Revue Francaise d Allergologie最新文献

Objectives

Immunotherapy is the gradual administration of increasing doses of allergens to reduce or eliminate the patient's adverse clinical response following exposure to these allergens. The goal of the current study was to evaluate the effectiveness of subcutaneous immunotherapy in patients with allergic diseases referred to the Bushehr Asthma and Allergy Clinic, Iran.

Materials and methods

Patients with respiratory allergic diseases, who had positive skin prick test, randomly enrolled in this observational study and underwent immunotherapy for one year. To evaluate the efficacy of immunotherapy, two questionnaires were completed for all the patients before and one year after the start of immunotherapy, including the Total Nasal Symptom Score (TNSS) and Asthma Control Test (ACT).

Results

A total of 878 patients with asthma or allergic rhinitis disorder [53.6% (n = 471) male and 46.4% (n = 407) female] with a median (IQR) age of 28.0 (12.0–35.0) years were randomly enrolled in this observational study. Five hundred forty-nine patients (64.8%) were over 18 years old and 298 patients (33.9%) were under 18 years old, the age of the other patients was not known. The median (IQR) duration of disease was 84.0 (36.0–138.0) months. Rinithis allergy had most frequent than asthma [39.9% (n = 350) vs. 22.2% (n = 195), respectively] and 218 patients (24.8%) have both of them. After the treatment, 234 patients (54.5%) completely stop and 26.3% patient (n = 113) used less than half of the drugs. The mean TNSS (n = 259) and ACT (n = 186) scores for patients had significant difference before and after immunotherapy [13.64 vs. 5.68, P < 0.001; 7.91 vs. 17.43, P < 0.001, respectively].

Conclusion

The mean TNSS and ACT score before and after the treatment significantly improved the patients’ symptoms. To conclude, standard immunotherapy can be effective in patients with moderate to severe allergic rhinitis and mild to moderate persistent allergic asthma to reduce clinical symptoms.

Introduction

Capecitabine is an oral fluoropyrimidine carbamate, analog of 5-fluorouracil. It is widely used for many malignant tumors. Hand-foot syndrome is the most common dermatological toxicity associated with capecitabine and Stevens-Johnson syndrome is the rarest manifestation. We report a case of Stevens-Johnson syndrome induced by capicitabine.

Case presentation

A 49-year-old patient, hospitalized in oncology for the management of a mucinous colorectal adenocarcinoma with peritoneal metastases. He was treated with capecitabine 3500 mg per day. The patient presented diffuse pigmented lesions and an erosive scrotal lesion with dysphagia to solids and liquids, vomiting and non-bloody diarrhea, which occurred 5 days after the onset of the treatment. The clinical examination found an altered patient. The skin examination found a pigmented desquamative plaque on the face, diffuse atypical target lesions, a pigmented plaque on the palms of both hands, a scrotal erosion and cheilitis. The histology confirmed the diagnosis Stevens-Johnson syndrome. The pharmacovigilance declaration concluded that Stevens-Johnson syndrome was secondary to capecitabine according to chronological and bibliographic data. The patient died of respiratory distress.

Conclusion

Stevens-Johnson syndrome is a rare and serious complication that can occur, rarely, in patients treated with capecitabine. Our case is the 5th case of capecitabine-induced SJS that has been reported in the literature since 2008.

Idiopathic anaphylaxis (IA) is a rare life-threatening disorder that may present with severe symptoms similar to other forms of anaphylaxis. It is an exclusion diagnosis and requires careful consideration of all recognizable and rare causes of anaphylaxis. Psychiatric conditions, such as somatoform disorders, should be considered in the differential diagnosis when there is a paucity or absence of clinical signs. A 17-year-old female patient was admitted to the inpatient clinic for pediatric allergy due to recurrent anaphylaxis. In the last two years, the patient was administered intramuscular epinephrine more than 200 times and was admitted to the intensive care unit four times due to severe anaphylaxis. The attacks frequently appeared as flushing, itching, shortness of breath, and rarely hypotension, but without a defined trigger. The patient was diagnosed with IA and received oral steroids, omalizumab, and rituximab. However, none of her attacks were accompanied by elevated tryptase levels and the aforementioned pharmacotherapies did not prevent relapse. After psychiatric evaluation, somatoform disorders were suspected despite striking variations in the severity of the physical symptoms. The psychiatric diagnosis was also supported by a good response to fluoxetine and supportive individual psychotherapy. The patient is currently being followed up without any anaphylactic attacks. Somatoform disorders should be considered in the differential diagnosis of IA because of overlapping physical symptoms. In the clinical practice of diagnosing and managing IA, symptoms that are not only subjective but also objective and unresponsive to conventional treatments should alert physicians to the probability of the psychiatric condition and the requirement for psychiatric consultation.

Introduction

Anaphylaxis is a life-threatening systemic allergic reaction. In this study, we evaluated the pedodontists’ knowledge, experience and preparedness for allergic reactions and anaphylaxis management.

Method

A cross-sectional survey was designed and distributed through the web-based application.

Results

One hundred and four pedodontists completed the survey. All of the participants questioned allergic diseases and drug allergies before the dental procedure. Of the participants, 81.7% were aware that the first choice in the treatment of anaphylaxis was adrenaline, and 71.2% of them were informed that the route of administration of adrenaline was intramuscular. However, 22.1% of the participants reported concern about not being able to recognize anaphylaxis and 59.6% of them were inaccurate about the dose of adrenaline that should be administered to treat anaphylaxis. The participants who were trained about anaphylaxis in the last 5 years responded more accurately to the adrenaline dose applied in the treatment of anaphylaxis (P = 0.001). There was no association between accurately knowing the dosage and route of adrenaline and the participants’ age, gender, duration of employment, or workplace (P > 0.05).

Conclusion

In this study, it was determined that the management of allergic diseases and anaphylaxis needs to be improved in pedodontic clinics.

We evaluated the relationships between children's housing, earthquake or tsunami damage affecting children, prevalence of allergic diseases, and levels of mite allergens and fungi on children's bedding after the Great East Japan Earthquake in four municipalities in Japan. We surveyed 464 children in Ishinomaki, 254 in Kami, 614 in Iwanuma, and 300 in Oiso whose parents or guardians had completed the International Study of Asthma and Allergies in Childhood questionnaire. We measured the levels of Dermatophagoides 1 allergens (Der 1) (Dermatophagoides pteronyssinus and Dermatophagoides farinae) on children's mattresses or futons and fungal counts (Aspergillus and yeast) between 2016 and 2018. Earthquake damage was significantly greater in Ishinomaki than in the other three municipalities. There were no differences in the prevalence of allergic disease among the four municipalities. Der 1 levels were significantly higher in Ishinomaki than in Iwanuma, but there were no differences among Oiso, Iwanuma, and Kami. Der 1 levels in children with asthma in Iwanuma and with allergic rhinitis in Kami were significantly higher than in those without these conditions. Total fungal counts and Aspergillus counts were highest in Kami and lowest in Oiso. Der 1 levels were significantly correlated with fungal counts in Kami and Iwanuma, but not in Ishinomaki or Oiso. Both Der 1 levels and total fungal counts in Ishinomaki were greater than those in other three municipalities. Housing and allergen-avoidance strategies varied among the four municipalities. Mite allergen and fungal levels in these Japanese municipalities might have been affected by the earthquake and tsunami, and these changes might have affected the prevalence of allergic diseases in children.

Introduction

Asthma is the most common chronic respiratory condition in children, affecting 7–10% of the school-age population. The objective of this study was to determine the prevalence and describe the consequences of asthma on the academic course of asthmatic children in Congo.

Patients and Methods

We conducted a cross-sectional study from February 14 to June 30, 2022, in Brazzaville. One class each from the primary and secondary cycles was randomly selected without replacement from 12 institutions, totaling 700 students. Each surveyed student completed a questionnaire and underwent a physical examination and spirometry before and after an exercise challenge. Reversibility testing was performed in cases of identified obstructive syndrome.

Results

The prevalence of asthma was 7%. The frequency of exercise-induced bronchoconstriction was 10.2% in asthmatics versus 3.2% in non-asthmatics (OR = 0.29 [0.07–0.29], P < 0.001). Atopy was found in 75.5% of asthmatic cases versus 32% in non-asthmatics (OR = 0.15 [0.07–0.29], P < 0.001). A significant number of students (42.8%) exhibited persistent and uncontrolled asthma. Our study revealed that 49% (n = 24) of asthmatics had at least one absence per year compared to 1.1% (7 cases/651) in non-asthmatics (P < 0.001). Asthma motivated the discontinuation of all sports activities in 34.7% (n = 17) of cases. Academic delay was observed in 24.5% of asthmatics.

Conclusion

The prevalence of asthma in the school environment is significant and has a real impact on the academic trajectory of students. The implementation of an Individualized Action Plan (IAP) would be beneficial to enhance their integration.

Introduction (contexte de la recherche)

L’eczéma de contact à l’aluminium dans les crèmes solaires est rare.

Objectif

Nous rapportons un cas original d’eczéma de contact à l’aluminium contenu dans une crème solaire minérale « bio ».

Méthodes

Un enfant de 2 ans a présenté une éruption cutanée eczématiforme du visage, du cou, des avant-bras, survenant 24 h après l’application d’une crème solaire minérale « bio » Alphanova bébé® appliquée à la crèche. Des patch tests ont été réalisés et étaient positifs pour la crème solaire (++) et aluminium chloride hexahydrate 2 % VAS (++), contenu dans la crème solaire. La mère rapportait la survenue de granulomes vaccinaux, confirmant une pertinence ancienne ainsi qu’une probable source de sensibilisation.

Résultats

L’eczéma de contact à l’aluminium est rare et peu de cas ont été publiés dans la littérature, essentiellement chez des enfants ayant des granulomes post vaccinaux. En effet, l’aluminium est souvent utilisé comme adjuvant dans les vaccins. Ces granulomes surviennent chez 1 % des enfants, parmi lesquels 96 % ont des patch tests positifs à l’aluminium.

L’aluminium est également utilisé dans les crèmes solaires minérales en raison de sa capacité à améliorer l’étalement de la crème solaire et à agir comme vecteur du filtre UV titanium dioxyde. Les eczémas de contact à l’aluminium dans les crèmes solaires n’ont pas fréquemment été publiés dans la littérature.

Conclusions

L’eczéma de contact à l’aluminium dans les crèmes solaires est rare, la source principale de sensibilisation est probablement la présence d’aluminium dans les vaccins.