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Allergies et risques liés aux plantes

Euphorbia characias (D.Lejeune)Les allergies, dont la prévalence augmente depuis plusieurs années, touchent actuellement environ un quart de la population, ce qui explique que cette notion soit familière à beaucoup. Quelles sont les plantes en cause ?


Les réactions allergiques

L’allergie est une réponse à un contact avec quelque chose d’a priori totalement inoffensif, comme les pollens, par exemple. Pourquoi réagit-on, parfois sévèrement, à quelque chose qui ne nous menace pas ? Le système immunitaire reconnaît en fait le soi et le non-soi ; l’allergie est une réponse immunitaire un peu particulière à du « non-soi ».
En réponse aux antigènes (substances étrangères qui provoquent une réaction immunitaire), le système immunitaire « normal » maintient l’intégrité de notre organisme par divers moyens :
- par des cellules : c’est l’immunité cellulaire (phagocytose, cytokines...)
- par des sécrétions : c’est l’immunité humorale, faisant intervenir les anticorps. Le dysfonctionnement immunitaire qu’est l’allergie se calque sur ce schéma. On pourra avoir des allergies médiées par les cellules, le contact entre certaines molécules et la peau se soldant par une réaction inflammatoire particulière : les dermites de contact, en général causées par de petites molécules (haptènes) et qui surviennent avec un certain délai (en général 12 à 48 h) après le contact. On parle de mécanisme retardé.
À côté des allergies à médiation cellulaire, on peut avoir un autre type d’allergie, en réponse à des protéines, de mécanisme immédiat, par le biais d’anticorps particuliers, les anticorps allergiques qui sont des IgE (Immunoglobulines de type E). Ces IgE sont produites, comme les anticorps « normaux », en réponse à une protéine étrangère. La réaction antigène-anticorps, qui aboutit à l’élimination de la substance étrangère dans le cas d’une réponse non allergique, aboutit, pour l’allergique, à une réaction inflammatoire tissulaire (peau, muqueuses) générant un certain nombre de symptômes. Plus la personne allergique est exposée, plus elle fabrique d’anticorps, et plus elle réagit vite et violemment à chaque nouveau contact. Les tableaux cliniques correspondant à ce mécanisme incluent la rhinite, l’asthme, la conjonctivite et certaines urticaires.

Les plantes en cause


Eczéma de contact

La plupart des troubles cutanés survenant au contact des plantes ne relèvent pas de l’allergie, mais d’un mécanisme irritatif ou toxique. Néanmoins, un certain nombre de plantes sont à l’origine d’authentiques allergies de contact. D’aspect variable, avec une tendance à l’extension des lésions à partir de la zone de contact, il peut aussi simuler une banale irritation. Les mains sont évidemment souvent touchées, mais il y a aussi des formes aéroportées, pouvant atteindre les zones découvertes, sans respect des zones photo-protégées (sous le menton, derrière les oreilles, sous le nez et les arcades sourcilières). Dans les photo-allergies aux végétaux, les lésions concerneront les zones cutanées exposées à la fois aux végétaux et au rayonnement ultraviolet.

Les Astéracées
C’est la première cause d’allergie de contact en Europe (selon Paulsen, 2002) surtout par les plantes ornementales (chrysanthèmes, marguerites et tournesols). Des plantes comestibles peuvent aussi être en cause, comme l’artichaut, la laitue, les scaroles, l’endive… Les adventices sont plus rarement concernées (Artemisia, Ambrosia, Arnica, Achillea, Taraxacum, Inula…)
Les allergènes responsables sont des lactones sesquiterpéniques, présentes principalement dans les poils glandulaires ou trichomes sous les feuilles et dans les têtes florales. Les lésions observées sont fréquemment un eczéma des mains et du visage (lésions aéroportées), simulant une photo-dermatose (mais sans respect des zones photo-protégées). Le diagnostic est basé sur les tests épicutanés (ou patchs-tests) réalisés avec une batterie standard européenne (où figurent lactones, primines, mousse de chêne), ou parfois directement avec certains fragments des plantes manipulées. D’autres plantes contiennent des lactones sesquiterpéniques : les Frullaniacées, poussant sur les écorces de chênes, de châtaigniers et sur certaines roches. Les Magnoliacées et les Lauracées contiennent également des lactones.

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Hervé Couteaux
Centre d’allergologie de Bordeaux-Nord
Journée à thème "Jardins, environnement et santé" Bordeaux 2010

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