Search

Rhinitis and asthma are common diseases that are strongly linked from both the epidemiological and patho-physiological point of view. A precise aetiological diagnosis is required in order to optimize treatment. Nasal provocation tests (NPT) determine precisely the role of the allergen in the initiation of the symptoms of rhinitis particularly when the history does not produce convincing evidence of the clinical relevance of an allergen. It may also have important consequences for the choice of an allergenic immunotherapy. NPT are not standardized but simple methods based on international recommendations provide us with good diagnostic accuracy. In this paper, we will discuss the practical aspects of NPT as well as the clinical or research situations where they may be useful for the respiratory physician.

Rhinosinusitis is an important health problem which is increasing in frequency and which has a large financial repercussion on society. Better understanding of ARS management has modified our clinical approach leading us to minimize unnecessary use of radiological investigations, overuse of antibiotics, and improve the under utilisation of nasal corticosteroids. The goal of this article is to present important new guidelines mainly based on the European position paper on rhinosinusitis and nasal polyps 2012 (EPOS 2012) in order to facilitate ARS management in general practice.

The aim of this study was to determine the prevalence and investigate associated factors for Blomia tropicalis (BT) sensitization in adolescent and adult patients with asthma in Yaoundé (Cameroon).We performed a cross-sectional study of 18 months duration (January 2012 to June 2013). All asthmatic patients who were seen for a consultation during the study period and who had a skin prick testing for perennial aeroallergens were included in the study.Two hundred and one asthmatic patients (132 female patients, 65.7%) with median age (1st-3rd quartiles) of 35 (20-51.5) years were included in the study. Ninety-six (47.8%) patients had positive skin tests to BT. BT sensitization was associated with sensitization to two other dust mites (Dermatophagoides pteronyssinus [DP] and Dermatophagoides farinae [DF]) in 75 (86.2%) patients. The only clinical factor associated with BT sensitization was the presence of persistent rhinitis (odds ratio [confidence interval 95%]: 2.06 [1.12-3.81]). The independent allergenic factors associated with BT sensitization were sensitization to DP (3.49 [CI 95%: 1.49-8.19]), to DF (4.88 [CI 95%: 2.10-11.36]) and to German cockroach (4.16 [CI 95%: 1.72-10.09]).Blomia tropicalis sensitization is common in asthmatic patients in Yaoundé. It occurs most often in the context of sensitization to multiple aeroallergens, particularly with sensitization to other dust mites and German cockroach.

The high prevalence of allergic rhinitis that occurs in elite athletes has been extensively investigated. However, data among recreational athletes practicing indoor activities remain contradictory. The aim of the present study was to determine whether taking part in gym based sporting activities constitutes a risk factor for allergic rhinitis in recreational athletes.A group of 50 recreational athletes was examined. A specific questionnaire for the screening of allergic rhinitis and a battery of skin prick-tests to aeroallergens were administered to each participant. Measurements of nasal symptoms, peak nasal inspiratory flow (PNIF) and lung function were also obtained before and after a training session.Thirty-two percent of the participants were atopic, 18% suffered from allergic rhinitis. This prevalence is similar to that of the general population (16.9%). After exercise, nasal symptom prevalence did not change significantly. However, an improvement in nasal inspiratory flow was observed in 70% of the participants. No statistically significant change in lung function was noticed.Our results showed that the occasional practice of sport in the gyms does not constitute a risk factor for atopy or allergic rhinitis. However, this kind of activity induces an increase in the nasal patency of both the healthy and the rhinitic subjects.

Respiratory allergies represent a global and public health problem, due to their prevalence (still increasing), morbidity, impact on the quality of life and costs for the society. They mainly concern rhinitis (or rhinoconjunctivitis) and asthma. The diagnosis of allergy is dependent on a history of symptoms on exposure to an allergen together with the detection of allergen-specific IgE. Accurate diagnosis of allergies opens up therapeutic options that are otherwise not appropriate, such as allergen immunotherapy and allergen avoidance, that are prescribed following a stepwise approach. It has been a century since the first trial in specific immunotherapy was performed and this still remains the only disease modifying treatment for allergic individuals. In terms of route of administration, sublingual immunotherapy represents a good alternative to subcutaneous immunotherapy, considering its proven efficacy and better safety profile.

Allergic rhinitis (AR) is a common IgE dependent disorder. AR is maybe one of the steps of the allergic march, which starts with atopic dermatitis and food allergy and includes atopic asthma. AR and asthma are frequently associated. AR is frequently under-diagnosed and undertreated although it affects quality of life and school performance. Management of AR depends on its severity and will associate environmental control (best guided by environmental investigation and skin testing of specific IgE antibodies), pharmacotherapy (with antihistamines and intranasal corticosteroids as first line drugs). At present allergen immunotherapy is considered in patients with severe AR, insufficiently controlled by pharmacotherapy and who demonstrate specific IgE antibodies to relevant allergens. Sublingual immunotherapy is well tolerated. Only immunotherapy with the right allergens has the potential to alter the natural history of the allergic march, by preventing the development of new allergen sensitizations and reducing the risk for the subsequent development of asthma. This fact might extend the indications of specific allergen immunotherapy. Patients (and parents) education is of utmost importance in the management of allergic disorders.

Allergic rhinitis is a daily problem to which are confronted principally general practitioner, paediatrician, ear, nose and throat specialist and allergologist. also, this subject is still always alive because allergy seems in a constant progression in our society.To clarify diagnostic and therapeutic criteria of this affection.we have realized a literature review concerning physiopathology, clinical symptoms, the position of paraclinical investigations and finally therapeutic modality of allergic rhinitis.Appropriated treatment of allergic rhinitis should be général it requires a knowledge and better comprehension of the disease and optimum prevention, if it is possible, of allergic symptoms.

House dust mite allergens from the Pyroglyphidae family are one of the most frequent and potent causes of allergic sensitatisation. Since 1988, molecular knowledge has increased considerably and structures and functions have been determined for most of them.Of the 22 defined allergens, the major IgE-binding has been reported for groups 1 and 2 accounting for 40-60% of the anti-house dust mite titres. Der p 1, 2, 4, 5, 7 allergens account for about 80% of the IgE-response. Der p 4, 5, 7, 11, 14, 15 have a prevalence of sensitization of about 10% each. The IgE-binding to groups 3, 8, 10, 20 is low. Most of the allergens can be identified by amino-acid sequences and the tertiary structures of the major allergens have been solved. Most allergens are proteolytic enzymes: Der p1 for instance is a cysteine protease. Der p 2 has structural homology with MD-2, a co-receptor of the Toll-like receptor (TLR4) whose ligand is LPS. Knowledge of the structure of mite allergens has allowed better interpretation of cross-reactions between allergens from the same family or from more distant families.From a practical point of view: the occurrence of multisensitisation is better explained and molecular epidemiology has allowed a better choice of allergen molecules useful for diagnosis. Finally, new concepts of immunotherapy based on genetically engineered hypoallergenic variants of major allergens, used alone or in combination, may lead to useful therapeutic approach.

Primary care physicians will conduct allergy diagnosis based on the history provided by the patient. In case of a possible IgE type allergy, investigations will be made by skin tests or measurement of specific IgE antibodies in the serum. Interpretation of positive tests will have to consider possible sensitizations in absence of allergic symptoms that should not lead to inadequate therapeutic measures or diet. This review will provide to primary care physicians guidance to choose the best method in the appropriate situations for allergy diagnosis.

There is good evidence that urban air pollutants, and particularly diesel exhaust particles (DP), contribute to the increasing prevalence of asthma and allergic rhinitis. Diesel exhaust particles act as adjuvants in the immune response and may aggravate allergic inflammation. This was first suggested by epidemiological studies and has now been largely confirmed by numerous experimental studies in animals and humans. We review the different underlying mechanisms, including effects on cytokine and chemokine production and immune cell activation. We also discuss the metabolic and cellular activation pathways followed by polycyclic aromatic hydrocarbons and allergens, and their interaction with diesel particles, which act in synergy in this immune response, resulting in IgE production and triggering allergic inflammation.

Asthma is a disease of the lung epithelial barrier, most often associated with allergy in children. Asthma and allergy are two distinct diseases, but the phenotypic expression of asthma depends on atopic status. A better definition of phenotypes of asthma would result in better targeting of prevention and treatment modalities. Secondary prevention aims to prevent the onset of asthma and the acquisition of new sensitizations in sensitized children. Studies concerning allergen avoidance are insufficient to reach a definitive conclusion and antihistamines have not been shown to be effective. The results for specific immunotherapy suggest a benefit to prevent transition from allergic rhinitis to asthma and the onset of new sensitizations. Tertiary prevention aims to reduce symptoms in children with an existing allergic asthma diagnosis. The avoidance of known respiratory allergens will only be effective in combination with management of the whole environment. Specific immunotherapy has a real place, in combination with background therapy. It should be used according to guidelines in appropriately treated patients.

International audience; OBJECTIVE: To assess the prevalence of allergic rhinitis (AR) (according to the SFAR, Score For Allergic Rhinitis and the ARIA Allergic Rhinitis and its Impact on Asthma classification) in the French adult general population and to describe its impact on quality of life, quality of sleep and prevalence of associated ocular symptoms. METHODS: This cross-sectional survey was carried out in 2006 in a French population-based sample. The data were collected by a polling organization in 3 waves using face-to-face interviews at home. Subjects answered to questionnaires of AR management, quality of life (SF-12), quality of sleep (MOS-Sleep) and daytime sleepiness (Epworth). Statistical analysis was performed using SAS software. RESULTS: Among the 10, 038 interviewed subjects, (mean age: 43 years), the overall prevalence of AR was 31%, with regional variations (from 26% in South West to 37% in the Mediterranean area). The prevalence was higher in younger subjects (39% in 18-25 years, 35% in 26-35 years, vs. 22% in >65 years, p or =7 constituted the AR group and 706 subjects with SFAR

The main objective of the survey was to determine the frequency of the mono and polysensitizations in patients consulting for respiratory allergy, rhinitis or/and asthma. The secondary objectives were to evaluate the severity, the number and the type of the sensitizations, the frequency of the asthma or rhinitis as a function of the sensitizations, the evolution of the sensitizations with age, and identify the principal responsible pneumallergens.The multicentric survey included a patient questionnaire allowing the collection and anonymous treatment of data on socio-demographic characteristics, clinical symptoms, cutaneous tests and sensitizations.A sample of 505 patients, mean age 24 years, consulting for rhinitis or asthma, monosensitized (36%) or polysensitized (64%), was evaluated. The percentage of polysensitized patients was similar in asthmatics, patients with rhinitis, and patients with both asthma and rhinitis (60%, 65%, and 63%, respectively). The mean number of the sensitizations was 2.4 for patients with asthma, 2.6 for those with rhinitis, and 2.6 for patients with both asthma and rhinitis. The greater the severity of the rhinitis or asthma, the higher the number of the sensitizations. Sensitizations to acarids, gramineae and cat were the most frequent. When practioners were asked about their intention to undertake desensitization in polysensitized patients, 52% of them replied positively.Data collected during this survey showed that a large proportion of the patients who consulted for rhinitis or asthma were monosensitized (36%). Sensitization to acarids was the most frequent. Even in polysensitized patients, more than half the practioners said they would use desensitization.

We evaluated the prevalence of allergic rhinitis in a rural population of Settat and its relationship with intestinal parasitosis and living conditions. The sample comprised 336 subjects living in 3 clusters. Rhinitis was evaluated using the ISAAC questionnaire. Prevalence of rhinitis was 37.8%. It was higher in those aged 15-49 years, illiterate subjects, active smokers, those presenting with overweight and those with hypereosinophilia. It was significantly lower in children < 10 years. Rhinitis was associated with sibship size and literacy, but not with intestinal parasitosis and helminth infections.

Since 1967, house dust mites have been shown to be the main allergens to be blamed in household dust allergy. In our countries, Dermatophagoides pteronyssinus and Dermatophagoides farinae are predominant. We find them by millions in our bedding. They are responsible of allergic reactions like asthma, rhinitis and atopic dermatitis. Different treatments are available of which some have proved there effectiveness, like subcutaneous immunotherapy and standard symptomatic treatments. On the other hand, the control measures remain controversial and led recently to a lively debate in the medical literature. We felt therefore that it was necessary to set the record straight.

Rhinitis and allergic conjunctivitis are frequent and may have severe impact on quality of life. Moreover risks of evolution of rhinitis to asthma are high, whereas conjunctivitis may either lead to eye-related complications when some topical drugs (such as steroids) are used, or when severe ailments are belatedly diagnosed. This article enables to review the treatment of allergic rhino-conjunctivitis. It also presents recent progress realized in the domain of allergen specific immunotherapy. In particular, this review underlines the search for hypoallergenic formulations that may minimize the risk of systemic allergic side effects as well as the use of new adjuvants to improve the efficiency of treatment and reduce its duration.

There is a strong and consistent association between immediate hypersensitivity, asthma and exposure to allergens. However, the role that the inhaled allergen plays and the timing of events related to sensitization are still controversial.Information obtained by studies of the follow-up of cohorts underlines the fact that there is no continuum between specific IgE responses and the development of childhood asthma. Allergic rhinitis and asthma result from a complex and multifactorial interaction between genetic factors, exposure to allergens, and many biological or chemical co-factors. However, when the child is exposed to an allergen, sensitization to the allergen is a risk factor for childhood asthma and severity of the disease.Despite numerous epidemiological studies, the association and links between atopy, allergens, environment, sensitization and allergic rhinitis and/or asthma remain difficult to evaluate and poorly understood. Complementary studies are also necessary for the standardization of therapeutic strategies.

International audience; The impact of chronic urban air pollution on asthma and allergy remains controversial, probably because exposure is difficult to evaluate. In this cross-sectional epidemiological survey of 9- to 11-year-old children living in six French towns, levels of air pollution were estimated by using dispersion models that take into account background air pollution levels along with traffic density, topography and meteorological conditions. We estimated three-year exposure, in the school environment, to benzene, volatile organic compounds, SO2, particles less than 10 microns in diameter (PM10), nitrous oxides (NO2 and NOx) and CO, which are the main urban air pollutants. Several health indicators were gathered by means of a questionnaire, a physical examination, skin prick testing, and measurement of peak-flow variations following an exercise test. Among the nearly 5000 children who had been living in the survey area for at least three years, the 12-month and cumulative prevalence rates of asthma and exercise-induced hyper-reactivity correlated with estimated levels of benzene, SO2, PM10, NOx and CO. The 12-month and cumulative prevalence rates of atopic dermatitis correlated with estimated benzene, PM10, NO2, NOx and CO levels. Pollen sensitization correlated with benzene and PM10 levels, and the cumulative prevalence of allergic rhinitis correlated with the PM10 level. These associations remained statistically significant among children who had spent their entire lives in the same community.

Respiratory and/or food allergy is common in children. Serous otitis media is also very frequent in children, especially those between 3 and 6 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.

Input from Housing and health counselling services is advisable when a patient's health seems to be impaired by their housing conditions.650 home visits have been performed by our organisation since 2002. Each visit includes a questionnaire to assess respiratory as well as non-respiratory indoor risk factors, Acarex test to assess mite-allergen content in mattress dust, mould sampling and, when appropriate, air sampling for measurement of volatile organic compounds and aldehydes.The dwellings studied were mostly flats located in the downtown and occupied by a tenant. In most instances, several health hazards were identified. These hazards, in decreasing occurrence included: mold (74.4%), mite infestation in mattress dust (56.3%), cleaning products accessible to children's'hands (47.8%), dangerous electrical circuits (21.1%), exposure to chemical air pollutants (9.0%), exposure to an electromagnetic field (2.8%). Numerous fungal species were identified often occurring in association.This service allowed the identification of numerous and various health hazards. Its efficacy and effectiveness remains to be evaluated.

In order to assess the acceptability of a new scent-free formulation of mometasone furoate (Nasonex) among allergic rhinitis patients, who already have been treated by the scented formulation of Nasonex, a phone survey was performed with a sample of 216 patients recruited by Nasonex GP's prescribers and pharmacists. The aim of this survey is to assess the diagnosis modalities, the allergic rhinitis characteristics and associated symptoms in one hand and in the other hand, the main reasons which led them to prefer a new scent-free formulation, in comparison with the only commercialized scented mometasone furoate (Nasonex) at the time when this survey was conducted. The impact of unscented Nasonex on patient's compliance to treatment was also assessed. This survey confirms that the GP is the key actor who usually establish the allergy diagnosis and the interrogatory is the principle method used. The prick test was more often and significantly used in 35% of the perennial rhinitis instead of 19% in seasonal allergic rhinitis (por = 0.05). When the diagnosis of allergy was established by an allergologist, 89% of them used a prick test. In this survey, asthma was associated in 24% of the patients, particularly in who suffering from perennial allergic rhinitis. 85% of patients rate their smell as globally good. 75% of the treated patients were interested by the new unscented formulation of Nasonex, regardless of the type of their rhinitis, seasonal or perennial. About 60% of patients stated that the lack of odor will led them to be more compliant to their treatment.

To establish the ENT specialists's interest for the nasal obstruction measurement by the Peak Nasal Inspiratory Flow (PNIF) for the primary care medical management of patients with allergic rhinitis.A nation wide mail survey was conducted on the whole set of 2,800 French ENT specialists. Physicians had to use the PNIF in 4-consecutive patients with allergic rhinitis and assess through a questionnaire their interest for this tool.About 8% of all ENTs (n = 228) responded. 65.3% of them had used the PNIF with their 4 patients, 29.7% used it in only 1 to 3 of their patients, and 5% did not use it at all. The PNIF was mainly used in moderate to severe rhinitis (94%) in contrast with mild rhinitis (32%) and in persistent rhinitis (94.2%) compared to intermittent rhinitis (54.8%). The primary motivation to use the PNIF on a systematic basis was to quantitatively assess nasal obstruction and to obtain an objective measurement of nasal obstruction. Conversely, the reasons for not using the PNIF were the needless of an objective measurement of nasal obstruction, the drawback of the PNIF in the patient physician relationship and lack of patient's acceptance of the device. Most physicians considered training for a correct usage of the PNIF was easy. Finally, about 2 thirds of the sample gave a positive rating on the usefulness of the PNIF for their patients.This study demonstrates the interest of the practitioners to dispose of a simple and reliable tool for the follow up of nasal obstruction in allergic rhinitis.

The high prevalence of allergic rhinitis in westernized countries, and the impact of allergic rhinitis on asthma require a well established diagnosis. Clues of increasing value can be obtained by any practitioner, relying on information about familial and personal atopic background, a precise record of symptoms of nasal hyperreactivity rhinorrhea, sneezing and pruritus, and of the evaluation of symptoms over the year. A precise questionnaire may be completed by a biologic screening for atopy, in order to refer the patient to the allergist to add evidence of the etiology by skin tests, search for specific IgE, and nasal challenges for specific cases.

Ocular allergy, with a significant increase of prevalence, is one of the most usual disease of the ocular surface. But, in a same entity, it means different kinds of clinical diseases with acute hayfever conjunctivitis, usually easy to diagnose, but also chronic perennial forms without any functional or clinical specificity among others ocular surface diseases. These clinical aspects are underlain by complex cellular mecanisms which are essentially located inside the conjunctiva. Initially, allergen cross the lacrimal tear film, the first natural barrier of the eye, then in the conjunctival epithelium, meet the antigen presenting cells, the Langerhans cells, lymphocytes and all the others components of the inflammatory and allergic reaction, including mast cells and eosinophils. The cornea could also be involved in allergic diseases, mostly in severe ones such as vernal or atopic keratoconjunctivitis, but most often, its pathology is due to direct cytotoxic effect of chemical mediators, such as eosinophil proteins, rarely results from mechanical or immunological pathways.

Allergic conjunctivitis is one of the most frequent reasons for a child's consultation with an ophthalmologist. Once the diagnosis of conjunctivitis is made and the clinical form is clearly established, the search for a cause is the most complicated step. Consultation with an allergist is necessary, in particular when questioning the patient points toward an allergic cause or brings up conditions suggestive of atopic disease. Ocular allergy can follow a type I hypersensitivity, i.e., mediated by IgE: most frequently this is acute and chronic allergic conjunctivitis. Demonstrating the allergen requires prick tests, which are easy to carry out and painless; their sensitivity is currently satisfactory. In vitro tests can complete the workup. In case of doubt on the allergen responsability for allergy, an allergenic provocation test can confirm or refute the allergen's involvement. Ocular allergy can also stem from a type IV mechanism, i.e., a cell-mediated mechanism such as in contact allergy involving different topical substances. In these cases, the clinical aspect and the patient's history may require consultation with a dermatologist-allergist for patch tests. To adapt practices when encountering conjunctivitis in a child, the ophthalmologist should be familiar with the allergens that may set off a conjunctivitis episode. Knowledge of the mechanisms at play also helps direct the examination toward allergy or another cause. In all these steps, collaboration between the ophthalmologist and the allergist is indispensable.

Epidemiological studies have shown that rhinitis and asthma are associated. At least four out of five asthmatics suffer from rhinitis and one out of four rhinitic subjects develop asthma. Recent progress in cellular and molecular biology confirms that the same inflammatory cells and similar mechanisms participate in the pathophysiology of the two diseases. Histological findings show that although nasal inflammation resembles bronchial inflammation, specific remodelling features that are present in asthma are lacking in rhinitis. This may be due to the different embryologic origin of the two organs. These similarities explain certain clinical interactions and are the basis of the ARIA (Allergic Rhinitis and its Impact on Asthma)--WHO guidelines recommending that symptoms of rhinitis be sought in asthmatic subjects and symptoms of asthma in rhinitic subjects.

A national surveillance programme of occupational asthma was set up to estimate the incidence and identify the causes of this disorder in Belgium.The programme was based on the voluntary notification of new cases of occupational asthma by chest specialists and occupational physicians during the period 2000-2002.92% of the reported cases included occupational asthma of an immunological type and 8% bronchial irritability. According to the opinion of the reporting physicians the diagnosis was considered certain in 39%, probable in 29% and possible in 32% of cases. On the basis of these notifications the mean annual incidence of occupational asthma is estimated as 23.5 cases per million workers (95% confidence interval 19.2-28.8). The most frequently incriminated substances were isocyanates (16%), cereals (12%) and latex (10%). At the time of diagnosis 38% of patients had not applied for compensation.The results of this programme of notification of occupational asthma agree with the data available from other countries and provide information complementary to the medico-legal statistics.

The eosinophil cationic protein (ECP) is one of the mediators released during eosinophil activation. These cells are effector cells taking part into the Th2-lymphocyte dependent allergic inflammation. Assaying ECP concentrations in blood and sputum may be useful in evaluating allergic inflammation (asthma and rhinitis). This summary considers the value of measuring ECP levels for the diagnosis of various diseases where an eosinophil-mediated tissue inflammation plays a role.Levels of eosinophil cationic protein have been determined in nasal secretions, sputum, gastric secretions, feces and serum. They are increased during seasonal allergic rhinitis and perennial rhinitis, allergic asthma and atopic dermatitis. They are also increased in various gastro-intestinal disorders, some of which are associated with IgE: eosinophil intestinal diseases (esophagitis, gastro-enteritis and colitis), gastro-intestinal food allergy and intestinal parasitoses. Finally, they are increased in non IgE-dependent disorders: non allergic asthma with aspirin intolerance, respiratory infections, sinonasal polyposis, Churg-Strauss disease and idiopathic hyper-eosinophilia (HES) syndrome.Assaying serum ECP could help in the diagnosis of several diseases. With parasitic disease the pathogenic progression may be accurately assessed, when serological tests are less indicative. ECP assay may point to non allergic asthma, either Fernand-Widal syndrome or Churg-Strauss disease. As for gastro-intestinal disorders, it indicates an eosinophilic tissue reaction. In the event of isolated hypereosinophilia, ECP assay may clarify whether it is benign or tending towards idiopathic HES. The assay of peroxidase and eosinophil-derived neurotoxin (EDN) should be also considered.

Ficus benjamina (FB), the weeping fig, belonging to the Moracea family, is now widely used as an indoor ornamental plant in houses and offices. Its latex can be responsible of IgE allergies : rhinoconjunctivitis, asthma, angiooedema, pruritus, anaphylactic shock. In some occupations such as gardeners, caretakers of plants, it can induce a contact urticaria. Most of these patients are atopics. We describe a case of non-occupational, indoor related rhinoconjunctivitis in a non-atopic patient. Prick-test and RAST to FB latex were positive and removal of the ficus plant resolved their symptoms confirming the etiologic role of the plant. The patient did not demonstrate sensitization to other common allergens (except weeds) involved in respiratory (latex of Hevea brasiliensis, mites...) and food allergies (negativity of the prick-tests for fig, avocado, banana, kiwi). Now, FB is a new hidden allergen in the house. Questionning for its presence and testing it should be considered; as it should be introduced in the standard prick-test panel.

Presentation of a case of workplace induced asthma in a person who prepared bouquets of mimosa for the Carnival of Nice and bouquets destined for export.

Diagnosis, nosological individualization, and treatment of allergic fungal sinusitis remain difficult and controversial despite the increasing number of publications. We present ten cases of allergic fungal sinusitis and review the literature to highlight the main clinical, radiological, biological, immunoallergological, mycological, and therapeutics features.This retrospective study included ten patients (six men and four women, mean age 45 years) with allergic fungal sinusitis diagnosed on the basis of all diagnostic criteria reported in the literature.Six patients had isolated allergic fungal sinusitis which was associated with allergic bronchopulmonary aspergillosis in the four others. Treatment combined endoscopic sinus surgery and corticosteroids, which provided good results in six patients and average results in three. Treatment failure was observed in one patient.As in the case of allergic bronchopulmonary aspergillosis, a set of clinical, radiological, histopathological, immunoallergological and mycological criteria is necessary for precise diagnosis and to avoid fungal drift. The most appropriate endoscopic sinus surgery and the best corticosteroid regimen remain to be determined.

When medical history and clinical examination for a recurrent or chronic cough reveal the presence of perennial allergy, the practitioner would be advised to look for mites present in the horse's environment. He can propose this service to his clients.

Diagnosis of allergic rhinoconjunctivitis, particularly in chronic forms, remains sometimes difficult. Systemic tests such as skin or blood tests may be not sufficient to assess local sensitization. Local tests are needed, performed from nasal secretion or tears. Measurement of total IgE in the local secretions of 41 patients suffering from rhinoconjunctivitis show that diagnosis contribution was upgraded from 61 to 88%. Very interestingly, in some cases, local tests were the only argument for allergy.

The atopic diseases, asthma, allergic rhinitis and atopic dermatitis, are common in children, adolescents and young adults. They may have important consequences on physical exercise, especially asthma.Elite athletes have been observed to have a high prevalence of asthma (and perhaps also rhinitis). The reasons for this observation are still debated, but different mechanisms linked to the intensity of physical activity in athletes are probably involved. Exercise-induced symptoms should be confirmed not only from the clinical history but also by objective measurements of lung function. In elite athletes confirmation of exercise-induced asthma might be difficult and may require special diagnostic tests such as bronchial provocation by eucapnic voluntary hyperventilation. Several drugs are effective in exercise-induced prevention of nasal and bronchial symptoms. Therapeutic approaches for atopic diseases in international guidelines (GINA and ARIA) are generally compatible with anti-doping laws but require compliance with specific prescription rules.A better understanding of mechanisms and risk factors involved in the increase of asthma prevalence in elite athletes may permit prevention by modifying training conditions during exercise.Atopic diseases are common in athletes. They require special therapeutic considerations. The increasing prevalence of respiratory asthma-like symptoms in elite athlete is opening new paths for research into airway physiology in extreme conditions.

In order to gain knowledge on the management of perennial allergic rhinitis by the practitioners in France, a survey (Enquête épidémiologique sur la rhinite allergique per-annuelle en pratique quotidienne--ERAP) was developed.In the year 2000, 1 346 doctors (including 689 general practitioners) enrolled 3 507 patients consulting for a fall/winter exacerbation of allergic rhinitis. Both doctors and patients filled out a specific questionnaire on the care networks, clinical characteristics, diagnostic modalities and treatment of allergic rhinitis, together with the patients'personal feelings.The patients were bothered on average 6 days a week (5.8 +/- 1.8 days) and 3 months a year (9.2 +/- 7.7 consecutive weeks) by symptoms largely exceeding the ENT area, with frequent ocular symptoms (36.7%), cough (31.9%), sleep disturbances (35.2%) or dyspnea (9.4%). In 70.3% of the patients rhinitis affected their professional life and 90.9% their daily life. The nose was examined in 63.3% of patients and a search for asthma was conducted in 39.3%. In 45.3% subsequent skin prick tests were scheduled and in 53.5% specific IgE measurements and in 33.5% subsequent specialized consultation. Prescribed drugs were mainly oral antihistamines (75.3%) and local glucocorticosteroids (48.5%). Prescriptions were written for a mean duration of 8 weeks. 78.6% considered that the information that they had received was adequate and easy to understand, but 61.1% of patients would have liked to have received more advice. Furthermore, only 48.7% followed their doctor's prescription scrupulously, and 34.3% adapted the prescription.Perennial allergic rhinitis indeed impairs quality of life and its management in France is now better understood.

The IgE-dependent reaction is a specific type of inflammatory reaction occurring in allergic persons responding to an allergen. When the allergen penetrates the airways, it is captured by the antigen presenting cells and presented to CD4+ T cells. The most important conditions of antigenic presentation are the presence of IL-4 and not IL-12 at the presentation site and the implication of certain coreceptors determining T-cell differentiation to Th2 cells, which produce IL-4, IL-3, and IL-5. Il-4 and IL-3 induce IgE production by plasmocytes and IL-5 activates eosinophils. The specific IgEs of the allergens then bid to their high-affinity receptor on the surface of mast cells (sensitivization phase). If the allergens are still present or if there is an new exposure, coaggregation of high-affinity receptors via specific IgEs induces mast cell degranulation and release of vaso- and broncho-active mediators which lead to the acute signs of rhinitis or asthma (early phase of the immediate reaction). At the same time, activated eosinophils, attracted by IL-5 as well as chemokines, infiltrate the mucosa, producing basic proteins toxic for the epithelium. These cells are responsible for the late phase of the immediate allergic reaction, and during repeated or continuous exposure, are the cause of the chronic allergic disease.

Asthma and atopy are polygenic diseases with an hereditary and an environmental component. Improvement in statistical and molecular tools has enabled the localization of a dozen chromosome regions bearing susceptibility genes: 1p32-34, 3q21, 5q31-33, 6p21-23, 11p15, 11q13, 12q14-24, 13q14-qter, 14q11, 17q11-21, 19q13 and 20p13. There are many candidate genes, particular the cluster of interleukin-4 genes (5q31-33), the major histocompatibility complex genes HLA D and the TNFalpha gene (6p21-23), the gene of the receptor B chain with strong affinity for IgE (11q13), the interferon-gamma gene (12q15-24), the genes of the alpha/gamma chains of the T receptor (14q11), the IL4 receptor gene (16p12), and the metalloprotease gene ADAM33 (20p13). Research will continue to define these genes more precisely or to recognize others and to apply this knowledge to therapeutic and diagnostic applications.

Desloratadine, the active metabolite of loratadine, is a new antihistamine. Because of its anti allergy properties, desloratidine has an affinity for histamine receptors 25 to 100 times greater to those of the usual antihistamines, coupled with a capacity to inhibit the production of pro-inflammatory mediators. When evaluated in healthy volunteers, the half life of desloratadine has been estimated at 27 hours, which is comparable with a night time length of action. Many clinical studies made with patients suffering with allergic rhinitis or chronic idiopathic urticaria have shown a rapid symptom reduction, lasting 24 hours after first taking. This action was correlated with an improvement in socio-professional activity, sleep and quality of life in general. In patients suffering from allergic rhinitis, rhinomanometry showed a significant improvement in nasal congestion by desloratadine. The clinical advantages of desloratadine on antihistamines taken previously were measured in a study made on almost 48,000 patients, of whom 91% found its efficacity satisfactory. By its powerful action, coupled with an excellent tolerance profile, desloratadine represents a real therapeutic advance for allergic patients.

This paper illustrates the principles of construction and validation of an epidemiological questionnaire by using various aspects of the questionnaire prepared for the Epidemiological Study of the Genetic and Environmental Factors in Asthma, Bronchial Hyper-responsiveness and Atopy (EGEA). Standardised international questionnaires (for adults and children) were adapted and augmented for the requirements of the study. New areas in relation to international epidemiological studies are described (detailed descriptions of asthma and allergic rhinitis, trigger factors exposure tovarious environmental factors and family history). Various aspects of validation are discussed: the acceptibility by the study of missing data in the description of asthmatic symptoms, the construct validity for a score for allergic rhinitis, the reliability of a new self-administered questionnaire for perceived hyper responsiveness to various stimuli and the validity of reported family history using information obtained from family members. Some of these elements could be used in the context of other clinical and epidemiological studies. The complete questionnaire, together with the source of the questions, instructions for interviewers and the method of coding are presented in an appendix available on the internet (http://www.splf.org/bbo/revues-articles/RMR/depotElectronique/2001-110_Kauffmann/Kauffmann2002.htm) which supplements the printed paper.