Allergie et immunologie最新文献

The role of Candida species in allergic diseases is briefly reviewed pointing out the more common forms of cutaneous and respiratory allergy where Candida can be implied, the current laboratory diagnostic methods and the possible effectiveness of Candida immunotherapy in selected patients.

Studies that compare the systemic impact of inhaled corticosteroids (CI) abound in the literature often with contradictory results. Most of the studies report secondary biological effects in the suprarenal function without clinical effect due to taking high doses of inhaled corticosteroids. Surveillance of the secondary effects on bone is difficult to demonstrate. Finally, speed for recognition in asthmatic children during the first year of treatment is slowed down but the level at adult age is not affected. The variability of these results is associated with the former taking of corticosteroids by the general route. Administration of corticosteroids by the systemic route, therefore makes difficult the evaluation of secondary effects due only taking inhaled corticosteroids.

The fresh outbreak of allergies and especially that increasingly early for food or even for new pneumallergens (sensitization already in utero) pushes us to test increasingly various and many allergens in children. The insufficiency of compliance of certain children to allergic skin tests encouraged us to seek new diagnostic methods. In our office we developed a new method of diagnosis by multipuncture, individualized and easily adaptable to each child. It is about a fast and reproductible prick-test which avoids stains and smudges due to the application of drops directly on the skin. It makes it possible to initially place easily all the tests on a plate (PIPET or Patient Individual Plate Easy Test) then on the skin by a multipuncture method. The tests can even already be prepared in the days which precede, provided that the plates are put in the fridge, with the name of the patient and the allergens used, for memory. It is about a rigorous test, reliable and careful, easy to carry out even in the most difficult children.

International guidelines on asthma recommend to add inhaled long-acting b2-agonists in patients insufficiently controlled with an inhaled corticosteroid alone. A multicentre prospective study was carried out in 250 children (age 8.4 +/- 2.7 years) whose asthma remained symptomatic with impaired lung function despite a treatment with 400-1000 micrograms/day of beclomethasone or equivalent. Salmeterol 100 micrograms/day was added to the previous dose of inhaled corticosteroid for 2 months. PEFR was improved as soon as the first month of treatment (67.2 +/- 44.4 L/min, p < 0.001) and at month 2 (75.0 +/- 44.1 L/min, p < 0.001). The percentage of symptomatic patients, the number of days and nights with symptoms, the number of days with prn bronchodilator use were significantly reduced (p < 0.001). The decrease in the distress and severity scores of the Childhood Asthma Questionnaire indicated an improvement in quality of life due to better asthma control. This study showed that lung function and symptoms were significantly improved as soon as the first month of treatment, improvement maintained thereafter, with a better quality of life and a good tolerability.

Background: Studies have shown that allergens are very important sensitizing agents in patients with asthma. Respiratory disorders such as asthma and allergic rhinitis are common in the United Arab Emirates, (UAE).

Objectives: The aim of this study was to investigate the relationship between allergen specific IgE antibodies and skin test reactivity in patients with asthma in hot climate and desert Arabian country.

Design: A hospital-based prospective study conducted.

Setting: Tawam Teaching Hospital, Al-Ain, UAE.

Patients: 327 adult patients recruited with respiratory, dermatologic and ophthalmologic diseases of suspected allergic origin who attended Tawam Teaching Hospital of Faculty of Medicine, Al Ain, UAE, during three years from 1996 to 1998.

Methods: Skin Prick Test (SPT) and radioallegosorbent tests (RAST) were performed on 327 patients for common allergens. The blood sample was taken for measuring specific IgE concentration.

Results: There were 327 UAE patients of whom 117 (35.8%) were males and 210 (64.2%) were females. The population sample had a higher prevalence of diagnosed asthma among females (48.1%) than in males (36.7%). Skin prick testing showed that 244 patients (74.6%) had positive results, and 83 patients (25.4%) were found to be skin test negative. 44% had a positive family history of asthma. The twelve most common reactions in the United Arab Emirates were: Mesquite (45.5%), Grass Mix (40.7%). Cottonwood (33.1%), Bermuda Grass (31.3%), Kochi (25.8%), Acacia (25.6%), Alfalfa (22.9%), Chenopodium (19.6%), Date palm (13.8%), Cockroach (14.7%), house dust (11.9) and Dust mite (9.5%). Total IgE level (> 100 kU/l) was strongly associated with history of wheeze (p = 0.019), asthma (p = 0.01) and allergic rhinitis (p < 0.0001), atopy (p < 0.0001) and the presence of specific IgE antibodies to grass pollen (p < 0.0001), mite (p = 0.008) and cockroaches (p = 0.025).

Conclusion: The present study revealed that hypersensitivity to pollens, house dust, dust mite and cockroach was common. The family history, environment, and airborne allergens are identified to be risk factors for asthma and other allergic diseases in Arabian Gulf Countries.

The currently proposed guidelines and consensus for asthma include Peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) as two criteria to classify asthma severity. The report between these functional data and clinical classification degrees has been evaluated in 153 asthmatic patients. Concordance between functional evaluation and clinical degree has been found only for moderate persistent asthma but not for intermittent or mild persistent asthma. These results suggest that the correlation between clinical evaluation and lung function proposed in the guidelines must be reevaluated.

Asthma from exposure to inhalation of isocyanates is an affection recognised under the title of work place diseases within table no 62 in the General Regulations and no 43 in the Agricultural Regulations. If workplace induced asthma is the most frequent of the workplace respiratory illnesses with a frequency of 2 to 15% of the asthmatic population, 1 patient in 2 will only be the object of a declaration and 1 in 3 the objective of a survey by the administrative authorities. The frequency of isocyanate asthma is on average 16.4% amongst workplace asthmas (19.6% in the industrial environment and 1.5% in an agricultural environment); if this prevalence is dose-dependent according to Baür, 30% of patients exposed to weak doses of isocyanate (0.3% ppb according to White) develop asthmatic disease whilst Bernstein estimates as 5 to 10% the frequency of asthmatic disease per 100,000 persons who are exposed to isocyanates.

Iodinated contrast media are responsible for immediate or delayed adverse reactions. Because of the wide use of these products, one must consider them as drugs. The delay and nature of the undesirable events must be carefully recorded because in some selected cases, a true allergic mechanism can be proved. Cutaneous skin tests identify the culprit drug and find safe alternative for the patient.

Introduction: What impact does the use of new drugs and latex gloves it have on the frequency and the severity of peri-anaesthetic anaphylactoid reactions? Does the evolution of in vitro techniques does represent a progress in the imputability of the substances at the origin of the shock?

The methods: They include the letter from the anaesthetic doctor, the questioning by the allergologist, skin tests (Pricks, IDR) with the anaesthetic substances and the latex according to the GERAP protocol and the biologic tests (Human Basophilic Degranulation test (TDBH), Radio ImmunoAssay (RIA), leukotrienes E4 assay (LTC4), Flow Cytometry (CMF)).

The results: 386 patients were explored (289 women and 88 men, mean age 41.5 years). The muscle relaxants are the first cause of anaphylaxis 77%. Muscle relaxants cross allergy is found in 55.1%. The Latex, tested since 1989 with Allerbio and Stallergenes extracts, is responsible for 25 shocks with one death and 15 with grade III or IV. Preventive antibiotherapy, since consensus meeting of 1992, seems responsible of 17 accidents. 116 TDBH, 216 RIA, 17LTC4 and 47CMF. TDBH are made concordant with skin tests in 48.2% against, 71.2% for the RIA.

Conclusion: The experience of 17 years of allergo-anaesthetic consultation confirms the first row for the muscles relaxants for the target of anaphylactic shock, but the imputability of Vecuronium and Rocuronium increases to the detriment of the Suxamethonium. The Latex is in the second row, but the target questioning, the systematic use of Prick tests and "latex free" surgery room limit its increase which should change down. The antibiotherapy occupies the third row and might increase. 54 accidents have remained unexplained.

Biodiversity on the Earth is mainly made up of the huge number of existing marine organisms. Marine animals and plants elaborate a great panel of chemicals, many of them exhibiting strong biological activities. So, the seas enable human kingdom to obtain a large number of active products of medicinal interest. This paper deal with the various steps since the collection of the marine samples up to the marketing of the new molecules. Recent drugs from the seas and the main scientific or industrial partners concerned are also introduced.