Revue francaise d'allergologie et d'immunologie clinique最新文献

The diagnosis of a rhinitis in children older than 7 years is usually easy. The task is more difficult in younger children with ENT inflammatory diseases since a lot of risk factors may coexist. Allergy should be suspected in cases of chronic rhinosinusitis, in cases of persistent chronic otitis media and in cases of recurrent croup or persistent vocal fold nodules. The challenge is to clearly identify the role of allergy among numerous others parameters (as GERD, smoking exposure, adenoid hypertrophy for example). Collaboration between ENT, allergists and pediatricians is helpful in order to determine the best treatment to be proposed to the child.

L’anaphylaxie alimentaire au soja est peu fréquente. Le réseau d’allergovigilance a colligé sept cas durant les deux dernières années. Ces réactions sévères présentent la particularité d’être survenues à la suite d’ingestion de boissons à base de lait de soja chez des patients non allergiques à l’arachide. La recherche d’IgE spécifiques par ImmunoCap^® soja (Phadia) est négative dans cinq sur sept cas, inférieure à 0,7 kU/l dans deux cas. Un taux fort d’IgE spécifiques anti-Gly m 4 est mis en évidence dans quatre cas avec négativité du Cap^® au soja. Les auteurs discutent sur la façon de conduire le diagnostic biologique d’une allergie au soja chez des sujets sensibilisés à Bet v 1. Ils soulignent que la sensibilisation croisée à un homologue de Bet v 1 peut engendrer une anaphylaxie sévère. Il n’est pas actuellement possible de déterminer s’il y a une augmentation de l’incidence de ce type d’allergie ou si des cas émergent, grâce à la mise à disposition de l’ImmunoCap^® rGly m 4.

Anaphylaxis to soy is infrequent. Seven cases have been declared by the Allergy Vigilance network through 2006–2007.They concern seven females, six of them being sensitized to birch pollen. Clinical reactions were related to soymilk. ImmunoCap^® to soy was negative in five and low (inferior to 07 kU/L) in two cases. Elevated levels of specific IgE to r Gly m 4 were observed in four cases with negative test to soy. The authors discuss the best biological tests to establish this Bet v 1-related soy anaphylaxis. They point out to the potential severity of allergy induced by Bet v 1 homologs such as Gly m 4. A real increase of prevalence of this type of soy allergy is questionable, since the diagnosis is clearly improved by the use of the recombinant allergen.

The angioedema disease represents a situation associated with production or accumulation of kinins at the endothelial cell surface. A classification of the different forms of the disease can be proposed upon the bases of the metabolic failure, either from the increased proteolytic activities towards kininogens (decreased control by C1 Inhibitor, escape to this control) or from the kinin accumulation associated with the decreased catabolism. The diagnostic must describe the failure of the C1 Inhibitor control, the gain of function of the kinin-producing kininogenases or the decreased activities of the proteases needed for kinin catabolism (kininases).

Allergen immunotherapy remains the only etiologic treatment for allergic diseases. During this last decade significant progresses have occurred in the field of mechanism knowledge of allergen immunotherapy and in the search of new routes of administration or new types of formulation. On the other side, new vaccine development that exploits molecular engineering techniques may allow to create allergen extracts with specific target on the immune system. All of these should promote the use of allergen immunotherapy both by increasing the number of patients and by extending spectrum of indications of immunotherapy beyond allergic respiratory diseases. So, in the future, allergen immunotherapy should remain a corner stone in the management of allergy.

Sixty-one adults with drug-induced anaphylactic shocks were admitted to the Teaching Hospital of Clermont-Ferrand between 1st January 1999 and 31st December 2005. The patients included in the study were identified on the basis of tryptase assay requested by the Laboratory of Immunology during that period. The study focuses on the epidemiology and aetiology of the anaphylactic shocks but also on their diagnosis and in particular the allergic investigation, which should be performed at least six weeks after the accident: in all, 14 patients were seen. Another aspect of the study concerns the diagnostic significance of the tryptase assay compared to the allergy results available and the clinical severity of the observations. The survey compares findings from the Laboratory of Immunology and the Hospital Allergy Department with cases noticed by the Regional Center of Drug Surveillance to improve the management of patients with a story of anaphylactic shock.

Atopy and the onset of an allergic reaction during vaccination sometimes result in abstention that disadvantages the patient. First, the problem of vaccinating the atopic individual is discussed with the recurrent problem of egg allergy. Only severe anaphylaxis to egg requires hospitalization for vaccines containing egg protein. Asthma exacerbation reactions or atopic dermatitis (flash phenomenon) require certain precautions before vaccination. Apart from these measures, there is no systematic vaccine contraindication for the atopic child and the French vaccination schedule can be applied to children with allergies. After reviewing the components of vaccines that have an allergic potential, we discuss the course to follow in cases of reaction to a vaccine.

The usual types I and II of hereditary angioedema (HAE) are related to mutations on the complement C1 inhibitor gene (SERPING1). These remain rare diseases and, in a certain number of cases, are worsened by estrogens. Another type has been described more recently and called “estrogen-dependent inherited form of angioedema” or type III. The clinical symptoms and the physiopathology are polymorphic. Deregulated bradykinin production is the common feature of HAE. Estrogens bind to specific receptors. The hormone–receptor complexes can activate the transcription of genes through binding to specific sequences of the DNA. Most of the steps are involved in bradykinin metabolism. Its production, the B2 receptor expression and its degradation can be controlled by estrogens at the molecular level. It was indeed shown that C1 inhibitor, the Hageman factor, kininogen, plasma and tissue kallikreins, B2 receptors and some enzymes involved in their catabolism are targets for the estrogens. These observations have some direct implications for contraception in the women with HAE. Estrogen containing pills are contra-indicated, whereas the various contraceptive progestins or IUD can be used. Concerning postmenopausal symptomatic women, estrogens are contra-indicated, whereas progestins and tibolone can help to alleviate the climacteric symptoms.

Childhood rhinosinusitis is a frequent motive for consulting a physician. Given its recurrent character, the patient should be assessed for intrinsic as well as environmental factors. Intrinsic factors to search for include adenoid hypertrophy, allergies, gastroesophageal reflux, diabetes, immunity deficiency, a ciliary disorder, and cystic fibrosis. Among the environmental factors, passive smoking should be discouraged; community living, repeated viral infections, and pollution have also been implicated.

Despites it's therapeutic efficiency, angiotensin I converting enzyme inhibitors are characterized by different acute complications which nature depends on the clinical context. Among these, angioedema has been reported in hypertensive patients but also during heart failure and in stroke patients treated by fibrinolysis. Angioedema associated with angiotensin converting enzyme inhibitors results from the meeting of different factors affecting the pharmacological activity of kinins and neurokinins, powerful vasodilatory and inflammatory peptides. This paper describes different experimental evidences pleading for a multifactorial nature of this rare but potentially life-threatening acute side-effect.