Pub Date : 2025-08-16DOI: 10.1016/j.reval.2025.104567
G. Pouessel , A. Deschildre , F. Amat , M. Morisset , V. Jubin , pour le Groupe de travail allergie alimentaire de la Société française d’allergologie
This article is a non-systematic review on the epidemiology and burden of peanut allergy. Peanut allergy is one of the most common IgE-mediated food allergies in children, with an estimated prevalence in France of 0.9% at the age of 5.5 years based on questionnaires from the ELFE cohort. Peanut allergy begins in 90% of cases before the age of 3 years and spontaneously regresses in only 20 to 25% of cases before adulthood. Peanut allergy is associated with sensitization to one or more other legumes in two thirds of cases, and sometimes with a cross-allergy. Patients with peanut allergy most often have associated atopic comorbidities, particularly asthma. Peanut is one of the most common allergens involved in severe and even fatal food anaphylaxis and is associated with a high risk of allergy recurrence. Peanut allergy leads to impaired quality of life and has a significant psychosocial impact. Peanut-allergic patients probably have a different phenotype than patients with other food allergies. Multidisciplinary care and a personalized treatment strategy should be considered in these patients.
{"title":"L’allergie à l’arachide. État des lieux et perspectives, par le GT2A. Partie 1 : épidémiologie et fardeau de l’allergie à l’arachide","authors":"G. Pouessel , A. Deschildre , F. Amat , M. Morisset , V. Jubin , pour le Groupe de travail allergie alimentaire de la Société française d’allergologie","doi":"10.1016/j.reval.2025.104567","DOIUrl":"10.1016/j.reval.2025.104567","url":null,"abstract":"<div><div>This article is a non-systematic review on the epidemiology and burden of peanut allergy. Peanut allergy is one of the most common IgE-mediated food allergies in children, with an estimated prevalence in France of 0.9% at the age of 5.5 years based on questionnaires from the ELFE cohort. Peanut allergy begins in 90% of cases before the age of 3 years and spontaneously regresses in only 20 to 25% of cases before adulthood. Peanut allergy is associated with sensitization to one or more other legumes in two thirds of cases, and sometimes with a cross-allergy. Patients with peanut allergy most often have associated atopic comorbidities, particularly asthma. Peanut is one of the most common allergens involved in severe and even fatal food anaphylaxis and is associated with a high risk of allergy recurrence. Peanut allergy leads to impaired quality of life and has a significant psychosocial impact. Peanut-allergic patients probably have a different phenotype than patients with other food allergies. Multidisciplinary care and a personalized treatment strategy should be considered in these patients.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 5","pages":"Article 104567"},"PeriodicalIF":0.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1016/j.reval.2025.104598
N. Taouri, A. Amazouzi, N. Boutimzine, O. Cherkaoui
Fluorescein retinal angiography is a very well tolerated test; however adverse reactions of various severity have been reported, ranging from simple nausea to anaphylactic shock. Nausea, followed by vomiting are the most common anaphylactic incident after fluorescein injection. Premedication is sometimes indicated for patients at risk. Some authors propose desensitization protocols before carrying out an examination, while others propose as an alternative a retinal angiography with oral fluorescein, and sometimes the use of OCT (optical coherence tomography), or OCT-A (optical coherence tomography angiography). Finally, for more safety, it is important to equip the examination room with the necessary tools to manage this type of reactions. We report a retrospective study of 4 cases of adverse reaction following the injection of fluorescein for retinal angiography.
{"title":"Les effets indésirables suite à l’injection de la fluorescéine pour la réalisation de l’angiographie rétinienne : rapport de 4 cas","authors":"N. Taouri, A. Amazouzi, N. Boutimzine, O. Cherkaoui","doi":"10.1016/j.reval.2025.104598","DOIUrl":"10.1016/j.reval.2025.104598","url":null,"abstract":"<div><div>Fluorescein retinal angiography is a very well tolerated test; however adverse reactions of various severity have been reported, ranging from simple nausea to anaphylactic shock. Nausea, followed by vomiting are the most common anaphylactic incident after fluorescein injection. Premedication is sometimes indicated for patients at risk. Some authors propose desensitization protocols before carrying out an examination, while others propose as an alternative a retinal angiography with oral fluorescein, and sometimes the use of OCT (optical coherence tomography), or OCT-A (optical coherence tomography angiography). Finally, for more safety, it is important to equip the examination room with the necessary tools to manage this type of reactions. We report a retrospective study of 4 cases of adverse reaction following the injection of fluorescein for retinal angiography.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 5","pages":"Article 104598"},"PeriodicalIF":0.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1016/j.reval.2025.104600
M. Sabib, T. Meskini, S. Ettair
Les allergies alimentaires et hypersensibilités médicamenteuses sont des complications de plus en plus reconnues après transplantation hépatique pédiatrique, avec une prévalence pouvant atteindre 54,3 %. Les allergies alimentaires IgE-médiées se manifestent fréquemment par des signes cutanés et des symptômes gastro-intestinaux tels que douleurs abdominales et diarrhées, tandis que les rectorragies comme présentation initiale restent rares. Nous rapportons le cas original d’une fillette de 12 mois ayant bénéficié d’une transplantation hépatique à l’âge de 9 mois. Elle présentait une atrésie des voies biliaires, initialement traitée par dérivation bilio-digestive sans succès, ayant évolué vers une cirrhose hépatique compliquée d’insuffisance hépatocellulaire, motivant la greffe hépatique et la mise en place d’une immunosuppression par tacrolimus. Elle a présenté deux épisodes de rectorragies de grande abondance. Une évaluation allergologique a confirmé une allergie IgE-médiée à l’œuf et une proctocolite hémorragique associée à une hypersensibilité aux protéines du lait de vache. De plus, une hypersensibilité à l’aspirine a été confirmée par un test de provocation orale. La prise en charge a inclus un régime d’éviction de l’œuf de poule et du lait de vache ainsi qu’un protocole de désensibilisation à l’aspirine, entraînant une amélioration clinique juste après éviction des allergènes. La survenue de ces rectorragies pourrait s’expliquer par des perturbations immunitaires induites par la transplantation hépatique, notamment sous tacrolimus. Cet immunosuppresseur favorise une réponse Th2 avec production accrue d’IgE. Associé aux antibiotiques, il altère le microbiote intestinal et augmente la perméabilité digestive, facilitant la sensibilisation aux allergènes. Ce cas souligne l’importance d’un dépistage allergologique pré-greffe et d’un suivi étroit après transplantation. Une vigilance particulière doit être accordée aux manifestations cliniques atypiques, telles que les rectorragies, afin de ne pas méconnaître une cause allergique et d’optimiser la prise en charge.
{"title":"Rectorragies révélatrices d’une allergie alimentaire après une transplantation hépatique : à propos d’un cas","authors":"M. Sabib, T. Meskini, S. Ettair","doi":"10.1016/j.reval.2025.104600","DOIUrl":"10.1016/j.reval.2025.104600","url":null,"abstract":"<div><div>Les allergies alimentaires et hypersensibilités médicamenteuses sont des complications de plus en plus reconnues après transplantation hépatique pédiatrique, avec une prévalence pouvant atteindre 54,3 %. Les allergies alimentaires IgE-médiées se manifestent fréquemment par des signes cutanés et des symptômes gastro-intestinaux tels que douleurs abdominales et diarrhées, tandis que les rectorragies comme présentation initiale restent rares. Nous rapportons le cas original d’une fillette de 12 mois ayant bénéficié d’une transplantation hépatique à l’âge de 9 mois. Elle présentait une atrésie des voies biliaires, initialement traitée par dérivation bilio-digestive sans succès, ayant évolué vers une cirrhose hépatique compliquée d’insuffisance hépatocellulaire, motivant la greffe hépatique et la mise en place d’une immunosuppression par tacrolimus. Elle a présenté deux épisodes de rectorragies de grande abondance. Une évaluation allergologique a confirmé une allergie IgE-médiée à l’œuf et une proctocolite hémorragique associée à une hypersensibilité aux protéines du lait de vache. De plus, une hypersensibilité à l’aspirine a été confirmée par un test de provocation orale. La prise en charge a inclus un régime d’éviction de l’œuf de poule et du lait de vache ainsi qu’un protocole de désensibilisation à l’aspirine, entraînant une amélioration clinique juste après éviction des allergènes. La survenue de ces rectorragies pourrait s’expliquer par des perturbations immunitaires induites par la transplantation hépatique, notamment sous tacrolimus. Cet immunosuppresseur favorise une réponse Th2 avec production accrue d’IgE. Associé aux antibiotiques, il altère le microbiote intestinal et augmente la perméabilité digestive, facilitant la sensibilisation aux allergènes. Ce cas souligne l’importance d’un dépistage allergologique pré-greffe et d’un suivi étroit après transplantation. Une vigilance particulière doit être accordée aux manifestations cliniques atypiques, telles que les rectorragies, afin de ne pas méconnaître une cause allergique et d’optimiser la prise en charge.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 6","pages":"Article 104600"},"PeriodicalIF":0.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1016/j.reval.2025.104586
J. Herry , C. Chassery , M. Virtos , D. Sabouraud , P. Beaumont , C. Ponvert
Rare cases of drug-induced enterocolitis syndrome have been reported with drugs administered by the oral (amoxicillin, pantoprazole) and intrarectal (paracetamol) routes. No cases have been described by injectable route. Diagnostic criteria, close to those of food protein-induced enterocolitis syndrome, have been proposed in 2019. We report the case of a 72-year-old patient scheduled for a total knee arthroplasty and recused on two occasions after rapid occurrence of drug-induced enterocolitis after peri-nervous injection of ropivacaine during a nerve block carried out before the surgery. Skin tests performed after the first reaction, according to EEACI/ENDA (European Academy of Allergy and Clinical Immunology) recommendations, were negative. The drug provocation test with ropivacaine was also negative. However, the symptoms recurred at the second anesthesia. A few cases of IgE-mediated hypersensitivity to local anesthetics have been reported, but, to our knowledge, this is the first case of drug-induced enterocolitis syndrome induced by an injectable drug, ropivacaine, recurring although skin tests and provocation test resulted negative.
{"title":"Syndrome d’entérocolite médicamenteuse induite par la ropivacaïne injectée par voie péri-nerveuse : premier cas rapporté","authors":"J. Herry , C. Chassery , M. Virtos , D. Sabouraud , P. Beaumont , C. Ponvert","doi":"10.1016/j.reval.2025.104586","DOIUrl":"10.1016/j.reval.2025.104586","url":null,"abstract":"<div><div>Rare cases of drug-induced enterocolitis syndrome have been reported with drugs administered by the oral (amoxicillin, pantoprazole) and intrarectal (paracetamol) routes. No cases have been described by injectable route. Diagnostic criteria, close to those of food protein-induced enterocolitis syndrome, have been proposed in 2019. We report the case of a 72-year-old patient scheduled for a total knee arthroplasty and recused on two occasions after rapid occurrence of drug-induced enterocolitis after peri-nervous injection of ropivacaine during a nerve block carried out before the surgery. Skin tests performed after the first reaction, according to EEACI/ENDA (European Academy of Allergy and Clinical Immunology) recommendations, were negative. The drug provocation test with ropivacaine was also negative. However, the symptoms recurred at the second anesthesia. A few cases of IgE-mediated hypersensitivity to local anesthetics have been reported, but, to our knowledge, this is the first case of drug-induced enterocolitis syndrome induced by an injectable drug, ropivacaine, recurring although skin tests and provocation test resulted negative.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 6","pages":"Article 104586"},"PeriodicalIF":0.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1016/j.reval.2025.104599
M. Oulad Kouider , A. Fissah , H. Madi , M.S. Aissani , K. Bouchbouch , K. Ouennoughi , A. Bachir Cherif , F. Zedam , L. Zemmour , S. Benzaoui , Z. Boukara , M. Kibboua , S. Alihalassa
Introduction
Although patients with severe asthma constitute only around 5% to 10% of asthmatic patients, they account for almost half of the costs related to this condition. This situation is related to the disease itself and its comorbidities.
Methods
This is a prospective observational study in the academic hospital of Blida in Algeria. Data were collected from May 2019 to November 2021. Only patients who met the criteria of severe asthma according to the definition GINA 2018. The included patients received a multidisciplinary approach along with personalized education.
Results
One hundred and fifty patients were included, and 65.3% of them were women. Among the patients, 93.3% had comorbidities, with chronic allergic rhinitis being the most common allergic comorbidity. Meanwhile, gastroesophageal reflux was the most prevalent non-allergic comorbidity (48.7%). After multidisciplinary care, only 27.3% of the participants continued to have severe asthma.
Conclusion
Patients with severe asthma require personalized education and the collaboration of different specialists.
{"title":"Impact de la prise en charge multidisciplinaire sur le contrôle et l’évolution de l’asthme difficile","authors":"M. Oulad Kouider , A. Fissah , H. Madi , M.S. Aissani , K. Bouchbouch , K. Ouennoughi , A. Bachir Cherif , F. Zedam , L. Zemmour , S. Benzaoui , Z. Boukara , M. Kibboua , S. Alihalassa","doi":"10.1016/j.reval.2025.104599","DOIUrl":"10.1016/j.reval.2025.104599","url":null,"abstract":"<div><h3>Introduction</h3><div>Although patients with severe asthma constitute only around 5% to 10% of asthmatic patients, they account for almost half of the costs related to this condition. This situation is related to the disease itself and its comorbidities.</div></div><div><h3>Methods</h3><div>This is a prospective observational study in the academic hospital of Blida in Algeria. Data were collected from May 2019 to November 2021. Only patients who met the criteria of severe asthma according to the definition GINA 2018. The included patients received a multidisciplinary approach along with personalized education.</div></div><div><h3>Results</h3><div>One hundred and fifty patients were included, and 65.3% of them were women. Among the patients, 93.3% had comorbidities, with chronic allergic rhinitis being the most common allergic comorbidity. Meanwhile, gastroesophageal reflux was the most prevalent non-allergic comorbidity (48.7%). After multidisciplinary care, only 27.3% of the participants continued to have severe asthma.</div></div><div><h3>Conclusion</h3><div>Patients with severe asthma require personalized education and the collaboration of different specialists.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 6","pages":"Article 104599"},"PeriodicalIF":0.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/j.reval.2025.104582
S. Türkiş , F.E. Günaydin
Higher average temperatures due to climate change tend to change the spatial and temporal distribution of pollens. The study area was conducted in the Urban Park areas of Ordu Province, where urban people spend the most time. In the last decade, various allergenicity indices such as Specific Allergenicity Index (SAI) and Urban Green Zone Allergenicity Index (IUGZA) have been proposed to control hypoallergenicity in urban areas. The study aimed to warn allergic individuals about the risk posed by pollens and evaluate the allergenicity of existing urban vegetation. Specific Allergenicity Index (SAI) and Urban Green Zone Allergenicity Indexes (IUGZA = 0.208) of 25 plant species spread in urban park areas were calculated. To determine these indices, life cycle, overlap-abundance values, height, pollination time, pollination process, allergenicity potential, and cross-reactivity values of the species were determined. Among the species, the species with the highest allergenic effect, i.e. both abundance and allergenic potential, is Corylus avellana var avellana. In terms of allergenic potential value (VPA), it is seen that C.avellana var. avellana, Alnus glutinosa, Cupressus sempervirens, Olea europae, Salix spp. and Acer spp. are the most effective species on the axes. The abundance of the species (0.802) was the factor that made the allergenic factors most effective. Determination of the urban allergenicity index of Ordu province to determine the ecological driving forces of the distribution of ecosystems is important in estimating the allergenicity index of urban green areas and in selecting the right species to minimize the allergenic in parks.
气候变化导致的平均气温升高往往会改变花粉的时空分布。研究区域是在Ordu省的城市公园区域进行的，那里是城市居民花费最多时间的地方。近十年来，人们提出了各种过敏原指数，如特异性过敏原指数（SAI）和城市绿区过敏原指数（IUGZA），以控制城市地区的低过敏原性。本研究旨在警示过敏个体花粉的风险，并评估现有城市植被的致敏性。计算了分布在城市公园区域的25种植物的特异性致敏性指数（SAI）和城市绿区致敏性指数（IUGZA = 0.208）。为了确定这些指标，测定了物种的生命周期、重叠丰度值、高度、授粉时间、授粉过程、致敏潜力和交叉反应性值。其中，致敏效应（即丰度和致敏潜力）最高的物种是Corylus avellana var avellana。从致敏潜值（VPA）来看，在轴上最有效的树种是黄樟（C. avellana var. avellana）、桤木（Alnus glutinosa）、柏树（perpressus sempervirens）、油橄榄（Olea europae）、柳树（Salix）和槭（Acer）。物种丰度（0.802）是使致敏因子最有效的因素。确定奥尔都省城市变应原指数，确定生态系统分布的生态驱动力，对于估算城市绿地的变应原指数和选择合适的物种以减少公园的变应原具有重要意义。
{"title":"Assessing allergenicity of urban parks: Ordu City","authors":"S. Türkiş , F.E. Günaydin","doi":"10.1016/j.reval.2025.104582","DOIUrl":"10.1016/j.reval.2025.104582","url":null,"abstract":"<div><div>Higher average temperatures due to climate change tend to change the spatial and temporal distribution of pollens. The study area was conducted in the Urban Park areas of Ordu Province, where urban people spend the most time. In the last decade, various allergenicity indices such as Specific Allergenicity Index (SAI) and Urban Green Zone Allergenicity Index (IUGZA) have been proposed to control hypoallergenicity in urban areas. The study aimed to warn allergic individuals about the risk posed by pollens and evaluate the allergenicity of existing urban vegetation. Specific Allergenicity Index (SAI) and Urban Green Zone Allergenicity Indexes (IUGZA<!--> <!-->=<!--> <!-->0.208) of 25 plant species spread in urban park areas were calculated. To determine these indices, life cycle, overlap-abundance values, height, pollination time, pollination process, allergenicity potential, and cross-reactivity values of the species were determined. Among the species, the species with the highest allergenic effect, i.e. both abundance and allergenic potential, is <em>Corylus avellana</em> var <em>avellana</em>. In terms of allergenic potential value (VPA), it is seen that <em>C.</em> <em>avellana</em> var. <em>avellana</em>, <em>Alnus glutinosa</em>, <em>Cupressus sempervirens</em>, <em>Olea europae</em>, <em>Salix</em> spp. and <em>Acer</em> spp. are the most effective species on the axes. The abundance of the species (0.802) was the factor that made the allergenic factors most effective. Determination of the urban allergenicity index of Ordu province to determine the ecological driving forces of the distribution of ecosystems is important in estimating the allergenicity index of urban green areas and in selecting the right species to minimize the allergenic in parks.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 5","pages":"Article 104582"},"PeriodicalIF":0.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-14DOI: 10.1016/j.reval.2025.104584
F.Z. El Fatoiki, Z. Mouhsine, Y. Mahdar, F. Hali, S. Chiheb
Para-phenylenediamine (PPD), a common allergen in hair dyes and black henna tattoos, is typically responsible for allergic contact dermatitis and, rarely, systemic reactions like anaphylaxis. We report the case of a 22-year-old female with no significant medical history who developed pruritic eyelid edema and respiratory distress 24 hours after using a PPD-containing hair dye. She had prior exposure to black henna without issues. Clinical examination revealed erythematous plaques with vesicles and eyelid edema. Respiratory symptoms included dyspnea, tachycardia, and dysphonia. The patient required intensive care, receiving nebulized and intramuscular adrenaline, followed by corticosteroids. Patch testing confirmed a positive reaction to PPD. This case highlights the rare but possible coexistence of immediate and delayed hypersensitivity reactions to PPD, reflecting a complex and potentially severe immunologic mechanism. It emphasizes the importance of PPD regulation, patch testing for diagnosis, and prevention of repeated exposures.
{"title":"De l’application de teinture capillaire à l’unité de soins intensifs : une réaction sévère à la para-phénylènediamine","authors":"F.Z. El Fatoiki, Z. Mouhsine, Y. Mahdar, F. Hali, S. Chiheb","doi":"10.1016/j.reval.2025.104584","DOIUrl":"10.1016/j.reval.2025.104584","url":null,"abstract":"<div><div>Para-phenylenediamine (PPD), a common allergen in hair dyes and black henna tattoos, is typically responsible for allergic contact dermatitis and, rarely, systemic reactions like anaphylaxis. We report the case of a 22-year-old female with no significant medical history who developed pruritic eyelid edema and respiratory distress 24<!--> <!-->hours after using a PPD-containing hair dye. She had prior exposure to black henna without issues. Clinical examination revealed erythematous plaques with vesicles and eyelid edema. Respiratory symptoms included dyspnea, tachycardia, and dysphonia. The patient required intensive care, receiving nebulized and intramuscular adrenaline, followed by corticosteroids. Patch testing confirmed a positive reaction to PPD. This case highlights the rare but possible coexistence of immediate and delayed hypersensitivity reactions to PPD, reflecting a complex and potentially severe immunologic mechanism. It emphasizes the importance of PPD regulation, patch testing for diagnosis, and prevention of repeated exposures.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 5","pages":"Article 104584"},"PeriodicalIF":0.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-11DOI: 10.1016/j.reval.2025.104585
E. Seigle-Ferrand , M. Merveilleau , P. Bierme , C. Braun
We report the case of a young boy who was referred to us for suspected anaphylaxis to a local anesthetic during a dental procedure. Shortly after the administration of a local anesthesia using adrenaline-laced articaine, he developed a grade 2 anaphylactic reaction, which was treated with an intramuscular injection of adrenaline. Unable to test articaine (which was still mixed with adrenaline), we tested lidocaine as an alternative and then performed a subcutaneous provocation test, which did not elicit any reaction, allowing us to rule out a lidocaine allergy. However, our skin tests, performed after disinfection with chlorhexidine, were positive for latex, which we initially suspected to be responsible for the anaphylactic reaction. But a control prick-test on untreated skin, not disinfected with chlorhexidine, was negative. Upon further questioning, we discovered that the patient had used a mouthwash containing chlorhexidine immediately before the local anesthesia, which had not initially been mentioned either by the dentist or by the family. The chlorhexidine prick-test, as well as specific IgE testing, both returned positive, ultimately confirming sensitization to chlorhexidine. This was therefore an IgE-mediated allergy to chlorhexidine, likely due to mucosal absorption through the breach caused by the gingival local anesthesia. This case serves as a reminder of the need for a systematic and thorough approach in evaluating drug hypersensitivity. Allergy to chlorhexidine should always be considered when investigating perioperative anaphylaxis, even when the product is well tolerated on intact skin or mucous membranes.
{"title":"Réaction anaphylactique énigmatique au cabinet dentaire","authors":"E. Seigle-Ferrand , M. Merveilleau , P. Bierme , C. Braun","doi":"10.1016/j.reval.2025.104585","DOIUrl":"10.1016/j.reval.2025.104585","url":null,"abstract":"<div><div>We report the case of a young boy who was referred to us for suspected anaphylaxis to a local anesthetic during a dental procedure. Shortly after the administration of a local anesthesia using adrenaline-laced articaine, he developed a grade 2 anaphylactic reaction, which was treated with an intramuscular injection of adrenaline. Unable to test articaine (which was still mixed with adrenaline), we tested lidocaine as an alternative and then performed a subcutaneous provocation test, which did not elicit any reaction, allowing us to rule out a lidocaine allergy. However, our skin tests, performed after disinfection with chlorhexidine, were positive for latex, which we initially suspected to be responsible for the anaphylactic reaction. But a control prick-test on untreated skin, not disinfected with chlorhexidine, was negative. Upon further questioning, we discovered that the patient had used a mouthwash containing chlorhexidine immediately before the local anesthesia, which had not initially been mentioned either by the dentist or by the family. The chlorhexidine prick-test, as well as specific IgE testing, both returned positive, ultimately confirming sensitization to chlorhexidine. This was therefore an IgE-mediated allergy to chlorhexidine, likely due to mucosal absorption through the breach caused by the gingival local anesthesia. This case serves as a reminder of the need for a systematic and thorough approach in evaluating drug hypersensitivity. Allergy to chlorhexidine should always be considered when investigating perioperative anaphylaxis, even when the product is well tolerated on intact skin or mucous membranes.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 5","pages":"Article 104585"},"PeriodicalIF":0.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-20DOI: 10.1016/j.reval.2025.104568
I. Bouaziz, R. Atheymen, R. Sahnoun, K. Ksouda, H. Affes, S. Hammami, K. Zghal
Objective
The aim of our study was to evaluate the utility of the patch-tests for the diagnosis of the delayed hypersensitivity reactions induced by antiepileptic drugs and to explore cross-reactivity between them.
Patients and methods
We included cases of delayed drug addiction to antiepileptics notified to the Sfax regional pharmacovigilance center during the period from January 2019 to June 2023. We used the French Bégaud method for the study of imputability. Patch testing was performed in all patients according to the recommendations of the European Network of Drug Allergy. The interpretation of the results was made according to the rules of the International Contact Dermatitis Research Group.
Results
We included 17 delayed drug reactions: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome (n = 10), maculopapular rash (n = 6), Stevens-Johnson syndrome (n = 1). Patch tests were positive in 76.47% of cases: 66.66% for maculopapular rash with cross-reactivity between carbamazepine and phenobarbital (n = 1) and 90% in DRESS syndrome with cross-reactivity between 2 or more antiepileptics (n = 5). For the patient with Stevens-Johnson syndrome, the tests were interpreted as irritating.
Conclusion
Patch tests are safe and useful to confirm the imputability of antiepileptic drugs in the genesis of delayed drug hypersensibility reaction and to detect possible cross-reactivity.
{"title":"Intérêt des patch tests dans l’exploration des réactions d’hypersensibilité retardée aux antiépileptiques","authors":"I. Bouaziz, R. Atheymen, R. Sahnoun, K. Ksouda, H. Affes, S. Hammami, K. Zghal","doi":"10.1016/j.reval.2025.104568","DOIUrl":"10.1016/j.reval.2025.104568","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of our study was to evaluate the utility of the patch-tests for the diagnosis of the delayed hypersensitivity reactions induced by antiepileptic drugs and to explore cross-reactivity between them.</div></div><div><h3>Patients and methods</h3><div>We included cases of delayed drug addiction to antiepileptics notified to the Sfax regional pharmacovigilance center during the period from January 2019 to June 2023. We used the French Bégaud method for the study of imputability. Patch testing was performed in all patients according to the recommendations of the European Network of Drug Allergy. The interpretation of the results was made according to the rules of the International Contact Dermatitis Research Group.</div></div><div><h3>Results</h3><div>We included 17 delayed drug reactions: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome (<em>n</em> <!-->=<!--> <!-->10), maculopapular rash (<em>n</em> <!-->=<!--> <!-->6), Stevens-Johnson syndrome (<em>n</em> <!-->=<!--> <!-->1). Patch tests were positive in 76.47% of cases: 66.66% for maculopapular rash with cross-reactivity between carbamazepine and phenobarbital (<em>n</em> <!-->=<!--> <!-->1) and 90% in DRESS syndrome with cross-reactivity between 2 or more antiepileptics (<em>n</em> <!-->=<!--> <!-->5). For the patient with Stevens-Johnson syndrome, the tests were interpreted as irritating.</div></div><div><h3>Conclusion</h3><div>Patch tests are safe and useful to confirm the imputability of antiepileptic drugs in the genesis of delayed drug hypersensibility reaction and to detect possible cross-reactivity.</div></div>","PeriodicalId":49130,"journal":{"name":"Revue Francaise d Allergologie","volume":"65 5","pages":"Article 104568"},"PeriodicalIF":0.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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