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As soon as the peace treaty terms were known (1871), Nancy purposed to shelter the Strasbourg Faculte de Medecine. Nevertheless, many people thought that Lyon would be more suitable for the transfer. Then, the final wars settled by Thiers (President de la Republique) was a political one showing his will to found, close to the new border line, a scientific centre which would include the Strasbourg Faculte de Medecine transferred into Nancy.

The shape of the capnogram is modified by airway obstruction, and the evaluation of this deformation, using measurable indices, could allow an indirect measurement of bronchial patency. A previous study undertaken in asthmatic subjects showed a good correlation between a capnographic index (end-tidal slope) and a spirometric parameter (forced expiratory volume in one second as a percentage of predicted (FEV1 %pred)) and suggested the study of other indices. The correlations between capnographic and spirometric indices were measured in 10 healthy subjects and 30 asthmatic patients. The usefulness of eight descriptive indices, analysing the successive phases of the capnogram, was assessed by measuring their reproducibility and their sensitivity to airway obstruction. The intraindividual and interindividual variabilities (Vi and VI) and the noise/signal ratio (Vi/VI) were measured by comparing the results of two successive capnographic measurements in 14 asthmatic subjects. The results show an increasing noise/signal ratio along the expiration (between 23 and 62%). Significant correlations between spirometry and capnography were found with all indices, but the strongest were observed with indices analysing the intermediate phase of the capnogram, that is the angle between the ascending phase (E2) and the alveolar plateau (E3). The correlations show that the analysis of the capnogram's shape is a quantitative method for evaluating the severity of bronchospasm. This ability, added to specific advantages (noninvasiveness, effort-independency, measurements during tidal breathing) opens new fields of application to capnography, such as measurement of bronchospasm in children and computerized monitoring of asthma.

The shape of the capnogram, which is related to uneven ventilation, is modified in obstructive diseases and especially during crisis of asthma. The most significant change is a rise in the slope of the "alveolar plateau". In this study, we measured the end-tidal slope (ETS) of the capnogram, calculated on 0.36 s before the end of expiration, and we compared this indice to usual spirometric measurements (FEV 1) in 21 control subjects and in 24 asthmatic subjects. The mean ETS in control subject was 0.08 +/- 0.06%/s, it was 0.3 +/- 0.23% in asthmatic subjects (p < 0.001). In the latter, we found a very significant correlation between ETS and FEV 1 (r = 0.83, p < 0.001). Thirteen asthmatic subjects were tested for a second time, immediately after inhalation of a beta 2-mimetic drug. They exhibit a very strong correlation between the rise of FEV 1 and the loss of ETS (r = 0.96, p < 0.001). These results show that the analysis of the capnogram's shape is a quantitative method for evaluating the severity of the bronchospasm. This ability, added to specific advantages (non-invasiveness, effort-independence) opens new fields of application to capnography: measurement of the bronchospasm in children, computerized monitoring of asthma.

A 46 year old woman had adverse reactions to paracetamol. Oral challenge tests with the drug showed that the reactions were dose-dependent and they reproduced similar symptoms consisting of vomiting, diarrhoea, pruritus, skin rashes, facial oedema, dyspnoea and hypotension. There was a marked increase in blood histamine but the complement components C3 and C4 remained at normal levels. Treatment with epinephrine and moderate doses of betamethasone brought fast recovery without any further complication.

In 20 intrinsic and 25 allergic asthmatic patients with active disease, vagal baroreflex sensitivity was assessed by use of the phenylephrine test, and vagal blockade effects on airways were measured by the response to intravenous atropine. For a given phenylephrine-induced increase in blood pressure, bradycardia was more marked in patients with intrinsic asthma than in those with allergic asthma. Intravenous atropine caused a similar spirometric improvement in both groups. It is suggested that: 1) an inverse relationship exists between vagal sensitivity and the allergic state in asthma; 2) antigenic related stimulation modulated by a low vagal tone and non-antigenic related stimuli with high tone modulation result in similar cholinergic discharges.

Histamine-liberation occurs mainly from the mast cells and basophils, the sitr of synthesis of histamine, and other intermediary substances such as serotonin, S.T.S.A. The possible causes for this histamine-liberation are numerous and varied. Histamine-liberation of immunological order only represents a particular case in this chapter as a whole. The study quite specifically deals with histamine-legeration provoked by the direct pharmacodynamic action of drug substances, in particular those which are used in anaesthesiology. These substances are numerous and act according to two essential mechanisms: action by diffusion in the region of the histamine carrying cell (the case of substances of low molecular weight), enzymatic action on the cell membrane (the case of substances with high molecular weight). From the standpoint of clinical consequences, discrimination between specific and non-specific histamine-liberation is therefore risky. In practice, in the face of a symptomatology of histamine shock, it is necessary to bear in mind what is known of the pharmacological action of the substances used, and on the other hand not to neglect the resources of the history, and to employ the laboratory tests capable of providing arguments for or against anaphylaxis.

The incidence of food allergy has been evaluated in 67 asthmatic patients (allergic asthma: 52, intrinsic asthma: 15). History was positive for post-meals attacks (7), symptoms involving other target organs (61%). Prick tests were found positive in 17/60; intradermal 77/682. Out of 110 human basophil degranulation tests or RAST, performed in 44 patients, 21/15 patients were found positive. Out of 18 inhalation challenges, 7 were positive. Out of 17 food oral challenges, 6 were positive (8 patients). A definite diagnosis of food allergy was accepted for 9 patients. Elimination diet, with 600 mg/day of cromolyn, induced a major improvement in 7 patients within 3 months, with 2 further failures after 1 year. A successful elimination diet was correlated with a positive food challenge. The relative incidence of food allergy in asthmatic adults is discussed (5.8%), as well as a non-immunologic mediated intolerance to food additives in intrinsic asthmatics, the incidence of vegetable allergies in pollen-sensitive patients, the procedures and meaning of inhalation and oral challenges, the relative importance of trophallergens. Food allergy appears to be a variable co-factor in bronchial hyperreactivity.

The specific IgE levels for 11 allergens were compared in 288 patients by means of the Phadebas RAST and the IgE-FAST. Agreement (less than 1 class difference) was observed in 78.7% of the cases. The best agreement was observed with Phleum pratense, egg white, corn, Betula verrucosa and cat epithelium. In 91 cases the results were retrospectively compared with clinical data and skin tests. When RAST and FAST differed (n = 31) 93.5% and 51.6% of the respective results were in agreement with the skin test. When RAST and FAST were similar (n = 60) 81.7% and 80.0% of the respective results were in agreement with the skin test. It was concluded that the RAST and the FAST gave similar results in most cases but that the RAST was more sensitive than the FAST, especially when the results obtained with both methods differed.

The authors undertook an epidemiological study to held useful criteria to identify asthma sufferers. A simple questionnaire was used asking three questions: - Do you wheeze on breathing? - Do you have attacks of breathlessness during the night? - Do you have asthma? 7,904 people were questioned at the Centre for Preventive Medicine at Vandoeuvre-les-Nancy over a year and 1,062 gave a positive response to at least one question. The replies were sub-divided into 5 groups according to the pattern of response and were then given a further clinical assessment as follows: - A sensitivity test for house dust allergy; - A bronchial sensitivity test to Acetylcholine; - The level of blood eosinophilia; - Presence or absence of a family history of asthma. The results were then compared to a matched group of controls who gave a negative reply to all three questions. The authors concluded that the term asthma should only be used by people who recognize themselves as asthmatics and can identify at least one trigger factor in their symptoms. One frequently finds in such people : a family history of asthma, a positive allergy test to the house dust mite, and eosinophilia. On the other hand those with only one or two symptoms (dyspnoea or wheezing) without recognizing themselves as asthmatics had little evidence of a family history of asthma, a sensitivity to the house dust mite comparable to controls and no eosinophilia; in these people there was a striking relationship to tobacco consumption. The Acetylcholine test shows little discriminative value in an epidemiological study of this nature; asthmatics could not be separated from patients with chronic air-flow obstruction, particularly when due to tobacco. It would be helpful to find a test of bronchial hyperactivity which could be used epidemiology. As a result of this study it is possibly to place the prevalence of asthma in the South of Lorraine in the range of 1.7 to 3.6% of the population.

The thoracic localization of endometriosis may involve the pulmonary pleura and the diaphragm, or the bronchopulmonary parenchyma, according to mechanisms which appear to be quite different. The principal clinical manifestations express themselves depending on their localization, a pneumothorax in the first case and hemoptysis in the second. One clinical characteristic, however, applies to them all, a rhythm strictly related to periods. The current methods of visualization of the pleura enable a macroscopic diagnosis to occur in the former cases in 64% and the body scanner now localizes the second in all cases. Treatment by Danatrol is often strikingly effective in a few months, notably in the cases with parenchymal localization.

A second clinical trial of the compound Ro 6-0787, which is a specific monovalent penicilloyl hapten inhibitor of allergic reactions to penicillin has been conducted by investigators from 9 different European groups in 90 patients allergic to penicillin. The effect of a combined Ro 6-0787-penicillin therapy was considered as clinically successful in the large majority of cases, since treatment with penicillin could be pursued or resumed without allergic manifestation in 42 from 46 cases (91 percent). The effect of Ro 6-0787 alone on acute allergic manifestations after interruption of penicillin therapy was more difficult to evaluate but was nevertheless considered satisfactory in 17 from 26 patients (65 percent). A depression of skin hypersensitivity to PPL and/or penicillin and penicillin derivatives sometimes persisting for weeks and months was obvious in numerous allergic patients submitted to combined Ro 6-0787-penicillin treatment. A depressing effect on antipenicillin antibody titers detected by passive hemaglutination was also manifest in some patients. Failure to suppress allergic manifestations was reported in 11 cases, among which some may have been due to insufficient dosage of inhibiting hapten. The overall tolerance of Ro 6-0787 in allergic patients has been very good. Nevertheless, the major obstacle to a wider general use of Ro 6-0787 at the present time appears to be the occurrence of positive skin reactions to that compound in approximately 5 percent of patients allergic to penicillin. It is not yet ascertained whether the occasional positive skin reactions and urticaria to Ro 6-0787 may have been due to aggregation, or incomplete dissolution of the compound or whether it reflects hypersensitivity to another antigenic determinant. With the reservation that patients with positive skin test to Ro 6-0787 have for the time being to be excluded from combined treatment, this monovalent hapten certainly offers a new possibility to resume and/or pursue penicillin therapy in patients demonstrably allergic to that drug.

Sensitization to simple chemical substances acting as haptens is not well known in food allergy. For that purpose, a study was made in rabbit using tartrazine alone with adjuvant, or mixed with human serum albumin (HSA), or conjugated by covalent BOP bonds with HSA. Hypersensitivity was evaluated by rabbit basophil degranulation test which would offer more specificity through cell membrane IgE-antibody reactions, and thus, more accuracy than classical passive cutaneous anaphylaxis. The data showed that sensitization could not be induced by ingestion of tartrazine with adjuvant or mixed with a protein. But covalent conjugate T-HSA mixed with adjuvant sensitized 8 of the 9 rabbits studied. It seems that preceding irritation of intestinal mucous membrane by acetylsalicylic acid enables one to obtain a more long lasting sensitization.

Factors which set up an allergy of the digestive tract are alimentary antigens, fungal or bacterial antigens, drugs, among other things. The allergy is favored by achlorhydria, lack of pancreatic or duodenal enzymes or inflammations of the gastro-intestinal mucosa. The origin of a digestive allergy quite decisively depends on the A immunoglobulins. They can combine with high molecular weight antigens and so inhibit the transit of the active antigen. In the diagnosis, the authors have found a test particularly useful in which a few drops of antigen solution are administered sublingually. Therapy includes restoration of disturbed digestive functions, an individually planned diet and the avoidance of alcohol and strong spices.

There are two situations where these products may be used and their justifications are quite different. For anaphylactic shock, the treatment should be aimed at limiting the effects of the acute reduction of volume due to vasoplegia and peripheral diapesis provoked by the liberated histamine. The medullary-suprarenal hormones are the first recourse, efficacious on the alpha and beta receptors. The alpha action is of the excitative type and provokes peripheral vasoconstriction. The beta-action suppresses the contraction of the smooth muscle, but in isolation can facilitate vasodilation. This is why adrenalin is suitable for strict control of arterial pressure: Immediate administration in IM (0.25 to 1 mg), by slow I.V. (dilution 1/10) It is appropriate, where possible to restore the blood volume with a volume expander. Cortico-therapy, both general and by aerosol is used in relays. For asthma: The question is, whether to use beta-2-agonists that have an action on muscle relaxation, on mucosal oedema, also on the secretion of mucus and indirectly on liberation of intermediate substances. Acute use of beta-2-agonists is: Perhaps for a specific purpose, for example to prevent effort-induced asthma: use of a spray is simple and efficacious. Perhaps for a greater and more prolonged use to treat an attack of asthma or a bad state of asthma before hospitalisation.(ABSTRACT TRUNCATED AT 250 WORDS)

In this double-blind, multicentre study the antihistamine acrivastine was compared with terfenadine for the treatment of seasonal allergic rhinitis. The study was divided into three periods which together lasted 56 days. Patients (n = 83) were randomly assigned treatment with either 8 mg acrivastine three times daily or 60 mg terfenadine twice daily. Both agents were equally efficacious in reducing the severity of sneezing, itchy nose, blocked nose, running nose, itchy eyes, watery eyes and itchy throat as recorded daily by patients, and as rated by both the patients and their physicians at the end of each treatment period. Acrivastine and terfenadine were equally well tolerated with no serious side-effects. Both effectively controlled the symptoms of seasonal allergic rhinitis in otherwise healthy individuals.

This investigation was performed to determine the possible significance of the IgE levels in intestinal secretions for the recognition of type I food allergy (immediate hypersensitivity). Four groups of individuals were studied and compared with each other: (1) healthy controls and patients with gastrointestinal disorders not affecting the small intestine; (2) patients with small intestinal disease; (3) patients with various manifestations of allergy but without food intolerance; and (4) patients with atopic sensitivity to foods. Despite the presence of proteolysis in the intestinal fluid, a statistically highly significant increase of the intestinal IgE level was observed in patients of group 4 with type I food allergy and in patients of group 3 as compared with normals. This was associated with an increase in the serum IgE level. An increased synthesis of the IgE in the lamina propria of the small intestine is most probable, but not yet adequately established.

Histamine is released from mastocytes and basophils polymorphonuclears. This occurs particularly in reaginic type of allergy. The different phases of the reaginic process has been studied: IgE bridgings with antigens, cell membrane activation, cytoplasmic biochemical reactions involving cyclic AMP and GMP leading to microtubules activities, contraction of microfibrils and degranulation. Calcium and magnesium contribute to the regulation of histamine release. Histamine releases could also be seen in non reaginic type of immuns allergic reactions by way of direct or indirect activation of complements, by stimulation of PAF, etc...Finally, quite a few substances could also provoke histamine release of non immunologic type (physical agents, snake and bee venoms chemical substances in micro or macromollecular forms used in therapeutics...). Their mechanisms of action are various; yet in a way, they present similaritis with immunoallergic reactions. In practice, it is often difficult to assert the allergic nature of a histaminic reaction. Immunologic evidences should be cautioniously searched before any conclusion.

An epidemiology study on atopy was performed in a Center of Preventive Medicine, in 505 children aged from 4 to 14 years old, in good health, in consultation with their parents. The clinical atopy was evaluated by a questionnaire inquiring about atopic dermatitis, hay fever, infantile asthma, previous recurrent infections, breast or bottle feeding. Total serum IgE were dosed (Phadezym) and pricks performed to mites and pollens. The clinical atopy is diagnosed in 14.46% of cases (atopic dermatitis: 10.28%--asthma: 3.76%--hay fever: 2/98%). Pricks are positive in 14.85% of cases (mites: 11.48%--pollen: 99.11%--both: 5.74%). The cutaneous sensibility is observed in 32.8% of cases with clinical atopy, 12.5% of other children. The total IgE are very variable and does not correlate with a normal distribution. This allows definition of the quartile below which 90% of the sample is to be found: 474 kUI/l. There is a highly significant relation (p 0.001) between clinical atopy and positive pricks to airborne allergens, clinical atopy and raised alone 474 kUI/l, positive pricks and IgE of more than 474 kUI/l. There is a close relation between atopy and recurrent infections, raised IgE in children and paternal atopy, specific IgE in children and maternal atopy. It appears also that breast feeding is a risk factor for raised IgE in children when the mothers are not atopic, which is somewhat unexpected. Investigation of an atopic terrain may be performed through skin tests or an assay of seric IgE, which seem to be closely comparable.

A homogeneous series of 103 cases of shock due to muscle relaxants has been used to identify the risk factors in anaphylactoid shocks due to either true anaphylaxis or to non-specific histamine release. Clinical atopy (asthma) and sub-clinical atopy as shown up by skin tests with mites and pollens, as well as a history of IgE-dependent drug allergy, were present with a significantly greater frequency in the history of patients presenting with anaphylaxis. Abnormal histamine release and reactivity to histamine, as assessed by skin tests with 48/80 and histamine, were often found in those patients who presented with non-specific histamine release induced by muscle relaxants. Whatever the mechanism for the shock, the frequency of spasmophilia was increased. A history of non-immunological intolerance to acetyl salicylic acid and other non-steroid anti-inflammatory drugs was more often found than in the reference drugs was more often found than in the reference population. However, 25% of the patients studied did not have any of these risk factors. Several possibilities of preventing anaphylactoid reactions are given, if one or more of these risk factors are found in the history: a better choice of anaesthetic drugs, in the light of previous anaesthetic protocols, the relief of anxiety by appropriate premedication, antihistamine premedication and the prevention of bronchospasm.

This pathology is not due to the drug but revealed or aggravated by it. The most commonly implicated drugs are the anti-inflammatory group, especially aspirin. However, the list of drugs liable to induce intolerance continues to grow. The clinical manifestations are mainly observed in middle age and may regress. Drug intolerance can be demonstrated by provocative tests; it can be limited by methods of drug tolerance. The most commonly pathogenic mechanisms are: -inflammatory mechanisms (role of kinin), -disturbance of the metabolism of arachidonic acid, prostaglandin blockage, stimulation of leukotrienes. This expanding pathogenic entity is independent though similar in many aspects to the immediate forms of allergy, so explaining its importance in the general field of pseudo-allergy.

Thirty patients with perennial vasomotor rhinitis were submitted to pharmacological tests to assess the autonomic responsiveness of extra-nasal and intra-nasal receptors to isoprenaline and phenylephrine by infusion, and to evaluate the effect of 14-days' treatment with mequitazine (5 mg twice daily) and placebo on clinical symptoms and on autonomic sensitivity. Isoprenaline induced a similar tachycardia in all patients, more pronounced than that observed in normal subjects, at the different times of testing, and also an increase in nasal resistance. With phenylephrine, marked bradycardia was observed, reflecting high vagal baroreflex sensitivity, and a transient decrease in nasal resistance was obtained. Mequitazine improved significantly the clinical symptoms but did not modify the autonomic receptivity. It is suggested that in patients with vasomotor rhinitis an autonomic dysfunction may play a role in a predisposing factor in nasal hyperreactivity with non-specific histamine release.