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

The aim of the present study was to analyze the short-term relationship between pollen exposure and antiallergic drug consumption in the general population, taking into account confounding factors such as atmospheric pollution and meteorological parameters. Data on the daily consumption of antiallergic drug by individuals in the Clermont-Ferrand urban area from January 1 2000 through December 31 2001 and from January 1 2002 through December 31 2003, was obtained from the French health insurance database. An episode of allergic rhinoconjunctivitis (ARC) was defined as the association of an oral antihistamine and a local-acting antiallergic drug on the same prescription. The relationship between daily changes in atmospheric pollen concentration and daily changes in the number of treated ARC cases was analyzed using time series analysis. The results showed that the risk of treated ARC increased significantly with an interquartile increase in pollen concentration for grasses (5%, P < 0.001), hazel (7%, P < 0.02), birch (7%, P < 0.001) and ash (2%, P < 0.001). The effect was significant on the same day for all except the grasses, for which the risk lasted three days. Time series studies of antiallergic drug consumption may be useful for assessing the risk of exposure to pollens in an ambulatory population.

Type III hereditary angiœdema (HAE) presents the same symptoms as type I and type II ones, which are associated with C1Inh deficiency. Women are principally affected. First symptoms often appear during pregnancies or with women taking combined pills. C1Inh and C4 assays are normal. Some of type III HAE can be associated with mutations of the Hageman factor gene. Type III HAE diagnosis is difficult. Kininogenase activity assay and the Hageman factor gene analysis will help us in the future. Treatment strategy is not known: tranexamic acid could be used. Also, C1Inh concentrate could be administrated for laryngeal attacks.

New drugs, especially biotherapies, are increasingly used for a rapidly expanding number of inflammatory and neoplastic diseases. Among these treatments, cytokines, monoclonal antibodies, anti-TNF, inhibitors of tyrosine kinase, inhibitors of epidermal growth factors receptors can induce adverse cutaneous effects. These patients need early and appropriate dermatological management. Other new drugs, such as voriconazole, lamotrigine, bupropion… are also a possible cause of skin reactions.

Primary and tertiary prevention of childhood allergies and asthma has progressed. It appears ever more certain that avoidance, whether primary or tertiary, should be global to be effective in the prevention of asthma. That is why it seems useful that medical home environment councilors (CMEI) who have the necessary time should audit the quality of the indoor air and give advice on the widest possible avoidance measures (including other household pollutants that may aggravate allergic asthma). With an environmental disease such as asthma, control of the environment is a therapeutic approach that should be offered to children with allergic asthma.

Allergens of plant and animal foods and pollen belong to a highly restricted number of protein families. The AllFam Database (http://www.meduniwien.ac.at/allergens/allfam/) provides regularly updated lists of protein families that contain allergens. At present, 2% of the 9318 protein families defined by the Pfam Database (http://pfam.sanger.ac.uk/) contain allergens. Related protein families can be grouped into superfamilies placing allergenic proteins in an evolutionary context. With the exception of the prolamin superfamily, allergenic plant proteins are found in few member families of their respective superfamilies. This might indicate that allergenicity emerged rather infrequently in a very limited number of protein families. Moreover, most members of a given protein family seem to be non-allergenic. In contrast to plant allergens, the allergenicity of animal food allergens seems to be dependent on the degree of identity to a human homologue. The closer a potential animal allergen is to a human protein, the less likely it is to act as allergen.

Perioperative allergic reactions occurring during anaesthesia are a potentially life-threatening complication. Perioperative screening for risk factors, primary prevention for latex allergy and secondary prevention for allergy to anaesthetic agents and antibiotics should result in a reduction of the incidence of this complication. The anaesthesia technique chosen should be regional when this is compatible with the surgery and the least active histamine liberators should be used when general anesthesia is necessary. To make the diagnosis of this complication during the anesthesia and then to refer the patient to an allergy consultation centre are essential for identification of the responsible agent and to prevent its being used subsequently. In spite of preoperative screening, the incidence of allergic reactions to latex remains significant. The use of latex-free medical and surgical equipment decreases this risk and it should be an institution-wide measure.

Training in allergy exists in Moroccan medical schools, but it does not have the place that it should if we take into account the increased frequency of allergic diseases in Morocco (and elsewhere) and the increase in the demand for care that results. In our country, allergy is not recognized officially as a specialty and allergic patients are cared for either by pulmonary specialists or physicians with some training in allergy, or by generalists with a French medical school diploma or with an allergy diploma. There is no explicit allergy training program in the medical schools, but instead there are sessions on allergy presented in the different medical specialities from the second to the fifth years, in which immunology, asthma, eczema and urticaria, nasosinusoidal allergies, conjunctivitis and anaphylactic shock are considered. The amount of time devoted to teaching allergy does not exceed 30 h (which is 1.4% of the entire curriculum). During classes in the third cycle, allergy is not clearly separated from other subjects; only the pneumology–pthisiology specialist course includes in-hospital training in allergy. Instruction is very limited in the other specialities. Moroccan medical specialists have the possibility to learn allergy on their own by enrolling in a university course in allergy and clinical immunology that is sponsored by the Department of Pulmonary Diseases in Casablanca. In regard to continued medical education, this can be done under the aegis of specialist scientific societies and associations. In conclusion, the teaching of allergy includes only an introduction but the number of hours devoted to this subject remains limited and it is time to think about the allergy course of the future. This teaching remains underrepresented in the third cycle which is devoted to clinical practice. This speciality must be developed, and it is now time to ask whether it should not be recognized officially.

In spite of numerous publications on occupational lung diseases, latex allergy, and the relationship of nose-to-bronchi, the particularities of the clinical, epidemiological and therapeutic aspects of latex allergic rhinitis (LAR) are very little considered in the literature. Based on our own experience and on a review of the literature, we will examine the environmental context of LAR and try to define its most important diagnostic and therapeutic criteria. An early diagnosis of LAR and reduction of exposure to latex allergens before its evolution to asthma, can limit the socioeconomic impact of this condition.

Eosinophilic airway inflammation may be encountered in asthma and in non asthmatic eosinophilic bronchitis, which is a recently identified and common cause of chronic cough. Non asthmatic eosinophilic bronchitis may be differentiated from asthma by the absence of airflow limitation and of bronchial hyperreactiveness (potentially reflecting the different localization of mast cells within the airway wall). Diagnosis is based on the confirmation of eosinophilic airway inflammation, usually by induced sputum, in the absence of other causes of chronic cough or of radiological and lung function abnormality. The cough is generally improved by inhaled corticosteroids. The long-term outcome is still not known; non asthmatic eosinophilic bronchitis may lead to the onset of fixed airway obstruction or asthma.