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

The suspicions of antibiotic allergies are extremely frequent. True demonstrated allergies are less frequent. If urticarias and maculo-papular eruptions are amongst the most frequent clinical presentations, clinical forms are numerous and severe anaphylaxis, severe toxidermia and/or organ involvements exist and are lifethreatening. Simple avoidance could be risky as well. A firm diagnosis is important because most of the suspicions are not confirmed. The precise description of the clinical history is mandatory. This diagnosis is based on immediate and late-reading skin tests and provocation tests, in the absence of contra-indications. These tests require special training and could be at risk, therefore expertise in the field is needed as well as following up the guidelines edited by the European Network for Drug Allergy - EAACI.

Respiratory and/or food allergy is common in children. Serous otitis media is also very frequent in children, especially those between three and six years of age. On the other hand, in spite of promising animal studies, a cause-and-effect relation between these two conditions in man has not been established. Concerning the treatment, avoidance of food allergens may be as efficacious for an active serous otitis media as for avoidance of a new episode. Conversely, antihistamines do not appear to be efficacious, at least with respect to being curative.

Severe food allergy is increasing, particularly at childhood age. Some risk factors are identified such as associated asthma and the delay for adrenalin injection. Patients identified as at risk must benefit of an adrenalin auto-injector prescription. It is also crucial to educate the patient, its family and its entourage of learning about avoidance diets and device handling.

Background

This paper presents the results from France of a prospective, cross-sectional, international survey conducted among patients and physicians to identify symptom perception and the impact of allergic rhinitis on health-related quality of life.

Methods

Data about the presence, severity and impact of symptoms were recorded by 504 patients and matched with data from their physicians. Health-related quality of life was assessed using the Mini Rhinoconjunctivitis Quality of Life Questionnaire.

Results

According to the physicians’ assessments, a large proportion (71%) of patients had moderate or severe disease, persistent disease (48.3%), and comorbidities such as asthma (32.3%) and anxiety (19%). Persistent disease was present in 55.3% of patients with perennial allergic rhinitis and 44.9% with seasonal allergic rhinitis. Physicians tended to underestimate the incidence of some symptoms reported by the patients, most notably cough, headache, and itchy eyes. Health-related quality of life was negatively correlated with disease severity and number of symptom-free days. Allergic rhinitis had a significantly greater impact on patients with more persistent disease compared with those with intermittent disease (2.0 ± 1.3 versus 1.8 ± 1.2; p < 0.05); nevertheless, 73.9% of patients with intermittent disease reported some impairment of their daily life.

Conclusions

Allergic rhinitis remains a significant health problem in France due to the high prevalence of moderate or severe, persistent disease in patients presenting during routine care as well as to the impact of the disease on health-related quality of life. Patients and physicians differed significantly in their perception of disease severity and in the reporting of some symptoms, including ocular symptoms and cough.

Asthma is a very common respiratory disease in cats, being very similar to human asthma with regards to its clinical and pathological aspects. Allergic asthma is the form the most frequently diagnosed in humans and this is presumably the same for cats. The present study concerns 20 cats with clinically significant asthma, with appropriate radiological and broncho-alveolar cytological evidence for which an allergic workup had been carried out. The cats had a history of recurrent coughing episodes, wheezing and expiratory dyspnea for which regular oral or systemic corticotherapy was required. After these corticoids were stopped and replaced by inhaled corticoids, skin tests were done on 18 of the cats. The results showed sensitization to aeroallergens, mainly house dust mites, less often to pollen, in 15 of them. Avoidance of dry cat food resulted in remission of symptoms in three cats allergic to storage mites. Specific immunotherapy was prescribed for 12 cats. After 6–9 months of therapy, total remission of asthma symptoms was observed in eight (67%) of them. Four cats still required pharmacotherapy, including inhaled bronchodilator and corticoid 2–3 times per week. This study illustrates the role of an allergenic factor in feline asthma and demonstrates the advantage of a specific therapy, avoidance or specific immunotherapy.

Allergic rhinitis has for a long time been considered to be a relatively minor allergic symptom, much less important than anaphylaxis and asthma. Its true frequency was unknown. Its management remained empiric. Its association with asthma was not clearly determined, although concerning adults, this association was rather well-known. A number of studies in children have now made more certain the association between asthma and allergic rhinitis, the impact of rhinitis on the child's quality of life, and the significance of allergic rhinitis in the natural history of allergy and asthma. This review will cover some current aspects of allergic rhinitis: its association with asthma and food allergy, quantification of atopy, and its impact on daily life. It leads to recommendations for everyday practice of allergy in pediatrics. Given that allergic rhinitis probably begins earlier and earlier, children with this condition need to be followed closely and, if necessary, have their allergy tests repeated. Specific immunotherapy certainly merits to be used more frequently.

The National Association of Continuing Medical Education in Allergy (Anaforcal) proposes, for the year 2008, a teaching module on the theme of allergic rhinitis aimed at general practitioners in 50 French cities. The choice of this theme is based on the frequency and the impact of this condition on public health. This teaching module will include three simple, didactic clinical cases. In addition, it contains the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) report on allergic rhinitis, with various documents on its diagnosis and therapy. The document strongly emphasizes the originality of this training in terms of its organization, conception and interactive teaching method.