Revue Francaise d Allergologie最新文献

Objectives

Design and methods

Results

Conclusions

Study objective

The DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a severe and potentially fatal toxidermia due to various visceral involvements. Identifying factors predisposing to serious complications is essential for clinical and therapeutic management. This study aims to analyze the cutaneous presentation of DRESS and its role as a prognostic factor.

Patients and methods

This is a retrospective, descriptive, and analytical study conducted over nine years at the dermatology department in Fes, including all hospitalized DRESS cases.

Results

The maculopapular rash was the most frequent phenotype (49.3%), followed by erythroderma, morbilliform exanthem, and polymorphous erythema-like rash. In all, 52.8% of patients had renal involvement and 45.8% had hepatic involvement, while 81.9% exhibited hypereosinophilia. The maculopapular rash and erythroderma were more associated with internal organ involvement, although no significant statistical correlation could be demonstrated. Allopurinol was the most implicated drug in 51.4% of the cases. No correlation was found between the type of medication and the cutaneous presentation. In all, 8.3% of the patients died, primarily those with erythroderma (15.8%).

Conclusion

Our study demonstrated that maculopapular rash and erythroderma are the most common presentations and are most associated with internal organ complications, with a more unfavorable prognosis for erythrodermic cases.

Context

The nursery welcomes children from a few months to the age of 3 years, age range where there is an increase in cases of anaphylaxis related to food allergies (FA).

Objectives

To draw up an inventory of the training and knowledge of staff with regard to FA. Observe the organization of the Individualized Reception Project (IRP) in the nursery. Take stock of the feelings and possible apprehensions of professionals to work on a daily basis with a child with FA.

Methods

Survey conducted in 2023 with 50 staff working in different childcare facilities.

Results

Seventy-four per cent had initial training on FA, 64% had no training on FA since taking a position in nursery and 66% never handled an adrenaline auto-injector (AAI). Twenty-one per cent of the structures have an internal medicine cabinet to support an inaugural reaction of FA and 14% are equipped with AAI (internal stock not taking into account the AAI of possible IRP). Sixty-eight per cent know that they are allowed to apply the IRP themselves in emergency situations in the nursery, in connection with the ministerial circular of 2021. Sixty-six per cent are comfortable in the daily reception of the child with FA, 38% are comfortable with the handling of the AAI.

Conclusion

Given the increasing frequency of FA in small children, it is necessary for early childhood professionals to be better trained and informed during their studies and in the nursery, especially on the administration of AAI. It is desirable that an in-house pharmacy be equipped with AAI for the management of inaugural FA.

Introduction

The aims of this study was to evaluate the impact of therapeutic education on the knowledge and skills of patients with atopic dermatitis at the Aristide Le Dantec University Hospital.

Patients and method

This prospective educational intervention study included 22 participants with AD. Knowledge was assessed before and after the therapeutic education sessions. The educational tools of the Pierre-Fabre Eczema Foundation translated into power points served as educational support to which creations of educational tools and iconographies on black skin were added. The comparison of means was made using the Student test.

Results

The educational diagnosis highlighted a lack of knowledge of: the disease, its aggravating factors, its treatments as well as frequent corticophobia. The therapeutic education allowed the acquisition of theoretical knowledge and practical skills in addition to empowering the participants. In addition, it reduced corticophobia although fear of topical corticosteroids persisted.

Conclusion

Patient therapeutic education through educational tools contextualized for our patients made it possible to improve knowledge and skills during atopic dermatitis.

Prurigo is a frequent disease in childhood. The aim of our work is to document the epidemiological, clinical, and etiological features of prurigo in children. It is a retrospective study carried out from January 2016 to December 2023 in the pediatric dermatology consultation of Ibn Rochd University Hospital in Morocco. All children from 0–14 years diagnosed clinically with prurigo were included. The prevalence of prurigo was 18% in the pediatric population. The mean age at the onset of the disease was 2.43 years. Pruritus was reported in all patients. Three subgroups were identified: estival prurigo: 43.45% of cases, per-annual: 25.60% of cases, and seasonal non-estival prurigo: 30.95% of cases. Thirty-five percent of patients reported an exacerbation of lesions by the consumption of histamine-releasing foods or those containing additives and colorants. Estival prurigo is the most common form of prurigo in children, lesions predominate in exposed areas and are induced by mosquito bites. Our study highlights a possible association with histamine-liberating foods.

Acute generalized exanthematous pustulosis (AGEP) is an uncommon and potentially life-threatening skin reaction primarily triggered by medications, notably antibiotics. Herein, we present a rare case of AGEP induced by phloroglucinol, a drug not commonly associated with AGEP, with a short literature review. A previously healthy 31-year-old woman exhibited fever and a pruritic widespread rash characterized by diffuse erythema interspersed with pustules, manifesting five days following oral phloroglucinol intake. Neutrophilic leukocytosis was evident upon blood analysis. Microbiological assessment confirmed the pustules to be sterile. Histopathological examination unveiled multifocal intra-epidermal pustules, exoserosis, and a polymorphic dermal infiltrate primarily comprising neutrophils and eosinophils. Diagnosis of phloroglucinol-induced AGEP was established, with an intrinsic imputability score of I4 (S3 C3) as per the updated criteria proposed by Begaud et al. Subsequent cessation of the offending drug led to marked improvement in the patient's condition. This case underscores the importance of considering less recognized culprits, such as phloroglucinol, in the etiology of AGEP, thereby broadening the spectrum of drugs implicated in this severe dermatological reaction. Early recognition and prompt withdrawal of the offending agent remain pivotal in mitigating AGEP-associated morbidity and mortality.

Depuis la description séminale impliquant l’occupation du récepteur X2 couplé à la protéine G liée à Mas (MRGPRX2) dans la dégranulation des mastocytes (MCs) par les médicaments, de nombreuses études ont été entreprises sur ce nouvel endotype potentiel de réactions d’hypersensibilité immédiate aux médicaments (RHMIs). Cependant, les preuves actuelles de ce mécanisme proviennent principalement de modèles animaux (mutants) ou d’études in vitro. Des preuves cliniques irréfutables chez l’homme font défaut. De plus, la traduction de ces résultats précliniques en pertinence clinique chez l’homme est difficile et doit être interprétée de manière critique. En partant de nos priorités cliniques et de notre expérience des analyses fonctionnelles des basophiles, MCs et lymphocytes T, l’objectif de cette revue est d’identifier certaines de ces difficultés, de souligner les obstacles qui pourraient entraver la transposition des observations précliniques en clinique et de mettre en évidence les différences entre les réactions médiées par les sIgE et par le MRGPRX2. Finalement, nous proposons un algorithme mécanistique théorique qui pourrait faciliter la discrimination entre la dégranulation des MCs due à l’activation de MRGPRX2 et la réticulation des anticorps IgE liés à la membrane et réactifs aux médicaments.

Objectives

To determine the frequency of allergic asthma; to describe the socio-demographic, clinical and paraclinical characteristics; to define the type of sensitization; to identify factors associated with the type of sensitization.

Methods

This was a cross-sectional study from August to December 2020 of asthmatic patients consecutively recruited in the pneumology and pediatrics departments of the Brazzaville University Hospital Center and who had completed a prick test. The standardized allergenic extracts used were: positive and negative control, mites (Dermatophagoides pteronyssinus [DP], Dermatophagoides farinae [DF] and Blomia tropicalis), cockroaches, molds (Alternaria alternata, Cladosporium herbarum, Penicillium notatum, Aspergillus fumigatus), pollen (5 grasses), hair (cat and dog) and latex.

Results

Of fifty-nine patients tested, 52 (88.1%) had at least one positive skin reaction. The average age was 29.5 years, and there was a predominance of women (63.5%). Of these patients, 82.7% were polysensitized and the average number of sensitizations was 3 ± 2. Sensitization to dust mites was the most frequent (80.7%) followed by cockroaches (46.2%). We noted a significant association between mite sensitization and young age (P = 0.06). Multiple sensitizations were strongly associated with mite sensitization (P = 0.0002). A significant association was found in our study between cockroach sensitization and asthma severity (P = 0.02).

Conclusion

Asthmatics followed in Brazzaville have a polysensitization dominated by dust mites.

Red ear syndrome (RES) is characterized by or recurrent unilateral bilateral painful attacks of the external ear, accompanied by ear redness, burning, or warmth. RES is classified as primary (idiopathic) and secondary. While the etiology of primary RES is not clearly known, secondary causes of RES include cervical spine and temporomandibular joint dysfunction. Although its prevalence in the pediatric age group is unknown, only a handful of pediatric cases of RES have been reported in the literature. Since its etiology and pathophysiological mechanism are unclear, there is no standard recommended treatment approach for RES. Patients with RES may be misdiagnosed as allergic contact dermatitis because of similar findings and because it is very rare. In this report, we present a case of RES, which is very rare disorder that is present in the differential diagnosis of allergic contact dermatitis, to draw attention to awareness on this issue.