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Abstract: 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. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: The information provided by pollen counts cannot be ignored by allergists and allergic individuals, but the divergence sometimes observed with clinical observations has led the réseau national de la surveillance aérobiologique (RNSA) to initiate the monitoring network of allergens by immunosampling (Monalisa) project. Moreover, some recent papers has shown the influence of pollution in the region and even of the year on the content in pollen allergens, particularly that of birch pollen. Thus, the goal of the Monalisa project was to set up a measuring system based on an immunological method that would result in validation of this new way of measuring airborne pollen counts. This European Life Environment project includes nine partners: Bertin Technologies (France), RNSA (France), NPARU (England), UCO (Spain), UTU (Finland), UAM (Poland), UEVORA (Portugal), AIA (Italy), and Meteoswiss (Switzerland). The results obtained during the 2006 season and then in the 2007 campaign, after modifications made in the sampler, were not very good. The principal results concern the measurement of birch and olive allergens, captured essentially in the prepollination period and sometimes in the postpollination period. Detection of these allergens may be due either to their presence on submicroscopic particles emitted independently of pollination, these allergens cross-reacting with birch and olive allergens. The difficulties encountered in this study lead us to say that pollen counts, phenological observations and clinical data are still the best way to assess the effects of airborne pollen. [Copyright &y& Elsevier]

Abstract: Atopic dermatitis (AD) is by definition a chronic pruritic skin disease characterised by a history of flares and remissions. Genetic studies have recently demonstrated a link of causality between an impaired permeability barrier defect and both AD and mucosal allergic disorders, putting the skin stratum corneum at the centre of the pathophysiology of these disorders. The respective importance of flare factors is difficult to sort out in published papers. Some of them, such as temperature, irritants and aeroallergens have a demonstrated impact on the permeability barrier anomaly, based on epidemiological or experimental evidence. However, a better methodology and terminology are needed to identify the most significant flare factors and promote an efficient prevention. [Copyright &y& Elsevier]

Abstract: Peanut allergy is one of the commonest food allergies in children and has a low natural recovery rate. It is severe and possibly causes fatal anaphylaxis. Current treatment is limited to strict eviction which, although it prevents accidents, does not abate sensitization and the risk of recurrence remains. A risk of increased sensitization has been demonstrated for milk and egg allergy in a randomized study comparing eviction with an oral tolerance induction protocol. Trials evaluating injectable immunotherapy could only be conducted when recombinant allergens, mutated to remove decisive B cell epitopes, would become available. Induction of specific oral tolerance is possible in experimental models. Studies in allergic children whose allergy resolved spontaneously have showed immunological modifications involving Th1–Th2 balance and indicating the role of regulatory T-lymphocytes. However, the slow natural evolution of food allergy in children justifies a therapeutical intervention consisting in daily administration of increasing doses of the food to reach the amount normally eaten. This aims to trigger, or accelerate, immunological tolerance. Studies on egg, milk and wheat flour allergies have produced satisfactory results, indicating a possible application to peanut allergy. This paper summarizes the main facts concerning natural oral tolerance mechanisms, the development of food allergy and spontaneous recovery, before considering specific oral tolerance induction protocols. Criteria of selection of patients are discussed. Protocol implementation modalities are presented, including the increment of doses, the duration of the treatment, parameters for the specific monitoring and later prescription concerning maintenance doses. [Copyright &y& Elsevier]

Abstract: Recently, a cross reactivity between cypress pollens and peach has been published. In this paper, we have tried to confirm this possibility in 33 patients suffering from cypress pollen allergy. The analysis of the collected patients data lead to the following classification of them into two groups: nine patients (27.3%) had a sensitivity to peach (four patients were allergic to peach and five patients were only sensitised to this fruit but could eat it without experiencing any symptoms), the second group of 24 patients were allergic to cypress pollens, but not sensitive to peach. These results clearly confirm that the cypress-peach syndrome exists together with the apple-birch syndrome. Other analysis on these patients will enable to characterise the cross-reacting allergens. [Copyright &y& Elsevier]

Abstract: The aim of this paper is to study the relation between climate change and the earliness of Birch pollination, a tree that produces allergenic pollen, which is of particular importance in north-western Europe. The study allowed us to make projections for the next few years in order to evaluate the evolution of Birch pollination starting date according to spring temperatures. It has been done in ten European locations, Kevo and Turku (Finland), London (United Kingdom), Paris and Lyon (France), Brussels (Belgium), Zürich (Switzerland), Vienna (Austria), Poznan and Cracow (Poland). The study period ranged from six to twenty-eight years depending on the city. Pollens were recorded daily thanks to volumetric Hirst traps, and the data were compared to monthly temperatures from January to May using correlations and multiple regressions. Except in Kevo where the trend is towards colder springs and a later pollination, in the other cities the results showed a spring warming associated with an earlier starting date of pollination: this trend is very well marked in Turku, Zürich, London, Vienna and Brussels, less evident in France while there is no trend in Poland. The results of this work should lead to an updating of the pollen calendars and the pollen forecast models, in the cities where there is a pronounced trend. [Copyright &y& Elsevier]

Abstract: The realization of the TPO begin with a precise analysis from criteria ensuring the safety from the child. The paper specify the prerequisites (place of realization, venous access, environment, food preparation), the methodology of the OFC (open, simple or double blind manner) and the management of a reaction occurring during the OFC. [Copyright &y& Elsevier]

Abstract: Much attention is now being focused on foods from genetically modified plants because of the risk of allergenicity. No such risk has been reported for the first generation of GM plants made resistant to herbicides and insect larvae. Current experiments with hypoallergenic GM plants are reported and discussed in the present paper. The second generation of GM plants will improve the nutritional aspects of natural foods. Transgenic proteins could reach from 4 up to 8% of the total protein content in these foods. Any potential difference in allergenicity between second generation GM plants and the natural varieties must be examined with respect to the risk for food allergy caused by food products made from these plants and the risk for respiratory allergies in the people living near the crops caused by airborne pollen originating from the plants. WHO–FAO directives as well as the Codex Alimentarius proposals and the European Food Safety Authority (EFSA) guidelines recommend that transgenic proteins be screened for homology (by in silico study) and cross-reactivity with known allergens, as well as being examined carefully for modifications of host-plant proteomes. In vivo animal studies are also to be carried out to assess any potential immunogenicity. Lacking adequate safety data, the absence of potential allergenicity of transgenic plants cannot be ruled out. This is why data that do not meet the recommended safety criteria required for commercialization of GM plants do not allow us to rule out absolutely the risk that may be associated with products that are going to be commercialized. Therefore, it is essential that commercialized GM plants be monitored. We propose the establishment of public reference serum banks based on up-to-date WHO–FAO recommendations concerning the selection of sera according to precise criteria. We also propose establishing a system of allergovigilance linking national and European health and food safety agencies and a network of university hospital-based clinical and laboratory reference centres, together with a network of clinical allergists, responsible for the creation of the serum banks. Allergists working through these networks would be able to identify new sensitizations to transgenic foods in the population, just as they now identify new types of food allergies, which, in this case, would be GM foods. Such a project is now being established in France. [Copyright &y& Elsevier]

Abstract: Asthma morbidity and mortality have increased over the last ten years in most countries. In some countries now, it apears that asthma prevalence has reached a plateau. The increased prevalence, especially in children, should be explained by environnemental factors, since obviously our genes have not changed. In this paper, we will review the recent data concerning asthma prevalence, mortality, socio-economic impact and both environnemental and genetic risk factors. [Copyright &y& Elsevier]

Abstract: If it can be confirmed that variations in the level of nitric oxide (NO) in expired air tells us something about the different physiological processes in which this molecule is involved (bronchomotor, vasomotor, immunoregulation), then we will have available a non-invasive technique that would be useful in conditions as varied as asthma, sickle cell anemia, mucoviscidosis and pulmonary arterial hypertension. This technique can be used routinely to the analysis of the concentration of NO in a single expired breath. However, analysis of the concentration of NO in several expired breaths, which is possible from the age of 8–9 years, also makes it possible, using a method that is now standardized, to determine the bronchial production of NO and its alveolar concentration, thus providing a method for differentiating the respective contribution of these two compartments. Other techniques now being developed should soon allow us to calculate even more precisely events during normal ventilation, which will then allow us to make these measurements in babies, in young children, and in patients on artificial ventilation. The aim of this present paper is to discuss the theoretical basis and the techniques of these different approaches. [Copyright &y& Elsevier]

During the last two decades, quality of life (QOL) has been perceived as an innovative indicator of patients’ self-perceived health status, allowing integration of a qualitative approach in medical decision-making. This is evident from the number of publications related to this topic: during the three decades between 1973 and 2002, 1124 papers dealing with QOL in asthma were cited in Medline, 85% having been published during the last 15 years and 65% during the last 5 years. A number of reasons can be given for the interest in this subject: the limitations of traditional indicators of health outcomes, the evolution of the relationship between patients and physicians, the rationalisation of health care expenditures, the increasing importance of health care interventions, and also the desire to keep up with the fashion. The medical community at large has been trying to define QOL, how to measure it, looking at the available instruments and how to use them; this is also true for allergy. Of the 1124 publications cited above, only 41 (3.5%) were written in French. We point out that QOL is a measurable concept, that it is based on a subjective approach and that it has numerous applications. Nevertheless, for a wider use in France, especially in allergy, decision makers must make it a key issue before clinicians are going to understand QOL and make full use of questionnaires used to measure it. [Copyright &y& Elsevier]

In this paper, special consideration will be given to the following points:

HIV-infected patients are at greater risk for drug hypersensitivity than non-HIV-infected patients. Sulfonamides and anti-retroviral drugs are most often the responsible agents. We detail in this paper our 5-year experience with this problem. Ninety-three HIV-positive patients with a clear history of hypersensitivity to cotrimoxazole, nevirapine, nelfinavir or efavirenz were included in a tolerance-induction protocol. The clinical manifestations were as follows: 68 patients had had pruriginous maculo-papular eruptions including 17 with fever and 12 with other symptoms (conjunctivitis, asthenia, digestive symptoms, etc). Fourteen patients presented with urticaria, with fever in 4 of them. Twelve doses of the responsible drug, prepared the day of the challenge, were given orally at 30-minute intervals. We were successful in 90% of the cases. Therefore, tolerance induction may be an alternative for such patients. [Copyright &y& Elsevier]

The efficacy of drug therapy in asthma varies widely between patients. Inter-subject variability may be due to environmental factors, differences in patient compliance, biological variations involved in the mechanisms of the disease or in the mode of action of drugs, some of which may be genetic in origin. The study of genetic factors determining treatment response to a given drug defines pharmacogenetics, a science in its infancy at the dawn of this new millennium. In asthma, a comprehensive screen of genes likely to be important in determining treatment response has not yet been performed. This paper will review the recent data regarding two good examples of polymorphisms apparently determining treatment response to two classes of drugs, the β2-agonists and the anti-leukotrienes. [Copyright &y& Elsevier]

Abstract: Wheat isolates, used as binders and emulsifiers in the food industry, mainly in meat products, are neo-allergens resulting from deamidation of wheat gluten. In this paper, we describe cases of anaphylactic reactions caused by a wheat isolate occurring after eating pasta. Sensitivity to wheat isolate was demonstrated by positive skin tests and specific IgE reactivity to wheat isolate extract (20.1 KU/l, class 4), and also by detection and quantification of wheat isolate in pasta by immunoblotting and ELISA inhibition. [Copyright &y& Elsevier]

Abstract: It''s obvious that epinephrine should not be used for the treatment of generalized urticaria without hemodynamic perturbations. However, the purpose of this discussion is to defend epinephrine prescription (and not necessarily it''s administration) as possible first aid treatment in a very precise situation, which concern children with a history of generalized urticaria due to confirmed food allergy. This position was defined, after careful examination of scientific evidences in the literature, by the French “tripartite commission” and published under the title “Conditions to establish a project for individualized management at school of children at risk for food allergy emergencies” in 2003 in this journal. This paper resume the main points supporting this statement. [Copyright &y& Elsevier]