Propositions de mise à jour des recommandations pour le bilan des allergies aux hyménoptères

Contexte : Les allergies aux hyménoptères sont fréquentes et peuvent être très grave. Le seul traitement préventif efficace est l'immunothérapie spécifique (ITS). Mais les modalités du bilan diagnostique et les indications de ce traitement se basent sur des recommandations datant de 2005, nécessitant d'être actualisées, et des enquêtes de pratiques récentes ont montré la variabilité des méthodes utilisées en dépit de ces directives. Objectif : Le but de cette étude était de faire des propositions de mise à jour des recommandations sur le bilan diagnostique des allergies aux hyménoptères afin d'améliorer et d'uniformiser les pratiques. Méthodes : Le travail consistait en l'analyse approfondie de la littérature depuis la publication des recommandations de l'Académie Européenne d'Allergologie et d'Immunologie clinique et de l'avis d'un groupe de travail de la Société Française d'Allergologie (SFA). Résultats : Parmi 422 articles retrouvés dans la littérature, 68 ont été retenus et ont permis d'aboutir à des propositions validées par le groupe d'expert. Nous proposons que le diagnostic et potentiellement l'ITS soient étendus à toutes les réactions systémiques, ainsi que pour certaines réactions locorégionales en cas de risques supplémentaires. Nous pensons nécessaire de rappeler que le diagnostic comprend des tests cutanés intradermiques et des dosages des IgE spécifiques, auxquels peuvent s'ajouter des allergènes recombinants et la tryptase sérique basale. Les tests d'activation des basophiles et les tests d'inhibition spécifique sont considérés comme cliniquement utiles et doivent être standardisés et rendus disponibles. Conclusion : Nous prévoyons de lancer une campagne de diffusion de cette étude à tous les allergologues par la SFA et de mesurer l'impact de ces recommandations à distance.ST ETIENNE-BU Médecine (422182102) / SudocSudocFranceF

Antigen 5-spiked Vespula and Polistes venom extracts for Vespid allergy diagnostics: A French multicenter study

International audienceVespula and Polistes spp venom extracts (VEs) for ImmunoCAP (Thermo Fisher Scientific, Uppsala, Sweden) platforms have beenspiked, that is, enriched, with group 5 allergens since 2012. Limited information was available from the manufacturer, but small cohortshave reported altered performance for in vitro diagnostics.1,2 Herein we present the results of a French multicenter study onantigen 5–spiked Vespula and Polistes VEs compared with nonspiked VE

Unique molecular signatures typify skin inflammation induced by chemical allergens and irritants

Background Skin exposure to chemicals may induce an inflammatory disease known as contact dermatitis (CD). Distinguishing the allergic and irritant forms of CD often proves challenging in the clinic. Methods To characterize the molecular signatures of chemical-induced skin inflammation, we conducted a comprehensive transcriptomic analysis on the skin lesions of 47 patients with positive patch tests to reference contact allergens and nonallergenic irritants. Results A clear segregation was observed between allergen- and irritant-induced gene profiles. Distinct modules pertaining to the epidermal compartment, metabolism, and proliferation were induced by both contact allergens and irritants; whereas only contact allergens prompted strong activation of adaptive immunity, notably of cytotoxic T-cell responses. Our results also confirmed that: (a) unique pathways characterize allergen- and irritant-induced dermatitis; (b) the intensity of the clinical reaction correlates with the magnitude of immune activation. Finally, using a machine-learning approach, we identified and validated several minimal combinations of biomarkers to distinguish contact allergy from irritation. Conclusion These results highlight the value of molecular profiling of chemical-induced skin inflammation for improving the diagnosis of allergic versus irritant contact dermatitis

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

International audienceBackground:Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.Methods:Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT.Findings:Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p  50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria

Can We Reduce Frame Rate to 15 Images per Second in Pediatric Videofluoroscopic Swallow Studies?

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