Revue Francaise d Allergologie最新文献

英文中文

Place du test d’activation des basophiles dans le diagnostic de l’allergie aux curares. Étude immunologique multicentrique 嗜碱性粒细胞活化试验在箭毒过敏诊断中的地位。多中心免疫学研究

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-19 DOI: 10.1016/j.reval.2024.104171

J. Sainte-Laudy , M. Cogné , J. Goret , J.C. Lecron , G. Kanny , T. Tabary , O. Barbier , E. Bellet , S. Guez , F. Lavaud , Y. Meunier , P.M. Mertes , C. Mouton , R. Stenger , F. Touraine

Aim of the study

Evaluation of the diagnostic value of the basophil activation test (BAT) by flow cytometry in allergy to neuromuscular blocking agents (NMBA).

Patients and methods

One hundred and twenty-one patients older than 18 having experienced a grade II to IV peranesthetic shock were included in nine French hospitals. The final conclusion of the allegro-anesthesiologist was based on clinical and biological data and on skin tests, representing the “gold standard” of muscle relaxant agent's allergy diagnosis. The most frequently used NMBAs were suxamethonium, rocuronium and atracurium. Skin tests were performed according to EAACI recommendations and BAT according to Bühmann's laboratory protocol. BAT results were expressed in percentage of basophils expressing CD63 (%CD63) and in an activation index (AI) calculated according to a specific algorithm.

Results

Out of the 100 cases included, the positive (PPV) and negative (NPV) predictive values for ST were respectively 100% and 75%. For BAT, out of 64 cases, the PPV and NPV were respectively 100% and 41% (%CD63) and 100% and 51% (AI). The khi² test calculated between ST and BAT was statistically significant (P < 0.001) for suxamethonium and rocuronium. Using a threshold of 2 kUA/L (threshold corresponding to 100% specificity), the PPV and NPV of morphine specific IgEs were respectively 100% and 27%. Cross-reactions observed by TC and TAB for benzylisoquinolinium and aminosteroid compound groups were not significantly different.

Conclusion

The ST characteristics observed in this study are consistent with literature data with a lower NPV but a high PPV for BAT authorizing its use for diagnosis and selection of a negative NMBA with a view to subsequent intervention concerning a patient allergic to an NMBA. Its sensitivity is, however, lower than for TC but may be improved by the simultaneous use of an early activation marker as the membrane IgE.

研究目的通过流式细胞术评估嗜碱性粒细胞活化试验（BAT）对神经肌肉阻滞剂（NMBA）过敏的诊断价值。患者和方法纳入了法国九家医院的 121 名 18 岁以上、经历过 II 至 IV 级麻醉休克的患者。麻醉科医生根据临床和生物学数据以及皮试得出最终结论，皮试是诊断肌肉松弛剂过敏的 "金标准"。最常用的 NMBAs 是舒喘宁、罗库铵和阿曲库铵。皮试根据 EAACI 建议进行，BAT 根据 Bühmann 实验室方案进行。结果在纳入的 100 个病例中，ST 的阳性预测值（PPV）和阴性预测值（NPV）分别为 100%和 75%。在 64 个病例中，BAT 的 PPV 和 NPV 分别为 100%和 41%（%CD63）以及 100%和 51%（AI）。计算出的 ST 和 BAT 之间的 khi2 检验结果显示，舒血宁和罗库溴铵具有统计学意义（P < 0.001）。以 2 kUA/L（特异性为 100%）为阈值，吗啡特异性 IgE 的 PPV 和 NPV 分别为 100%和 27%。本研究中观察到的 ST 特性与文献数据一致，BAT 的 NPV 较低，但 PPV 较高，可用于诊断和选择阴性 NMBA，以便对 NMBA 过敏患者进行后续干预。不过，其灵敏度低于 TC，但同时使用膜 IgE 等早期活化标记物可提高灵敏度。

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引用次数: 0

Characteristics of Fungal Monosensitization in Turkey 土耳其真菌单敏性的特点

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-18 DOI: 10.1016/j.reval.2024.104162

S. Gültuna , D.G.U. Erkaya , Y.S. Demirel , O. Aydın

Study Objective

Fungi are recognized as allergenic sources and may play a role in the development, persistency, and severity of allergic diseases. Alternaria, Cladosporium, Penicillium, and Aspergillus, which belong to the Phylum Ascomycota, are well-characterized four genera among fungi species. To our knowledge, there is not enough data about monosensitization to fungi. We aimed to investigate the characteristics of monosensitized patients to fungal allergens.

Patients-Methods

Sixty-seven adult patients, who had a positive skin prick test reaction with fungal allergen out of a total of 4200 SPT results performed between January 2015 and June 2022 in two tertiary centers were included in the study. The clinical data of the patients were obtained retrospectively from the hospital medical records.

Results

Fifty-six (83.6%) patients were sensitized to one type of fungal allergen (Female/Male: 38/18) and eleven (16.4%) (Female/Male: 9/2) were sensitized to two types of fungi. Aspergillus was the most prevalent fungal allergen, followed by Cladosporium and Alternaria. Allergic rhinitis was the most common allergic disease.

Conclusion

Monosensitization to fungal allergens is rare. Monosensitization to at least one fungal allergen may lead to significant allergic diseases by potentially impacting the immune system.

研究目的真菌是公认的过敏源，可能在过敏性疾病的发生、持续和严重程度中起作用。属于子囊菌门的 Alternaria、Cladosporium、Penicillium 和 Aspergillus 是真菌中特征明显的四个属。据我们所知，关于真菌单敏性的数据还不够多。我们的目的是调查对真菌过敏原单敏患者的特征。患者-方法研究纳入了 67 名成年患者，他们在 2015 年 1 月至 2022 年 6 月期间在两家三级医院进行的总共 4200 次 SPT 结果中，对真菌过敏原的皮肤点刺试验反应呈阳性。结果56名（83.6%）患者对一种真菌过敏原过敏（女性/男性：38/18），11名（16.4%）患者对两种真菌过敏（女性/男性：9/2）。曲霉菌是最常见的真菌过敏原，其次是Cladosporium和Alternaria。过敏性鼻炎是最常见的过敏性疾病。对至少一种真菌过敏原单敏可能会影响免疫系统，从而导致严重的过敏性疾病。

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引用次数: 0

Allergie aux fruits à coque chez l’enfant : quelle prise en charge en pratique 儿童坚果过敏：如何在实践中加以控制

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-17 DOI: 10.1016/j.reval.2024.104167

F. Amat , E. Michaud

Tree nuts are plant allergens frequently involved in allergic reactions to food in children. Among them, cashew, walnut, hazelnut, pistachio and almond are the most implicated, with sometimes anaphylactic reactions. The diagnosis of an allergy to nuts is simple and is based on history, skin tests, and biological assessment (specific IgE, molecular allergology). Cross-reactivity should be searched, between nuts but also with peanuts and sesame. It should be possible not to perform an oral food challenge in all cases to explore these potential cross-reactivities. Oral immunotherapy protocols, especially for hazelnuts, cashews, pistachio and walnuts are being developed.

树坚果是植物过敏原，经常引起儿童对食物的过敏反应。其中，腰果、核桃、榛子、开心果和杏仁最容易引起过敏反应，有时还会导致过敏性反应。对坚果过敏的诊断很简单，只需根据病史、皮肤测试和生物学评估（特异性 IgE、分子过敏学）。应寻找坚果之间的交叉反应，以及与花生和芝麻的交叉反应。不可能在所有病例中都进行口服食物挑战，以探索这些潜在的交叉反应。目前正在开发口服免疫疗法方案，尤其是针对榛子、腰果、开心果和核桃的方案。

引用次数: 0

Investigation of the safety of measles–mumps–rubella vaccine in children with food allergies 食物过敏儿童接种麻疹-腮腺炎-风疹疫苗的安全性调查

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-16 DOI: 10.1016/j.reval.2024.104166

H. Yağmur , Ö. Kangalli Boyacioğlu , S. Asilsoy , D. Baysal Bakir , G. Kabadayi , D. Tezcan , Ö. Atay , N. Uzuner

Study objective

This study investigated the reaction frequency to the measles, mumps, rubella (MMR) vaccine and symptoms during this process in patients with egg allergy (EA) and/or cow's milk allergy (CMA).

Patients and methods

Patients diagnosed with CMA and/or EA were studied and followed up at the Department of Pediatric Allergy and Immunology, Dokuz Eylul University Faculty of Medicine, between December 2021 and December 2022. These patients were vaccinated with MMR vaccine (MMR vaccine from the Serum Institute of India Pvt. Ltd.). Demographic data, clinical findings, laboratory tests, and reactions following vaccination were reviewed.

Results

Overall, 62 patients with median age of 12 months, including 46.8% males, were investigated; 56.5%, 40.3%, and 3.2% were followed up for atopic dermatitis, urticaria, and anaphylaxis, respectively. Moreover, 44% had EA, 21% had CMA, and 35% had CMA and EA (CM&EA). Among the CMA and CM&EA groups, allergen-specific immunoglobulin E (Sp IgE) for milk and total IgE levels were significantly different (P < 0.001). Significant differences were observed in Sp IgE levels and skin prick test (SPT) results for milk among the EA and CM&EA groups (P < 0.017). Anaphylactic reactions occurred in five patients following MMR vaccination. All these patients had CMA; no mortalities were reported.

Conclusion

Patients with food allergies should be evaluated before MMR vaccination. No reactions were observed in the group allergic to eggs. All patients who experienced reactions had CMA. This suggests that milk allergy is a significant risk factor for adverse reactions compared to EA.

研究目的本研究调查了鸡蛋过敏（EA）和/或牛奶过敏（CMA）患者接种麻疹、腮腺炎、风疹（MMR）疫苗后的反应频率以及接种过程中出现的症状。患者和方法2021年12月至2022年12月期间，Dokuz Eylul大学医学院儿科过敏与免疫学系对确诊为CMA和/或EA的患者进行了研究和随访。这些患者接种了麻风腮疫苗（印度血清研究所有限公司生产的麻风腮疫苗）。结果共调查了 62 名患者，中位年龄为 12 个月，其中男性占 46.8%；分别有 56.5%、40.3% 和 3.2% 的患者因特应性皮炎、荨麻疹和过敏性休克而接受随访。此外，44%患有特应性皮炎，21%患有CMA，35%患有CMA和特应性皮炎（CM&EA）。在 CMA 组和 CM&EA 组中，牛奶过敏原特异性免疫球蛋白 E（Sp IgE）和总 IgE 水平有显著差异（P <0.001）。在 EA 组和 CM&EA 组中，牛奶的 Sp IgE 水平和皮肤点刺试验（SPT）结果有明显差异（P < 0.017）。五名患者在接种麻腮风疫苗后出现过敏反应。结论对食物过敏的患者在接种麻腮风疫苗前应进行评估。对鸡蛋过敏的人群未出现任何反应。所有出现反应的患者都患有 CMA。这表明，与 EA 相比，牛奶过敏是不良反应的一个重要风险因素。

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引用次数: 0

Mise au point sur l’immunothérapie multi-aliment 关注多种食品免疫疗法

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-16 DOI: 10.1016/j.reval.2024.104163

E. Bradatan , A.-K. Correard , D. Caimmi , A. Nemni , P. Biermé , C. Favre-Metz , D. Sabouraud , F. Morel Codreanu , E. Michaud , F. Villard-Truc , C. Braun

Multi-food oral immunotherapy (OIT) represents a potential avenue for the simultaneous management of multiple food allergies. It encompasses the ingestion of a range of allergens on a daily basis, with doses increasing progressively until a maintenance dose is reached. Multi-food OIT must follow a patient-centered approach. As with single-food OIT, multi-food OIT is responsible for mainly mild to moderate allergic reactions, which can be readily managed or prevented by conventional anti-allergy medication. However, the available literature suggests that multi-food OIT is as well tolerated as single-food OIT. The need for a technical platform and expertise continues to impede the accessibility of multi-food OIT. Low-dose OIT may be a solution to reduce allergic side effects and facilitating access to office-based multi-food OIT.

多种食物口服免疫疗法（OIT）是同时治疗多种食物过敏的潜在途径。它包括每天摄入一系列过敏原，剂量逐渐增加，直至达到维持剂量。多种食物 OIT 必须遵循以患者为中心的方法。与单食物 OIT 一样，多食物 OIT 主要导致轻度至中度过敏反应，这些反应可通过常规抗过敏药物轻松控制或预防。不过，现有文献表明，多食物 OIT 的耐受性与单食物 OIT 相当。对技术平台和专业知识的需求继续阻碍着多食物 OIT 的普及。低剂量 OIT 可能是减少过敏副作用的一种解决方案，同时也方便了在办公室使用多种食物 OIT。

引用次数: 0

Acute localized exanthematous pustulosis caused by topical plant 局部外用植物引起的急性局部红斑脓疱病

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-16 DOI: 10.1016/j.reval.2024.104147

C. Fikri , L. Bendaoud , M. Aboudourib , O. Hocar , S. Amal

A 42-year-old woman presented with an acute eruption of multiple non-follicular pustules on an erythematous base, localized on the leg and hip, with mild pruritus. No mucosal or nail involvement. It appeared a few hours after the application of the medicinal plant “Copparisspinosa” for sciatica in the leg and disappeared after withdrawing the plant. The diagnosis of ALEP was made according to recently proposed diagnostic criteria for acute localized exanthematous pustulosis (ALEP). ALEP is a rare skin reaction described as multiple non-follicular and sterile pustules developing on an erythematous background. The pathogenesis of ALEP is largely unknown. It is drug-induced in 84%, mainly by antibiotics, and non-drug-induced in 16%, mainly by herbal medicines. Herein, we report the first case of PEAL in Morocco caused by a herbal medicine, Copparisspinosa.

一名 42 岁的妇女因腿部和臀部局部红斑上多发性非赘生物脓疱急性发作，伴有轻度瘙痒。无粘膜或指甲受累。在使用药用植物 "Copparisspinosa "治疗腿部坐骨神经痛数小时后出现，撤药后消失。根据最近提出的急性局部化脓性脓疱病（ALEP）诊断标准，诊断结果为 ALEP。ALEP 是一种罕见的皮肤反应，表现为在红斑背景上出现多个非叶状无菌脓疱。ALEP 的发病机理尚不清楚。84%的ALEP由药物诱发，主要是抗生素；16%的ALEP由非药物诱发，主要是草药。在此，我们报告了摩洛哥首例由一种草药铜钱草引起的 PEAL 病例。

引用次数: 0

Influence du sexe sur l’épidémiologie, la sévérité et la réponse au traitement de l’allergie alimentaire 性别对食物过敏的流行病学、严重程度和治疗反应的影响

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-16 DOI: 10.1016/j.reval.2024.104159

C. Elbany , P. Bégin

L’allergie alimentaire est un problème de santé publique croissant, affectant différemment hommes et femmes. La prédominance masculine durant l’enfance et féminine à l’âge adulte est observée dans diverses maladies atopiques. Les garçons montrent une prévalence plus élevée d’allergies alimentaires dans l’enfance, une tendance qui s’inverse chez les femmes jeunes avant de revenir à l’équilibre après la ménopause. Les hormones sexuelles jouent un rôle clé dans ces différences, modulant la dégranulation des mastocytes et favorisant ainsi les réactions allergiques. Au-delà de la prévalence, le sexe influence également la sévérité des allergies alimentaires. Les femmes adultes sont plus susceptibles de souffrir de réactions sévères, y compris d’anaphylaxie alimentaire induite par l’effort, tandis que les garçons présentent un risque accru de poly-allergie alimentaire durant l’enfance. Cependant, des paradoxes subsistent, comme la sévérité accrue de l’allergie à l’arachide chez les filles malgré une prévalence plus élevée chez les garçons. Cela souligne l’influence potentielle du genre et du comportement. La réponse aux traitements, notamment l’immunothérapie orale (ITO), varie également selon le sexe. Les filles présenteraient moins de réactions sévères avant 13 ans, tandis que les garçons en auraient moins après cet âge. En conclusion, une meilleure compréhension des influences sexospécifiques sur l’allergie alimentaire pourrait optimiser la prévention, le diagnostic et les traitements. Cette approche devrait tenir compte des différences hormonales, biologiques et socio-culturelles, ainsi que de l’influence du genre, pour une gestion plus efficace des allergies alimentaires.

食物过敏是一个日益严重的公共健康问题，对男性和女性的影响各不相同。在各种特应性疾病中，儿童期以男性为主，成年期以女性为主。男孩在童年时食物过敏的发病率较高，这一趋势在年轻女性中发生逆转，直到绝经后才恢复平衡。性激素在这些差异中起着关键作用，它能调节肥大细胞的脱颗粒作用，从而有利于过敏反应的发生。除了发病率，性别也会影响食物过敏的严重程度。成年女性更容易出现严重反应，包括运动诱发的食物过敏性休克，而男孩在儿童时期出现多种食物过敏的风险更大。然而，悖论依然存在，例如，尽管男孩花生过敏的发病率更高，但女孩花生过敏的严重程度却更高。这凸显了性别和行为的潜在影响。对治疗，尤其是口服免疫疗法（OIT）的反应也因性别而异。13 岁以前女孩的严重反应似乎较少，而 13 岁以后男孩的反应较少。总之，更好地了解不同性别对食物过敏的影响可以优化预防、诊断和治疗。这种方法应考虑荷尔蒙、生物和社会文化差异以及性别的影响，以便更有效地控制食物过敏。

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引用次数: 0

Place des diététiciens dans le parcours d’immunothérapie orale alimentaire (ITO) 营养师在口服免疫疗法（OIT）计划中的作用

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-15 DOI: 10.1016/j.reval.2024.104168

A. Doc , Y. Shahali , A. Campion , R. Pontcharraud , S. d’Herlincourt , J.M. Rame

This article examines the crucial role of the Dietitian Nutritionist specialized in Allergology (DNA) in the oral immunotherapy (OIT) pathway for food allergies. We will describe the specific tasks of the DNA, who works by delegation and under the supervision of the allergist in the implementation and monitoring of OIT. The different perspectives of this role are discussed, based on available bibliographic data and on current practices as part of a recent care pathway experiment involving DNA and an allergist.

本文探讨了过敏症专业营养师（DNA）在食物过敏口服免疫疗法（OIT）中的关键作用。我们将介绍 DNA 的具体任务，DNA 在过敏学家的授权和监督下开展工作，实施并监控 OIT。我们将根据现有的文献资料和当前的实践，讨论这一角色的不同视角，这也是最近由 DNA 和过敏学家共同参与的护理路径实验的一部分。

引用次数: 0

Unveiling the paradox: Infliximab-induced pustular psoriasis in psoriasis vulgaris 揭开悖论的面纱：英夫利昔单抗诱发寻常型银屑病中的脓疱型银屑病

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-15 DOI: 10.1016/j.reval.2024.104165

K. Ferchichi , A. Chamli , R. Frioui , I. Helal , H. Hammami , A. Zaouak , S. Fenniche

Paradoxical psoriasis induced by tumor necrosis factor-alpha (TNF-α) antagonists is a rare adverse reaction of these drugs, with the pustular presentation being even more uncommon. Diagnosing and management of paradoxical pustular psoriasis in patients undergoing TNF-α antagonists treatment for psoriasis can be challenging. Therefore, we present a case report highlighting the occurrence of paradoxical pustular psoriasis caused by infliximab in a patient undergoing infliximab treatment for psoriasis, two weeks after the ninth injection. A switch to another TNF-α antagonist was considered, with no relapses at 6-month follow-up. This case underscores the importance of vigilant monitoring and recognition of atypical reactions and considering the switch to another TNF-α antagonist as a safe option for these patients.

肿瘤坏死因子-α（TNF-α）拮抗剂诱发的矛盾性银屑病是这类药物的一种罕见不良反应，而脓疱型银屑病则更为罕见。在接受 TNF-α 拮抗剂治疗的银屑病患者中，诊断和处理矛盾性脓疱型银屑病具有挑战性。因此，我们提交了一份病例报告，着重介绍了一名接受英夫利昔单抗治疗的银屑病患者在注射第九次英夫利昔单抗两周后出现的由英夫利昔单抗引起的矛盾性脓疱型银屑病。考虑改用另一种 TNF-α 拮抗剂后，随访 6 个月未再复发。该病例强调了对非典型反应进行警惕性监测和识别的重要性，并考虑将换用另一种TNF-α拮抗剂作为这些患者的安全选择。

引用次数: 0

Urticaire à l’uméclidinium bromure inhalé 吸入乌美溴铵引起的荨麻疹

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2024-10-15 DOI: 10.1016/j.reval.2024.104169

A.M. Rabain , J. Cottin , S. Bauler

We report a case of a man who developed urticaria 48 to 72 hours after inhaling umeclidinium bromide. Urticaria resolved after discontinuation umeclidinium treatment but recurred on reintroduction. Umeclidinium bromide is an anticholinergic inhaled treatment indicated in the background treatment of COPD, for which marketing authorization was obtained in 2014. The most frequent adverse reactions are: nasopharyngitis, headache, tachycardia, cough or pharyngeal pain, constipation, urinary tract infection or sinusitis. Effects related to antimuscarinic activity are of undetermined frequency. Allergic reactions to this product are rare.

我们报告了一例男子在吸入乌美司溴铵 48 至 72 小时后出现荨麻疹的病例。荨麻疹在停止使用乌美司啶治疗后缓解，但再次使用时又复发。乌美溴铵是一种抗胆碱能吸入治疗药物，适用于慢性阻塞性肺疾病的背景治疗，于2014年获得上市许可。最常见的不良反应有：鼻咽炎、头痛、心动过速、咳嗽或咽痛、便秘、尿路感染或鼻窦炎。与抗心绞痛药活性有关的不良反应发生频率尚不确定。对该产品的过敏反应非常罕见。

引用次数: 0

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