Allergie et immunologie最新文献

Pollution of the air of the interior of premises are generally less understood than exterior town atmospheric pollution. Now the time spent at home is considerable, around 80%. Aerocontaminants are of chemical, biological or particulate nature. Amongst asthmatics, internal NO2 is capable of producing an asthmatic crisis, perhaps by a direct effect of the pollutant and perhaps by potentiation of the bronchial response to the allergen. COV and formaldehyde may have a bronchial effect on asthmatics, at significant levels that are rarely found in a domestic environment. Endotoxins present in domestic dust may also be a serious co-factor in asthmatics who are allergic to mites. Concerning allergens, identification and quantification of immunodominant proteins of the principal pneumoallergens of the internal environment has emphasized the great diversity of levels, and given a comparison of the link between the level of allergen in the air and dust, and the development of the sensitization of a predisposed subject. Measurement of the aerodynamic behaviour of pneumoallergens has led to a better understanding of the physiology of allergic asthma. Nevertheless it is appropriate to follow the work that tries to assess the relative importance of each of these factors, both in allergic sensitization and in the clinical response to the allergen. Understanding the respective roles played by the different domestic pollutants should allow an improvement in diagnosis and treatment of pathologies that are linked to the domestic environment.

The diagnosis of IgE dependant food allergy relies on the demonstration of specific IgE by prick tests or in vitro tests. The ENEA System II (CIS bio international) is a new automatic assay analyser of specific IgE, that uses allergens coupled to a solid phase and a urease marked anti-IgE antibody. This study aims to compare the performance of the ENEA System II to that of Pharmacia CAP System for the assay of food specific IgE (milk, eggs, peanuts) by means of unit tests and multitests. Sixty three patients were included: 10 non atopic controls, 19 egg-allergic patients, 10 patients allergic to cow's milk, and 24 patients allergic to peanuts. The food allergy was proved by means of a double blind oral, labial or bronchial challenge and/or effective avoidance of the food. For both systems, the specificity of unit tests was 100%. Sensitivity was 60% and 100% with both systems, using milk and peanuts respectively. However, using eggs, it was only 74% with ENEA System II versus 95% with Pharmacia CAP System. The intra-trial variation coefficients were comparable. In contrast, inter-trial variation coefficient was very high for the ENEA System II (20.3% versus 7.3%). The multitest named "children's food" showed an important inter-set variability. In conclusion, the ENEA System II is a rapid automatic tester whose performance has to be improved. The actual thermostatically control of the system was shown to achieve quality assay. The conservation of the solid phase, recently perfected, is expected to suppress the inter-set variability.

Allergy to mosquitoes that produces anaphylaxis is very exceptional. We present two observations of anaphylaxis to mosquitoes with good correlation between the clinical history and the immunological indications of which the basophil activation test proved to be effective. The many allergens of mosquitoes are contained in the juices and salivary glands and their molecular weights are between 22 and 95 kD. Specific immunotherapy, which uses whole body extracts of mosquito, gives good results of protection that induces excellent tolerance and has very good efficacy.

Business and tourist journeys by air contribute to exposure of the body to multiple environments. The allergic patient, considered rightly to be a sentry of the environment, has many reasons to care about his journeys and to take precautions that are adapted to his case under the impetus of advice and information from his physician and his specialist. Some advice falls within a simple logic that is enough to remember when planning the journey while the others measures must follow a correct preventative strategy for allergy risks as much as those that concern the modalities before leaving as a drive taken on the ground. It is important therefore to know how to give advice and information on the different risks linked to the allergic condition and to the field of allergy and help the patient to orientate his choice of place of the journey, the methods of lodging, of transport and the programme of the journey. The advice should also include the preventative measures as a function of the known pathology under the form of medical equipment before, during the stay and on return. Finally some advice relative to medical equipment for prevention and cure would appear to be judicious.

Undersea diving is an activity that is practised more and more in holiday clubs. There is no precise legislation on the causes of unfitness of the amateur, in contrast to the professional diver, where the medical criteria are strict and controlled. When diving with a cylinder, on descent, the ventilatory load increases with increase of the ambient pressure and dynamic resistance in the airways increases. "As with an insufficient respiration on the surface, a healthy subject when diving has a ventilatory ability that is drastically reduced". Moreover with cylinder ventilation, the diver has available a reserve of gas under pressure from which he inspires with the aid of a breathing apparatus (regulator): he breathes dry gas that is dried before compression in the reservoirs, chilled by the relief valve on leaving the reservoir. This inhalation of cold, dry air associated with a hyperventilation during the descent produces ideal conditions to trigger exercise induced asthma. All subjects who present a bronchial hyperreactivity have the risk when diving with a cylinder of triggering a bronchospasm that is identical with that of a sporting asthmatic. During surfacing: the re-surfacing diver runs the risk of an accident of pulmonary suppression if he does not expire sufficiently during his return to the surface: the mass of intrapulmonary air of the resurfacer dilates and the excess of volume is exhaled by the diver: a volume of air of 5 l at 10 m depth corresponds to a volume of 10 l on the surface. Therefore the airways must remain free: an obstruction of the peripheral airways associated with an urgent re-surfacing produces a very rapid thoracic dilation which is responsible for pulmonary barotrauma (pulmonary barotrauma is frequently lethal with 30% of accidental deaths).

The most common "allergic" photodermatoses are reported in this review: (a) systemic and topical exogenous photosensitizations with phototoxic and photoallergic reactions and the most frequently chemicals photosensitizers incriminated. (b) idiopathic photodermatoses including benign summer eruption, polymorphous light eruption and solar urticaria. Clinical recognition patterns are stressed as well as differential diagnosis. Photobiological exploration is also detailed.

Objective of the study: To describe the use of the Prolair Autohaler (Prolair AH) in the conditions of "natural" prescription so as to define its place in the therapeutic arsenal available to practitioners. NATURE OF THE STUDY: Open study conducted in any practice of liberal chest physicians.

Results: Three hundred and seventy six patients (56.1%) were treated by Prolair AH and 296 (43.9%) continued their usual treatment with a standard aerosol doser (BDP ADS) that contained the same active principle, used with an inhalation chamber (65 patients, around 22%) or without (231 patients around 78%). The comparisons between the two groups, made at the end of two months of treatment, showed significant differences in efficacy of the two therapies. The percentage of patients who presented a respiratory shortage was significantly lower at day 60 in the Prolair AH group than in the BDP ADS (33.6% vs 41.4%; p < 0.05) though the percentages were comparable at inclusion. Peak problems were significantly more frequent at inclusion in the Prolair AH group (45.5% vs 37.8%; p < 0.05) but at day 60 were significantly less frequent (14.6% vs 22.9%; p < 0.05). Up to day 60, in each treatment group, the same percentage of patients presented whistling (Prolair AH 21.8% vs 22.9%; p: NS) although initially they were significantly more frequent in the patients of the Prolair AH group (60.3% vd 49.8%; p < 0.01). Improvement of DEP measured theoretically was significantly more important (p < 0.05) in the Prolair AH group which passed from 67.6% to 78.8% against 70.5% to 75.6% in the BDP ADS group.

Conclusion: When prescribed to patients with a more evolutive asthma and poor coordinators, Prolair Ahas produced results that are comparable to or better than those of patients treated with ADS that contains the same active principle, together or not with an inhalation chamber.

Etiological diagnosis of an allergic condition is assured mostly clinically and in particular by the data from a specific and minute interrogation. Complementary investigations only confirm the diagnostic suspicion produced by this interrogation, which includes several essential steps: The history of the patient from the first symptom to the day of consultation. The common criteria of unity of time, place or action on the different manifestations of hypersensitivity. The provocation factors and improvement of critical episodes. The mode of life of the subject and the factors of environmental imbalance.

Chronic urticaria in otherwise healthy sport horses, generally has an origin in a food allergy, accompanied by a facultative latent enteritis. Etiological diagnosis may be made by skin tests that permit a following targeted avoidance.

Introduced in the 1930s, the sun filters (chemical screens) are very widely used as they are contained in photo-protective creams and in many other cosmetics. Allergy to sun filters seems to be rare in the general population (< 2%), but more frequent in populations which are suspected of photo-dermatosis (2 to 25%). It is composed of contact allergies, but also photo contact allergies in 45 to 85% of cases. Photo-biological exploration is comprised of application of photopatches and thus is necessary together with epidermotests. Crossed allergies, though rare, may be seen between filters, but also with substances that have a close chemical structure. Treatment such as prevention, if photo-protection is necessary, rest in discarding the causal filter and use of non-allergenic mineral screens.