Revue Francaise d Allergologie最新文献

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.

Background

White mulberry (Morus alba) pollen grains trigger allergic diseases including asthma, allergic rhinitis, and allergic conjunctivitis. Non-specific lipid transfer proteins (nsLTPs) are robust allergens found in higher plants. Although it was isolated and immunologically characterized in the fruits of Morus nigra, it has not yet been determined whether nsLTP is one of the M. alba pollen allergens.

Objective

This study aims to examine the possible allergenicity of M. alba pollen nsLTP by producing it recombinantly, followed by immunoblotting.

Methods

Total RNA was isolated from M. alba pollen grains, and the nsLTP gene was obtained by reverse transcriptase polymerase reaction. It was cloned into Escherichia coli using pQE2 plasmid and purified by immobilized metal affinity chromatography following the expression. To confirm the immunoreactivity of the purified r-nsLTP, immunoblotting was performed with the serum of patients allergic to M. alba pollen. B-cell epitopes of nsLTP were also predicted using the bioinformatics tools, namely Bioinformatics Predicted Antigenic Peptides, BepiPred-2.0, and the Immune Epitope Database, whereas T-cell epitopes were estimated by using NetMHCIIpan-4.0 and NetMHCII-2.3 servers.

Results

The r-nsLTP showed positive results in immunoblotting with sera of 7/7 (100%) of M. alba allergic patients. Five B-cell epitopes (26–31, 43–50, 65–71, 92–100, 105–115) and three T-cell epitopes (57–65, 78–86, 105–113) were predicted by in silico analyses.

Conclusion

Data obtained in this study are expected to support the use of r-nsLTP in solutions for diagnosis and treatment of M. alba allergy and cross-reactivities between nsLTPs, as well as recombinant allergen production for vaccination.

Study objective

The study aims to analyse 36 children presenting with acute fish and shellfish food protein-induced enterocolitis syndrome.

Patients and methods

This is a retrospective, single-centre study conducted between 2016 and 2024. Diagnosis was established based on the international diagnostic criteria published in 2017.

Results

The most frequently implicated foods were cod and prawns. The median age at first reaction was 12 months for fish and 61 months for shellfish. Only one out of 35 patients showed positive allergological tests, but 21 out of 36 patients had a personal history of atopy. Twenty-eight patients reacted exclusively to fish, 6 exclusively to shellfish, and 2 to both. Eight patients reacted to multiple types of fish, while 13 tolerated types of fish other than the one responsible for the initial reaction. Four children also reacted to other types of food.

Conclusion

This study confirms that fish is one of the most important triggers of food protein-induced enterocolitis in children in Europe and that reactions to shellfish are more frequent at a later age. These patients generally tolerate other types of fish and shellfish than those responsible for the initial reaction. Therefore, it is important to encourage patients to incorporate other varieties of these foods in their diet, if necessary with an introduction through an oral food challenge.

The development of oral immunotherapy in food allergy calls for ethical reflection. Material norms of justice are expected when individuals are entitled to receive particular goods due to their health condition, while their availability is not total. After outlining how these issues arise in medical literature, this paper draws on Aristotle's philosophy to present the dual face of justice: while it is socially indispensable, it is also an individual virtue. Contemporary doctrines propose competing standards for the allocation of goods, ranging from utilitarianism to procedural justice. For the clinician, torn between the care of the individual patient and collective concerns, the virtue of justice may be the only way to resolve dilemmas that principles alone cannot address.