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Adverse reactions to iodinated contrast media, which is used during computed tomography (CT) examinations, are rare. As a result, radiographers have limited experience handling those situations and may feel uncertainty and a lack of confidence. The aim of this study was to investigate radiographers' confidence in handling hypersensitivity reactions to contrast media during CT examinations. A survey in the form of a questionnaire was conducted to gather both quantitative and qualitative data. There were 31 clinics that participated in this study, of which four were university hospitals, 17 were medium-sized hospitals and 10 were small hospitals. In total, the questionnaires were distributed to 700 radiographers. The questionnaire contained 12 questions and was distributed via email with a link to the questionnaire. Two hundred-ninety radiographers participated in the survey. 72% of the respondents answered in the middle of the four-point scale (2–3) in response to the statement "I feel confident in handling hypersensitivity reactions". 65% answered that they did not have routines for training regularly regarding hypersensitivity reactions. Qualitative data showed that many of the respondents wished to receive education and training regularly. The confidence of radiographers regarding the management of hypersensitivity reactions was deficient and most of the respondents wished they felt more confident. To increase radiographers' confidence in handling hypersensitivity reactions, it is recommended that the radiology clinics review their routines and the possibility to implement regular training. [ABSTRACT FROM AUTHOR]

Background: A clinical scoring system to estimate the likelihood that a reaction represents a perioperative immediate hypersensitivity reaction has been devised using a Delphi consensus process. Agreement of this clinical scoring system with the outcome of allergological assessment would allow the use of this tool in post-resuscitation and subsequent management of suspected perioperative immediate hypersensitivity reaction and potentially as a new standard reference for clinical investigations.Methods: We prospectively scored 301 cases of suspected perioperative immediate hypersensitivity reaction according to the Hypersensitivity Clinical Scoring Scheme. Classification of cases was by allergological workup based on immediate and delayed investigations. The discrimination and calibration of the Hypersensitivity Clinical Scoring Scheme was compared with results from an expert panel of allergologists, skin testing, mast cell tryptase ratios, and specific IgE assays, as was agreement by Cohen's kappa coefficient.Results: The Hypersensitivity Clinical Scoring Scheme predicted cases of allergic perioperative immediate hypersensitivity reaction with comparable discrimination to an expert panel, mast cell tryptase formula, and specific IgE assays in anaphylaxis to neuromuscular blocking drugs. Using a score threshold of 15 or greater to indicate allergic perioperative immediate hypersensitivity reaction, the sensitivity was 88.9%, with a specificity of 79.4%. Prospectively, the Hypersensitivity Clinical Scoring Scheme correctly classified a greater number of subjects than the expert panel and the optimal post hoc binary logistic regression model (86% vs 85% vs 84%), however it was inferior to skin testing.Conclusion: The Hypersensitivity Clinical Scoring Scheme predicts allergic perioperative immediate hypersensitivity using features of the acute syndrome. This approach could guide algorithms for the post-resuscitative management of suspected perioperative immediate hypersensitivity, and identify patients requiring drug provocation challenge. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This narrative review seeks to distinguish the clinical patterns of pre-existing allergic conditions from other confounding non-allergic clinical entities, and to identify the potential related risks and facilitate their perioperative management. Follow-up investigation should be performed after a perioperative immediate hypersensitivity to establish a diagnosis and provide advice for subsequent anaesthetics, the main risk factor for perioperative immunoglobulin E (IgE)-mediated anaphylaxis being a previous uninvestigated perioperative immediate hypersensitivity reaction. The concept of cross-reactivity between drugs used in the perioperative setting and food is often quoted, but usually not supported by evidence. There is no reason to avoid propofol in egg, soy, or peanut allergy. The allergenic determinants have been characterised for fish, shellfish, and povidone iodine, but remain unknown for iodinated contrast agents. Iodinated drugs may be used in seafood allergy. Evidence supporting the risk for protamine allergy in fish allergy and in neutral protamine Hagedorn insulin use is lacking. Conversely, cross-reactivity to gelatin-based colloid may occur in α-gal syndrome. Atopy and allergic asthma along with other non-allergic conditions, such as NSAID-exacerbated respiratory disease, chronic urticaria, mastocytosis, and hereditary or acquired angioedema, are not risk factors for IgE-mediated drug allergy, but there is a perioperative risk associated with the potential for exacerbation of the various conditions. [ABSTRACT FROM AUTHOR]

Résumé Les anti-inflammatoires non stéroïdiens (AINS) sont les médicaments les plus pourvoyeurs de réactions d'hypersensibilité immédiate. Parmi ces réactions, l'urticaire aiguë isolée est l'atteinte la plus fréquente et d'origine non allergique. Elle correspond à un effet secondaire pharmacologique par déséquilibre du métabolisme de l'acide arachidonique induit par les AINS. Le diagnostic de cette urticaire aiguë est clinique, sans nécessité d'exploration allergologique. Lorsqu'ils sont réintroduits, les AINS anti-COX-1 sont dans la grande majorité bien tolérés. Cette revue effectue une mise au point sur les réactions d'urticaire aux AINS, dont la prise en charge est simple. Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common providers of immediate hypersensitivity reactions. Among these reactions, isolated acute urticaria is the most common clinical feature with a non-allergic origin. It is a pharmacological side effect resulting from the alteration of arachidonic acid metabolism induced by NSAIDs. Diagnosis of this acute urticaria is clinical, requiring no allergy testing. Currently, the recommended therapeutic management of NSAID urticaria is the avoidance of all NSAID with COX-1 inhibitor activity (even if when reintroduced, they are most often well tolerated) and the use of selective COX-2 inhibitors. This review focuses on urticaria reactions to NSAIDs, which are simple to manage. [ABSTRACT FROM AUTHOR]

The production of antibodies is accompanied by a slight excess of synthesis of κ and λ immunoglobulin light chains; small amounts of them are released in the peripheral blood and can also be found in various body fluids, such as synovial fluid, cerebrospinal fluid, urine and saliva. They are rapidly filtered by the glomerulus and > 99% are reabsorbed from the cells of the proximal convoluted tubule, making them present in the urine in only trace amounts. The production of an excess of protein without a reason or a specific function in a biological system is rare. Free light chains, considered for years a waste product of Ig synthesis, are currently known to be very active molecules, able to bind antigens as well as whole immunoglobulin and helping to develop specific antibody affinity. The ability of free light chains to activate mast cells and then become an active part of the pathogenic mechanisms of chronic inflammatory diseases has increased interest in their clinical use, both as an attractive therapeutic target or as a biochemical marker of disease evolution or remission. This is an overview of relevant scientific interest that immunoglobulin light chains κ and λ have attracted over the years, a report on the progress in knowledge about their structure and function, with a special focus on their biological meaning and potential clinical utility in different diseases. [ABSTRACT FROM AUTHOR]

Résumé L’allergie aux bêtalactamines est une situation fréquente car environ 10 % des malades se disent allergiques à la pénicilline. Cependant ce diagnostic est largement porté par excès. Derrière cette notion d’allergie on distingue les hypersensibilités immédiates pouvant conduire au choc anaphylactique et les hypersensibilités retardées, du plus fréquent exanthème maculo-papuleux aux toxidermies bulleuses sévères ou DRESS pouvant mettre en jeu le pronostic vital. La réalisation d’un bilan allergologique comportant des tests cutanés orientés selon le tableau clinique, complétés de tests de provocation orale en l’absence de contre-indication, va permettre de confirmer ou infirmer ce diagnostic et d’identifier en cas d’allergie confirmée, les alternatives sures au sein des bêtalactamines. Allergy to beta-lactam antibiotics is a common condition and about 10% of patients report being allergic to penicillin. However, this diagnosis is largely overestimated. Two types of allergy should be distinguished and include immediate hypersensitivity that can lead to anaphylactic shock and delayed hypersensitivity, ranging from the most common maculopapular exanthema to severe bullous toxidermia or life-threatening DRESS. Allergy challenge with oriented skin tests according to the clinical features, supplemented with oral challenge in the absence of contraindication, will confirm or invalidate the diagnosis of beta-lactam allergy and will help to identify if necessary safe alternatives to beta-lactams. [ABSTRACT FROM AUTHOR]

Résumé L’anaphylaxie est une urgence allergique dont la fréquence augmente constamment. Son management repose sur l’administration d’adrénaline et la coordination entre urgentistes et allergologues. L’objectif de l’étude était de déterminer l’incidence de l’anaphylaxie en 2015, d’en décrire les principales caractéristiques et d’évaluer les pratiques. Quatre centres hospitaliers lorrains ont été sélectionnés. Les dossiers médicaux informatiques des patients admis aux urgences adultes ou pédiatriques entre le 1 er janvier et le 31 décembre 2015 ont été interrogés sur leurs motifs de recours et code diagnostique. Les dossiers dont le codage était susceptible de correspondre à une réaction anaphylactique (95 codes sélectionnés) étaient revus individuellement par un investigateur allergologue, puis inclus en cas de confirmation. Un questionnaire standardisé a permis le recueil des données épidémiologiques, caractéristiques cliniques et prise en charge des patients. L’anaphylaxie représente 0,16 % des passages aux urgences pour 2015, avec une incidence de 34 pour 100 000 personnes-année en Lorraine. La présentation clinique est influencée significativement par l’âge, le facteur étiologique, certains cofacteurs (asthme, comorbidité cardiovasculaire, médications), et la gravité de la réaction. En cas d’anaphylaxie sévère, le recours à l’adrénaline n’était que de 32,4 % (48/148), et 4 fois sur 10 la durée de surveillance hospitalière était inférieure à 6 heures. Une orientation vers l’allergologue était proposée chez 57,9 % (187/323) des patients. L’anaphylaxie est une cause non exceptionnelle d’admission aux urgences. Les recommandations sont encore trop peu appliquées, et une meilleure connaissance de la pathologie et de sa prise en charge est nécessaire pour les professionnels gérant l’urgence. Anaphylaxis is an allergic emergency, and its frequency increases in all countries since the 2000s. Epinephrine administration and allergist-emergency room interactions are the key points of its management. The objective of the study was to determine the incidence of anaphylaxis in 2015, to describe its main characteristics and to evaluate practices in Lorraine for this period. Four hospitals in Lorraine were selected. Medical records from each center's adult and pediatric emergency rooms, from 1st January to 31th December 2015, were classified based on their admission cause and diagnosis code. When data were consistent for an anaphylaxis (95 selected ICD-10 codes) record was analyzed by an allergist practitioner and included if confirmed. Epidemiological data, clinical characteristics, management assessment and orientation were provided through a standardized questionnaire. Anaphylaxis is responsible for 0.16% emergency rooms’ admissions in the participating centers in 2015; the estimated incidence in Lorraine is 34 per 100,000 person-years. Clinical presentation depends on age, etiologic agent, several cofactors (asthma, cardiovascular comorbidities, treatments) and reaction's gravity. When anaphylaxis was serious (Ring-Messmer's grade ≥ 3), epinephrine use was only 32.4% (48/148) and observation duration was less than 6 hours 4 times on 10. An allergist referral was proposed in 57.9% (187/323) patients. Anaphylaxis is not a rare cause for emergency rooms’ admission in Lorraine. Therefore guidelines are insufficiently followed and a better knowledge of the pathology and its management is necessary for emergency healthcare practitioners. [ABSTRACT FROM AUTHOR]

Abstract: Herbal medicines have ever been thought harmless, but it is obviously not true. Many adverse reports emerged with the development of their popular application in the world. Allergic reactions, especially serious immediate hypersensitivity, frequently occurred when herbal injections were used in clinic and made this ever prevailing agent nearly disappear in China. The aim of this study is to establish a rapid and economical method for the prediction of the allergenicity of herbal injections. Ovalbumin (OVA) and four other herbal injections, in which two of them were well known for their allergenicity, were selected to sensitize and stimulate the animals. Serotonin in the animal serum was detected with HPLC to reflect the anaphylactic response and compared with the other cytokines which could mediate the anaphylaxis, including histamine, IgE and β-hexosaminidase. The results suggest that serotonin can be detected quickly and has good correlation with the other allergy-related cytokines. It is a promising way for predicting the allergenicity of the herbal injections and those complicated natural products. [Copyright &y& Elsevier]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

2010 was marked by rapid progress in our understanding of the cellular and molecular mechanisms involved in the pathogenesis of allergic inflammation and asthma. Studies published in the Journal of Allergy and Clinical Immunology described advances in our knowledge of cells associated with allergic inflammation (mast cells, eosinophils, dendritic cells, and T cells), as well as IgE, cytokines, receptors, signaling molecules, and pathways. Studies used animal models, as well as human cells and tissues, to advance our understanding of mechanisms of asthma, eosinophilic esophagitis, food allergy, anaphylaxis and immediate hypersensitivity, mast cells and their disorders, atopic dermatitis, nasal polyposis, and hypereosinophilic syndromes. Additional studies provided novel information about the induction and regulation of allergic inflammation and the genetic contribution to allergic inflammation. Critical features of these studies and their potential effects on human atopic disorders are summarized here. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The year 2009 was marked by rapid progress in understanding cellular and chemical mechanisms in the pathogenesis of asthma and other allergic disorders. Studies published in the Journal of Allergy and Clinical Immunology described advances in our knowledge of signaling molecules and pathways, cytokines, and activation and tolerance in asthma and murine models of this disease; food allergy; anaphylaxis and immediate hypersensitivity; mast cells and their disorders; atopic dermatitis; allergic conjunctivitis; nasal polyposis; and hypereosinophilic syndromes. Additional studies provided novel information about the induction and regulation of allergic inflammation and the genetic determinants of asthma and responsiveness to asthma therapy. Critical features of these studies and their potential effect on human atopic disorders are summarized here. [Copyright &y& Elsevier]

Abstract: The incidence and morbimortality of immediate hypersensitivity reactions following iodinated contrast media (ICM) injection remain unknown. The diagnosis of an immediate hypersensitivity reaction relies on a triad associating the precise description of the initial clinical manifestations and their delay of onset, the results of the biological assessment performed after the reaction including histamine and tryptase serum level measurements, and the results of skin testing with the culprit agent. Analysis of these data allows identification of the pathophysiologic mechanism of the reaction and the allergen involved in case of allergic hypersensitivity. Skin tests should be performed according to strict criteria. Cross-reactivity with ICM has to be investigated in order to propose a nonreactive ICM for future procedures. Allergic hypersensitivity to a given ICM imposes its definitive avoidance but not the avoidance of all iodinated drugs. The allergenic sequence has not yet been identified but is not the iodine atom itself. Asthma and treatment with β-blockers are not risk factors of immediate allergic reactions to ICM per se, but may increase their severity. The various published protocols of premedication do not prevent the occurrence of an allergic/anaphylactic reaction to an ICM. The avoidance of the culprit ICM is the only way to prevent further reactions. [Copyright &y& Elsevier]

Abstract: Late phase reaction (LPR) of immediate hypersensitivity is a Th2 response characterized by eosinophil recruitment and related to allergic asthma pathogenesis. Several strategies were developed trying to control the tissue damage observed in this reaction. Recently, we verified that killed Propionibacterium acnes (P. acnes), a Gram-positive bacillus, immunomodulated LPR in a murine model, potentiating or suppressing it depending on the treatment protocol used. However, the bacterium compounds responsible for this effect are not known, leading us to investigate if P. acnes purified soluble polysaccharide (PS) could be a major component involved on the modulation induced by the bacterium. Recently, we demonstrated that PS, like P. acnes, induces adjuvant effect on DNA vaccine, increases bone marrow dendritic cell precursors in vivo and its maturation in vitro, and modulates in vitro macrophage tumoricidal activity. Herein, we determined the chemical PS composition, which is mainly constituted by galactopyranose, ribopyranose, arabinopyranose, glucopyranose, ribofuranose and mannopyranose, and analyzed its capacity to modulate the immediate hypersensitivity in mice. Animals were subcutaneously implanted with coagulated hen''s egg white (HEW) and 14 days later challenged with ovalbumin (OVA) in the footpad, developing a typical LPR after 24h. Similarly to the whole bacterium, Th2 response to OVA was potentiated when PS was administered concomitantly to HEW implantation, by increase in footpad eosinophilia and IL-4-producing spleen cells, and decrease in anti-OVA IgG2a titers and IL-12- or IFN-γ-producing cells. On the other hand, the reaction was abrogated when HEW implantation was performed 1 week after PS-treatment, by decrease in footpad swelling, eosinophilia and anti-OVA IgG1 levels, and increase in IgG2a titers and IL-12-producing cells. These data suggest that PS seems to be the major P. acnes compound responsible for its effects on the modulation of immediate hypersensitivity reaction in mice. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Patients with self-reported penicillin allergy are frequently denied β-lactam antibiotics. Objective: To identify and correlate clinical and genetic risk factors of self-reported penicillin allergy. Methods: We conducted a case-control study of adults recruited from allergists'' offices. Cases had a history of urticaria, angioedema, wheeze, hypotension, vomiting, or anaphylaxis after a dose of penicillin. DNA from buccal swabs was genotyped for variants associated with candidate genes linked to immediate hypersensitivity (IL4, IL4R, and IL10) and penicillin metabolism (LACTB). Logistic regression was used to calculate the association between penicillin allergy and clinical and genetic factors. Results: Seventeen allergists identified 76 adults. Complete data were available for 23 cases and 39 controls. Penicillin allergy was associated with a history of penicillin allergy in first-degree relatives (P = .002), a history of other adverse drug reactions (P = .008), and atopy (P = .039). However, in the multivariable analysis, only family history of penicillin allergy remained significant. IL4 single nucleotide polymorphisms (SNPs) rs11740584 (P = .012), rs10062446 (P = .021), and rs2070874 (P = .035) were associated and LACTB SNP rs2729835 (P = .058) was marginally associated with penicillin allergy. Adding rs11740584 or rs10062446 individually improved the clinical multivariable model (R 2 increased from 0.23 to 0.33). Haplotype analysis did not provide additional information to the SNP analysis. Conclusion: Self-reported penicillin allergy may be influenced by clinical and genetic factors such as IL4. [Copyright &y& Elsevier]

Abstract: Perfumes remain the most important allergenic cosmetic products. However, the European Union had published a list of the 26 most allergenic fragrance mixes and has limited their use to well-defined concentrations, according to whether the product is a rinse or no-rinse one. As a result, it appears that the incidence of cutaneous reactions to perfumes is decreasing. For the sensitized patient, however, avoidance of these fragrance mixes is never easy and usually incomplete. In addition, because of their polymorphism and of the various routes of sensitization, clinical reactions are still difficult to control. [Copyright &y& Elsevier]

Abstract: Peranesthetic anaphylactic shock (an IgE-dependant immediate hypersensitivity reaction) is caused most often by myorelaxants. Depending on the sequence of events, immediate laboratory tests are done to demonstrate histamine release, mast cell degranulation and, eventually, IgE specific for the causative agent. An elevated plasma histamine concentration can be due to an allergic mechanism or to non-specific histamine release. The blood sample must be obtained rapidly (<30min in mild reactions and <2h in severe reactions). An increased tryptase concentration, between 15min and several hours after the reaction, is evidence of mast cell activation and favors an allergic mechanism. For moderate reactions, comparison with a base-line level is recommended. The level of myorelaxant-specific IgE remains constant from the moment of the reaction to a much later time. [Copyright &y& Elsevier]

Background: IgE synthesis by human B cells results from allergen-dependent, TH2-mediated isotype switching. Exposure to a farming environment protects against IgE responses. Objective: We reconstructed allergen-dependent switching patterns in vivo to identify the level or levels at which farm exposure acts to protect against atopy. Methods: Serum IgG1 to IgG4 and IgE to grass (rPhl p 1 and rPhl p 5), cat (rFel d 1), and mite (rDer p 2) were assessed by means of ELISA in the Allergy and Endotoxin study population (812 children). Farm exposure was defined as currently living on a farm, exposure to stables/farm milk in the first year of life, or both. Results: Farm exposure did not affect allergen-specific IgG2 and IgG3 levels but had complex allergen-specific effects on IgG1, IgG4, and IgE levels. Exposure protected against grass-specific responses at every step along the IgG1/IgG4/IgE switching pathway but had no significant effect on mite responses. Protection from cat responses was concentrated at the IgG1 level. For all allergens, failure to express IgG1 was associated with low prevalence of IgG4 or IgE responses. Notably, coexpression of IgG1, IgG4, and IgE to grass was associated with increased risk of allergic disease and higher IgE levels compared with production of IgG1 and IgE without IgG4, suggesting IgG4 coexpression marks stronger activation of TH2-dependent events. Conclusion: The protective effects of farm exposure were confined to TH2-dependent IgG1, IgG4, and IgE expression and were allergen and switch stage specific, suggesting that distinct mechanisms regulate individual steps within allergen-induced class switching in vivo. Clinical implications: Environmental interventions to prevent IgE expression might need to be tailored to specific allergens. [Copyright &y& Elsevier]

Abstract: To investigate the cause of a pre-operative adverse reaction, intradermal tests are the validated method used for the diagnosis of immediate allergic reactions to curares. The maximal concentrations to be injected are still under discussion. The aim of this study was, therefore, to show that tests done with 1/10 dilutions of rocuronium and cis-atracurium lead to false positive reactions. Twenty-six healthy volunteers were tested with rocuronium and 53 with cis-atracurium. Intradermal tests were done with concentrations of 1/10 (1 mg/ml and 0.1 mg/ml, respectively), the cutaneous responses being read 15-20 minutes later. A wheal with a diameter of at least twice the diameter of the wheal produced by the injection was considered positive. Our results showed a tendency toward nonspecific histamine liberation at the concentrations of the two myorelaxants used. Thus, we observed positive reactions in 11/26 (42%) of the rocuronium controls and 19/53 (36%) of the cis-atracurium controls. Our results support the present recommendations of the Société Française d’Anesthésie et de Réanimation concerning the dilutions to be used with rocuronium and cis-atracurium to avoid false positive skin tests. In screening for peri-operative allergy, the maximum concentration used in intradermal testing with these two curares should not exceed 1/100. [Copyright &y& Elsevier]

Copyright of Revue Francaise des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hypersensitivity reactions induced by low molecular weight compounds are investigated extensively in the skin. However, these reactions can also occur in the lungs of previously sensitized individuals after local airway challenge. This hapten-induced pulmonary hypersensitivity reaction resembles features observed in asthmatic patients, such as bronchial hyperreactivity, accumulation of inflammatory cells, and airway edema. We review data that hapten-induced hypersensitivity reactions in mouse airways can be models for both atopic and non-atopic asthma associated with low molecular weight compounds. [Copyright &y& Elsevier]

• Mast cell activation is linked to common drug side effects, including pain and itch. • Many of these drugs can activate mast cells directly through the receptor MRGPRX2. • MRGPRX2 antagonists may be a novel way to reduce these symptoms. Symptoms that resemble allergic reactions, such as pruritus, flushing, and hypotension, are common side effects of therapeutic drugs. In a true allergic reaction, Immunoglobulin E (IgE) antibodies recognize the drug and trigger mediator release from mast cells through cross-linking of IgE receptors. However, many drugs can bypass this pathway and can activate mast cells directly through MRGPRX2, a G protein-coupled receptor that responds to a wide range of small molecules, peptides, and proteins that have little in common except for a net positive charge. This review will provide an overview of MRGPRX2, including its expression pattern, studies of its pharmacology, and its orthologs. It also will review evidence for MRGPRX2 activation by many drugs closely associated with these reactions. [ABSTRACT FROM AUTHOR]

Abstract: We report the cases of two patients who experienced anaphylactic shock during Caesarean section over a five-year period in Guadeloupe (French West Indies). Outcome was good in both cases after adequate resuscitation and postevent analysis showed latex responsibility as causal agent. Consistently with others findings, these cases suggest a high incidence and severity of latex anaphylactic reactions during caesarean section. Moreover, in West Indies, latex sensitization may occur more frequently due to contact with the Hevea brasiliensis tree or tropical fruits. Further epidemiological studies focusing on tropical overseas territories and on gyneco-obstetrical procedures are needed to confirm these trends. Such data are needed to evaluate the need and cost-effectiveness of primary prevention strategies such as latex withdrawal from maternity wards. [Copyright &y& Elsevier]

Abstract: We present a case of vocal cord dysfunction syndrome (VCDS) presenting as acute angioedema of the upper airway. The presentation of this syndrome and its differentiation from other upper airway conditions that require far different and more urgent treatment is discussed. [Copyright &y& Elsevier]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: We describe a grade IV anaphylactic shock to atracurium. A 34-year-old woman was scheduled for her ninth abdominal surgery. Within the last 10 months, for previous abdominal procedures she had received atracurium, cisatracurium or suxamethonium. No adverse event was reported. In the present case, a cardiac arrest occurred within 1min after atracurium injection. Anaphylaxis was immediately evoked and treatment started. The diagnosis of anaphylaxis to atracurium was confirmed by the allergological assessment. This case report highlights the fact that patients without any previous adverse events to neuromuscular blocking agents are never exempt from risk of anaphylactic shock, even with a designated low-risk agent of sensitization. [Copyright &y& Elsevier]