnosis of anti-NMDAR encephalitis. Results: The medical records of 111 adult patients were reviewed. Psychiatric features were the initial presentation in 65 patients (59%). Among them, several psychiatric manifestations were observed, including visual and auditory hallucinations (n = 26, 40%), depression (n = 15, 23%), mania (n = 5, 8%), acute schizoaffective episode (n = 15, 23%), and eating disorder or addiction (n = 4; 6%). Forty-five patients (40% of total cohort) were first hospitalized in a psychiatric institution (91% women), with a median duration of stay of 9 days (range 0.25–239 days). Among them, 24 patients (53%) had associated discreet neurologic signs at the first evaluation, while 17 additional patients (38%) developed neurologic signs within a few days. Twenty-one patients (47%) were transferred to a medical unit for a suspicion of antipsychotic intolerance characterized by high temperature, muscle rigidity, mutism or coma, and biological results suggesting rhabdomyolysis. Conclusions: Several psychiatric presentations were observed in patients with anti-NMDAR encephalitis, although none was specific; however, patients, mostly women, also had discreet neurologic signs that should be carefully assessed as well as signs of antipsychotic intolerance that should raise suspicion for anti-NMDAR encephalitis.

https://nn.neurology.org/content/nnn/3/5/e280.full.pdf

Neuroleptic intolerance in patients with anti-NMDAR encephalitis

Background: Juvenile Huntington disease (JHD) is a rare clinical entity characterized by an age at onset younger than 20 years. Patients usually have an expansion of more than 60 CAG repeats in the Huntington disease (HD) gene, and the disease is usually inherited from the father. In general, precise age at onset is difficult to assess in HD because of insidious onset and anosognosia. Onset of motor difficulty signs is usually used to define age at onset. Objectives: To evaluate diagnosis delay in patients with JHD and to analyze the clinical and genetic features of JHD. Design: Retrospective clinical and genetic review. Setting: Referral center for HD at Salpetriere Hospital, Paris, France. Patients: Twenty-nine patients with HD with onset before or at age 20 years who carried an abnormal CAG repeat expansion in the HD gene. Results: The mean ± SD delay before diagnosis was 9 ± 6 years (range, 0-21 years). The most remarkable signs at onset were severe psychiatric and cognitive disturbances (19 of 29 [65.5%]); rigidity was absent. Unusual signs at onset included myoclonic head tremor in 3 patients, severe isolated drug or alcohol addiction in 2, psychotic disorder in 1, and difficulty writing in 1. One patient had progressive cerebellar signs associated with cerebellar atrophy on cerebral magnetic resonance imaging before signs suggestive of HD appeared. During the course of the disease, psychiatric disturbances were severe, with at least 1 suicide attempt in 7 of 29 patients. Transmission was maternal in 25% of patients. Forty-six percent of patients withJHD had fewer than 60 CAG repeats; 6 of these patients inherited the disease from their father. Anticipation (mean±SD, 18±9 vs 25±11 years; P=.27) and age at onset (mean±SD, 17.14±2.2 vs 13.29±5.5 years; P=.09) was similar in patients with maternal compared with paternal transmission, respectively. Conclusions: Patients with JHD started showing disease symptoms through nonspecific features, mostly psychiatric and cognitive difficulties. This led to misdiagnosis or diagnosis delay, especially in cases without a familial history of HD. Maternal transmissions and expansions of fewer than 60 CAG repeats were unexpectedly frequent in this series and should not be considered exceptional.

Psychiatric and cognitive difficulties as indicators of juvenile huntington disease onset in 29 patients : A matter of perspective. Commentary

http://speapsl.aphp.fr/pdfpublications/2012/2012-22.pdf

Medical and developmental risk factors of catatonia in children and adolescents: A prospective case–control study

Anti-NMDA-Receptor encephalitis is a severe form of encephalitis that was recently identified in the context of acute neuropsychiatric presentation. Here, we describe the case of a 17-year-old girl referred for an acute mania with psychotic features and a clinical picture deteriorated to a catatonic state. Positive diagnosis of anti-NMDA-receptor encephalitis suggested specific treatment. She improved after plasma exchange and immunosuppressive therapy. Post-cognitive sequelae (memory impairment) disappeared within 2-year follow-up and intensive cognitive rehabilitation.

/pdf/malignant-catatonia-due-to-anti-nmda-receptor-encephalitis-126lt7mpuf.pdf

Malignant catatonia due to anti-NMDA-receptor encephalitis in a 17-year-old girl: case report

Catatonia is an infrequent but severe condition in young people. Organic diseases may be associated and need to be investigated though no specific recommendations and guidelines are available. We extensively reviewed the literature of all the cases of organic catatonia in children and adolescents from January 1969 to June 2007. We screened socio-demographic characteristics, organic diagnosis, clinical characteristics and treatment. We found 38 cases of children and adolescents with catatonia due to an organic condition. The catatonic syndrome occurred in 21 (57%) females and 16 (43%) males. The mean age of patients was 14.5 years (+/-3.39) [range=7-18 years], and three died from their condition. The organic conditions included infectious diseases (N=10), neurological conditions (N=10), toxic induced states (N=12) and genetic conditions including inborn errors of metabolism (N=6). The onset was dominantly acute, and the clinical presentation most frequently stuporous. Although benzodiazepines were recommended as primary symptomatic treatment, they were rarely prescribed. In several cases, therapeutic approach was related to organic cause (e.g., plasma exchange in lupus erythematosus; copper chelators in Wilson's disease). Based on this review and on our own experience of catatonia in youth, we proposed a consensual and multidisciplinary diagnostic strategy to help practitioners to identify underlying organic diseases.

/pdf/multidisciplinary-approach-of-organic-catatonia-in-children-4cv9wpiobv.pdf

Isabelle An-Gourfinkel

Papers

Medical and developmental risk factors of catatonia in children and adolescents: A prospective case–control study

Malignant catatonia due to anti-NMDA-receptor encephalitis in a 17-year-old girl: case report

Multidisciplinary approach of organic catatonia in children and adolescents may improve treatment decision making.