Search

Little is known about the prevalence and factors associated with long-term remission in cutaneous lupus erythematosus (CLE).To assess the prevalence, the factors associated with remission, and the long-term remission with and without treatment during CLE.Longitudinal cohort study including biopsy-proven patients with CLE seen between November 1, 2019 and April 30, 2021, with at least 6 months of follow-up after diagnosis. Demographic data, CLE subtypes, remission status, and treatments were recorded. Remission was defined by a Cutaneous Lupus Erythematosus Disease Area and Severity Index activity score of 0. Long-term remission was defined by remission3 years.Among 141 patients included (81% of women), 93 (66%) were in remission at last follow-up with a median duration since diagnosis of 11.4 years (interquartile range, 4.2-24.7). Long-term remission was observed in 22 (19%) of 114 patients with at least 3 years of follow-up, including 5 (4.4%) with no systemic treatment. Active smoking (odds ratio, 0.22 [95%CI: 0.05-0.97]; P = .04) and discoid CLE lesions (odds ratio, 0.14 [95%CI, 0.04-0.48]; P = .004) were associated with a lower risk of long-term remission.Partial retrospective data collection and tertiary center population.Long-term remission is rare in CLE and negatively associated with active smoking and discoid CLE.

In evaluating adverse drug reactions (ADRs), patch tests (PTs), skin prick tests (SPTs), and intradermal tests (IDTs) are useful tools for identifying responsible drugs and finding safe alternatives. Their diagnostic value depends on the clinical features of the ADR and on the drug tested. PTs have a good sensitivity in assessing acute generalized exanthematous pustulosis and drug rash with eosinophilia and systemic symptoms. SPTs done with all drugs except opiates are used for immediate hypersensitivity reactions. IDTs seem sensitive for immediate hypersensitivity reactions to beta-lactam antibiotics, iodinated contrast media, heparins, general anesthetics, and platinum salts.

An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years.To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB.We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB.A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components.CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

The term Sneddon's syndrome (SS) has been used since 1965 to describe a vasculopathy characterized by a combination of cerebrovascular disease with livedo racemosa. SS may be classified as antiphospholipid+ (aPL+) or antiphospholipid- (aPL-). Little is known about aPL- SS; in this review we describe the epidemiology and pathogenesis of aPL- SS, as well as the clinical and histologic features. We discuss recent findings in terms of neurologic and cardiac involvement. Moreover, differential diagnoses of conditions that may present with both livedo racemosa and stroke are discussed. Finally, we discuss real-life practical issues such as the initial investigations to be performed, long-term follow-up, and therapeutic management of aPL- SS patients.

Submitted by (omml@ubi.pt) on 2021-07-05T10:47:24Z No. of bitstreams: 1 2021_Bousquet J_A_COVID anaphylaxis.pdf: 12561118 bytes, checksum: 2f801ee76ad2cb3cbdaa02ffabea8e09 (MD5) Approved for entry into archive by Pessoa (pfep@ubi.pt) on 2021-07-05T10:49:11Z (GMT) No. of bitstreams: 1 2021_Bousquet J_A_COVID anaphylaxis.pdf: 12561118 bytes, checksum: 2f801ee76ad2cb3cbdaa02ffabea8e09 (MD5) Rejected by Pessoa (pfep@ubi.pt), reason: Rever os nomes dos autores. Depois da correção é só voltar a submeter. on 2021-07-05T10:54:19Z (GMT) Submitted by (omml@ubi.pt) on 2021-07-05T11:52:24Z No. of bitstreams: 1 2021_Bousquet J_A_COVID anaphylaxis.pdf: 12561118 bytes, checksum: 2f801ee76ad2cb3cbdaa02ffabea8e09 (MD5) Approved for entry into archive by Pessoa (pfep@ubi.pt) on 2021-07-05T13:34:51Z (GMT) No. of bitstreams: 1 2021_Bousquet J_A_COVID anaphylaxis.pdf: 12561118 bytes, checksum: 2f801ee76ad2cb3cbdaa02ffabea8e09 (MD5) Approved for entry into archive by Pessoa (pfep@ubi.pt) on 2021-07-05T13:35:49Z (GMT) No. of bitstreams: 1 2021_Bousquet J_A_COVID anaphylaxis.pdf: 12561118 bytes, checksum: 2f801ee76ad2cb3cbdaa02ffabea8e09 (MD5) Made available in DSpace on 2021-07-05T13:35:49Z (GMT). No. of bitstreams: 1 2021_Bousquet J_A_COVID anaphylaxis.pdf: 12561118 bytes, checksum: 2f801ee76ad2cb3cbdaa02ffabea8e09 (MD5) Previous issue date: 2021-04-02 info:eu-repo/semantics/publishedVersion

Background Drug reactions with eosinophilia and systemic symptoms (DRESSs) and acute generalized exanthematous pustulosis (AGEP) are potentially severe cutaneous adverse drug reactions. Objective To describe the clinical findings and sensitization profiles of DRESS and AGEP patients who had been administered iodinated contrast media (ICM). Methods All adult patients in the dermatologist's French Investigators for Skin Adverse Reactions to Drugs (FISARD) network diagnosed with a DRESS or AGEP highly suspected to have been caused by an ICM were included retrospectively. Results Thirteen DRESS patients and 19 AGEP patients who had been administered ICM were included, and the median delay in DRESS and AGEP occurrence after ICM administration was short, 4 and 1 days, respectively. Five AGEP patients had systemic involvement. A high cosensitization rate (46%) was observed among the DRESS patients, mainly with beta-lactam antibiotics. Overall, 77% of our patients were sensitized to several ICM. Patch tests identified the suspected ICM for 21 cases (72%). The retrospective nature, the limited number of subjects, the absence of a control group of healthy individuals, and the lack of detailed information on previous exposure to sensitizing drugs are limitations of this study. Conclusions We report a large series of DRESSs and AGEPs related to ICM administration. Skin tests appear useful for diagnosis and potentially to identify alternative ICM.

International audience; No abstract available

The two clinico-pathological patterns are 'Sweet-like syndrome' and 'Multiple COVID-Arm'. 'Sweet-like syndrome' presents clinically as erythematous and oedematous papules or plaques, sometimes developing vesiculation or bullae. Histology shows classical Sweet syndrome with a diffuse dermal neutrophilic infiltrate, or an infiltrate of histiocyte-like immature myeloid cells consistent with a histiocytoid Sweet syndrome. 'Multiple COVID-arm' is characterized by multiple large inflammatory plaques with histological analyses showing a perivascular and interstitial inflammatory infiltrate with eosinophils.

Objectives To describe the clinical and pathological features of biopsy-proven cutaneous vasculitis (CV) associated with SLE, focusing on diagnosis classification and impact on overall SLE activity. Methods Retrospective multicentric cohort study including SLE patients with biopsy-proven CV identified by (i) data from pathology departments of three university hospitals and (ii) a national call for cases. SLE was defined according to 1997 revised ACR and/or 2019 ACR/EULAR criteria. CV diagnosis was confirmed histologically and classified by using the dermatological addendum of the Chapel Hill classification. SLE activity and flare severity at the time of CV diagnosis were assessed independently of vasculitis items with the SELENA-SLEDAI and SELENA-SLEDAI Flare Index. Results Overall, 39 patients were included; 35 (90%) were female. Cutaneous manifestations included mostly palpable purpura (n = 21; 54%) and urticarial lesions (n = 18; 46%); lower limbs were the most common location (n = 33; 85%). Eleven (28%) patients exhibited extracutaneous vasculitis. A higher prevalence of Sjögren’s syndrome (51%) was found compared with SLE patients without CV from the French referral centre group (12%, P Conclusion SLE-related vasculitis seems very rare and other causes of vasculitis should be ruled out before considering this diagnosis. Moreover, in more than half of patients, CV was not associated with another sign of active SLE.

The repeated open application test (ROAT) is an adjuvant investigation measure to patch testing in the diagnosis of allergic contact dermatitis. ESCD recommends a 15 days duration but its overall duration varies according to publications and patients hardly adhere to prolonged ROAT duration beyond 1 week.The Dermatology and Allergy Group of the French Society of Dermatology performed a prospective study with the aim of determining the best duration for the ROAT.A total of 328 ROAT results were collected for topical products, including cosmetics (60%) and topical medications (31.1%). Fifty-nine (18%) ROATs were positive, and 16 (5%) were doubtful. All the positive ROATs occurred within 10 days, with a median time to positivity of 3 days.According to our results, a minimum duration of 10 days is necessary to achieve a positive ROAT to a topical product.

There are limited data on the use of skin testing, other than patch testing, and challenges in the evaluation of epidermal necrolysis (EN), including Stevens-Johnson syndrome and toxic epidermal necrolysis.To report a French multicenter experience in skin testing and challenges in EN, and investigate the factors associated with tests' positivity.All patients who were evaluated by patch tests (PTs), skin prick tests, intradermal tests (IDTs), or drug provocation tests (DPTs) for EN between 2010 and 2020 were retrospectively included through 2 French drug reaction networks.In total, 113 patients were included from 8 centers. Median (interquartile range) time from EN to hypersensitivity workup was 7.9 months (5.1-15 months). All patients had PTs, 17 (15%) had skin prick tests or IDTs with delayed readings and 32 (28.3%) had DPTs. One mild reaction occurred after a DPT. Overall, 22 patients (19.5%) had positive PTs, and the only factors associated with positivity were Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN) score and drug class. Only 1 IDT was positive but considered irrelevant. The DPTs were never performed to prove responsibility of a highly suspected drug but were used to confirm current tolerance of needed medications.Allergological workup in EN, performed by specialists involved in EN, seems safe. Skin tests, although of limited sensitivity, can be helpful for considering the reintroduction of essential drugs according to a benefit-to-risk decision. We propose an algorithm for approaching hypersensitivity testing in patients with EN, to be adapted to each patient.

International audience; Introduction: This is a clinical case illustrating a diagnosis of an IgG4 related-disease (IgG4-RD) diagnosed in a vascular context.Case report: A 47-year-old man with no past medical history consulted for a recent and disabling Raynaud phenomenon without trophic disorder. Vascular examinations revealed multiple arterial thromboses with no abnormal finger and toe pressures. Secondly, weight loss and submandibular glands enlargement appeared, leading to the diagnosis of IgG4-RD without a link being able to be established with vascular involvement. This is the second observation of this association. A French translation of the new classification criteria for IgG4-RD published in 2019 by the American College of Rheumatology and European Ligue Against Rhumatism (ACR/EULAR) is offered with direct application to the clinical case.Conclusion: A Raynaud phenomenon with distal arterial thrombosis is rarely observed in the IgG4-RD.; Introduction: Les phénomènes de Raynaud secondaires sont exceptionnellement rapportés au cours de la maladie associée aux IgG4. Nous en rapportons une observation et détaillons les nouveaux critères diagnostiques de la maladie associée aux IgG4.Observation: Un homme de 47 ans sans antécédent présentait un phénomène de Raynaud des mains, bilatéral, d'apparition récente, sans trouble trophique. Les examens vasculaires révélaient des thromboses artérielles multiples et distales sans anomalie des pressions digitales. Quelques mois après, une perte de poids et une hypertrophie sous-mandibulaire conduisaient au diagnostic de maladie associée aux IgG4 selon les critères de l'American College of Rheumatology/European Ligue Against Rhumatism (ACR/EULAR 2019) dont une traduction française est proposée. Il s'agit de la deuxième observation d'un phénomène de Raynaud avec thromboses artérielles distales au cours d'une maladie associée aux IgG4.Conclusion: Un phénomène de Raynaud avec thromboses artérielles distales s'observe de façon exceptionnelle au cours de la maladie associée aux IgG4.

Coronavirus disease 2019 (COVID‐19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID‐19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off‐label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings togetherall the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off‐label drugs andhighlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactionsin the course of the disease.

Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions (CADRs), and determining safer, alternative drugs. PTs have a low sensitivity but are valuable in investigating maculopapular exanthema (MPE), as well as severe CADR, including toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and in particular, acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). To ensure their specificity, at least 10 control tests should be performed. Prick tests are mainly used in the evaluation of immediate-type hypersensitivity and can be performed with all drugs, except opiates. IDTs can be used to explore immediate and delayed-type hypersensitivity, if an injectable form of the drug exists. Except for SJS/TEN, IDTs should be performed by injecting 0.02 mL of the drug. We here provide a practical, up-to-date review on the use of these skin tests in the work-up of CADRs. Numerous negative controls for drug PTs, as well as criteria for the immediate and delayed positivity of prick tests and IDT, are included. It should be emphasized that a negative result never excludes the potential responsibility of a drug in a CADR.

This descriptive case series investigates the potential association between the use of proton pump inhibitors and drug-induced lupus erythematosus in cases reported in 2 large pharmacovigilance databases.

Immune modulation is a key therapeutic tool for allergic diseases and asthma. It can be achieved in an antigen-specific way via allergen immunotherapy (AIT) or in endotype-driven approach using biologicals that target the major pathways of the type 2 (T2) immune response: IgE, IL-5 and IL-4/IL-13. COVID-19 vaccine provides an excellent opportunity to tackle the global pandemics and is currently being applied in an accelerated rhythm worldwide. It works as well through immune modulation. Thus, as there is an obvious interference between these treatment modalities recommendations on how they should be applied in sequence are expected. The European Academy of Allergy and Clinical Immunology (EAACI) gathered an outstanding expert panel under its Research and Outreach Committee (ROC). This expert panel was called to evaluate the evidence and formulate recommendation on the administration of COVID-19 vaccine in patients with allergic diseases and asthma receiving AIT or biologicals. The panel also formulated recommendations for COVID-19 vaccine in association with biologicals targeting the type 1 or type 3 immune response. In formulating recommendations, the panel evaluated the mechanisms of COVID-19 infection, of COVID-19 vaccine, of AIT and of biologicals and considered the data published for other anti-infectious vaccines administered concurrently with AIT or biologicals.

Mineral oils and waxes are mixtures of predominantly saturated hydrocarbons consisting of straight-chain, branched and ring structures with carbon chain lengths greater than C14. They have been used for many decades in skin and lip care cosmetic products due to their excellent skin tolerance as well as their high protecting and cleansing performance and broad viscosity options. In contrast to vegetable oils, mineral oils are non-allergenic since they are highly stable and not susceptible to oxidation or rancidity. They have a long history of safe use which is confirmed by clinical and epidemiological data. In Europe, mineral oils are only permitted in cosmetics if compliant with purity specifications on polycyclic aromatic hydrocarbons and safety requirements laid down in the European pharmacopoeia and the EU cosmetics regulation EC/1223/2009. The high quality of these mineral oils is assured by robust quality assurance and a refining/purification process designed to exclude substances with carcinogenic potential and to minimize the presence of mineral oil aromatic hydrocarbons. Given their highly lipophilic properties, mineral oils do not penetrate human skin and, thus, are not systemically bioavailable in the body. Moreover, no significant changes in the skin and no effects on any internal organ system have been reported and attributed to the topical application of refined mineral oils. Regarding potential oral exposure from cosmetic lip care products, Cosmetics Europe, the European trade association for the cosmetics and personal care industry, has advised cosmetic manufacturers to only use mineral oil fractions for which recognized food acceptable daily intake (ADI) values apply. The estimated dose of mineral oils ingested via lip care products contributes to

Resume Introduction Les engelures sont des lesions dermiques inflammatoires liees a une hypersensibilite au froid, qui siegent de maniere bilaterale et symetrique sur les extremites. Leur survenue lors de pathologies pro-thrombogenes ou de pathologies auto-immunes est bien decrite mais leur association a des causes locoregionales favorisantes est peu connue. Observations Cas 1 : un homme de 57 ans, tabagique a 80 paquets-annees, qui souffrait d’un deficit des releveurs du pied droit sequellaire d’une lombosciatique paralysante L5, consultait pour des lesions necrotiques unilaterales des orteils, recidivant chaque hiver uniquement sur le membre paralyse. Cas 2 : un homme de 60 ans avait eu un liposarcome de cuisse droite traite par radiotherapie et chirurgie, qui s’etaient compliquees d’une monoparesie sequellaire et d’une arterite post-radique. Il presentait des macules purpuriques unilaterales des orteils du pied droit, sans evolution necrotique, recidivant chaque hiver. Dans les deux cas l’examen clinique, le recul evolutif, l’histologie et les examens complementaires confirmaient le diagnostic d’engelures idiopathiques. Conclusion Les hypotheses physiopathologiques expliquant l’unilateralite des engelures en cas de paralysie sont une diminution du flux sanguin dans le membre paralyse, un desequilibre des neuromediateurs, un dysfonctionnement du systeme nerveux autonome, une atrophie cutanee avec hypertrophie des tissus mous sous-jacents et enfin une hypoesthesie qui vient aggraver les troubles trophiques.

Resume Introduction Le lymphome intravasculaire a grandes cellules B (LIVB) est une hemopathie rare de diagnostic difficile. La biopsie cutanee en peau saine pourrait etre utile pour en faire le diagnostic. Nous rapportons un cas de LIVB diagnostique grâce a cet examen, et proposons une revue de la litterature afin d’en preciser la sensibilite. Observation Une femme de 67 ans etait hospitalisee pour fievre prolongee inexpliquee (FPI) et alteration de l’etat general. Le bilan biologique montrait un syndrome inflammatoire, une elevation des LDH superieure a 2000 UI/L, une cytolyse hepatique et un abaissement du temps de prothrombine a 47 %. Les prelevements infectieux et les examens d’imagerie eliminaient une etiologie infectieuse ou inflammatoire, ainsi qu’une neoplasie solide. Une biopsie cutanee en peau saine permettait de retenir le diagnostic de LIVB. Discussion Ce cas clinique illustre l’interet de la biopsie cutanee en peau saine pour le diagnostic de LIVB chez les patients hospitalises pour FPI. A partir d’une revue systematique de la litterature dans PubMed/Medline, nous avons inclus huit series d’au moins trois patients evaluant l’interet de la biopsie cutanee en peau saine pour le diagnostic de LIVB. La sensibilite pour le diagnostic variait de 67 % a 100 %, avec une sensibilite de 100 % dans quatre des huit etudes. Le detail des sites de biopsie etait disponible dans trois etudes et la sensibilite etait globalement similaire entre la cuisse, l’abdomen et les bras. Conclusion La biopsie cutanee en peau saine realisee sur au moins deux sites est un examen sensible et peu invasif pour le diagnostic precoce de LIVB.

Introduction Des donnees recentes suggerent que pres 50 % des patients atteints de lupus erythemateux cutane (LEC) sont en remission apres 5 ans de traitement. Cependant aucune etude n’a evalue la possibilite de diminuer ou arreter l’hydroxychloroquine (HCQ) apres remission dans le LEC. Materiel et methodes Cette etude retrospective multicentrique a inclus des patients avec LEC chez qui l’HCQ a ete diminuee ou arretee apres remission. Des courbes de Kaplan-Meier ont ete realisees pour evaluer le risque de rechute, definie comme une recidive des lesions justifiant reprise du traitement ou reaugmentation de la dose. Resultats 56 patients ont ete inclus (48 femmes, 87 %) ; l’âge median etait de 46 ans (extremes 11–81) et la duree mediane d’evolution du LEC de 3 ans (extremes 0,04–43). Les types de LEC etaient : discoide (n = 31), lupus engelure (n = 6), panniculite lupique (n = 6), tumidus (n = 19), subaigu (n = 9). Selon les criteres SCLICC, 18 patients (32 %) avaient un lupus systemique (LES), principalement articulaire. Quatre strategies de reduction de l’HCQ ont ete utilisees. La duree mediane avant rechute n’etait pas significativement differente entre ces 4 strategies. Trente-quatre patients (61 %) ont eu au moins une rechute durant le suivi, avec une duree mediane avant rechute > 3,6 ans (0,4–119 mois), incluant 26 patients apres la premiere diminution de dose ou arret de l’HCQ et 8 apres un arret secondaire a une diminution de dose continue ou saisonniere. Au cours du suivi, 39 patients (70 %) ont subi un arret complet de l’HCQ, parmi lesquels 22 ont rechute (56 %). Les lesions acrales etaient le seul facteur significativement associe aux rechutes (HR : 16,74 [95 %CI : 3,38–84,82], p = 0,0006). A l’inverse, il n’y avait pas de difference entre les patients avec ou sans LES (HR 1,01, [95 % CI : 0,41–2,47], p = 0.98). Toutes les rechutes etaient purement cutanees a l’exception d’un patient LES en rechute articulaire. La duree mediane de suivi etait de 5,9 ans (range 0,7–21,3). Au dernier suivi 23 patients (41 %) ne recevaient plus de traitement, 22 (39 %) une dose diminuee d’HCQ et 11 (20 %) avaient repris un traitement actif. Aucun patient de l’etude n’a developpe de maculopathie au cours du suivi. Discussion Cette etude, bien que limitee par son petit echantillon, son caractere retrospectif et l’heterogeneite des strategies utilisees, suggere que reduire ou arreter l’HCQ est un objectif realisable apres remission chez les patients atteints de LEC. La toxicite maculaire de l’HCQ au long cours est bien connue ; la diminution ou l’arret de l’HCQ pourrait prevenir cet effet secondaire severe.

Introduction Face a la diminution du nombre de dermatologues, le developpement de la teledermatologie peut faciliter la communication entre medecins generalistes (MG) et hopital, et reduire certains delais de prise en charge grâce a un tri efficace des patients. Cependant, peu de donnees sont disponibles en France sur les performances diagnostiques et therapeutiques de tels outils, et sur les opinions des MG ayant participe a ce type de projet. Materiel et methodes Nous avons etudie les performances diagnostiques et therapeutiques d’une plateforme de teleexpertise (TE) developpee pour les MG exercant a proximite d’un hopital. Pour chaque patient inscrit par un MG sur la plateforme, le teledermatologue proposait une hypothese diagnostique principale, une ou deux hypotheses alternatives et une prise en charge therapeutique. Ces propositions etaient comparees avec celles retenues au decours d’une consultation face-a-face avec un dermatologue senior du service, dans les 72 h suivant la TE, en aveugle de la TE. Les taux de propositions correctes en TE ont ete compares avec ceux des MG en utilisant le test de McNemar, avec calcul des odds ratio (OR) et intervalles de confiance a 95 % (IC 95 %). Le taux de consultations evitables ainsi que les avantages et inconvenients rapportes par les MG ont egalement ete analyses. Resultats Au total, 298 patients ont ete inclus entre novembre 2016 et janvier 2020, dont 169 femmes (57 %). L’âge median etait de 44,5 ans (extreme 0–96). Le taux de propositions correctes pour la premiere hypothese diagnostique en TE etait de 62 % (n = 184/298) et de 80 % (n = 239/298) lorsque les hypotheses alternatives etaient prises en compte. Le taux de propositions therapeutiques correctes en TE etait de 81 % (n = 225/277). Au total, 43 % des consultations (n = 127/298) remplissaient les criteres de consultation evitable. Le taux de propositions correctes pour la premiere hypothese diagnostique etait significativement plus faible pour les MG par rapport a la TE (OR = 0,34 [IC 95 % : 0,20–0,56], p Discussion La TE en dermatologie apparait comme un outil sur et efficace pour ameliorer la prise en charge des patients en ambulatoire, en coordination avec les MG. Le taux de satisfaction est eleve parmi les MG malgre certaines limites notables, comme le caractere chronophage ou l’absence de compensation financiere pour certains actes.

Introduction Fin décembre 2020, les vaccins anti-Covid-19 à ARNm Comirnaty© de Pfizer-BioNTech et Moderna© de Moderna Biotech ont obtenu l’AMM conditionnelle en France. Ces vaccins étaient contre-indiqués chez les personnes ayant présenté des manifestations allergiques graves telles que des réactions anaphylactiques par l’HAS, le ministère de la Santé, l’Assurance maladie et l’ANSM. Nous avons vacciné avec Comirnaty© sous surveillance allergologique rapprochée les patients supposés à risque allergique et évalué la tolérance de cette vaccination. Matériel et méthodes Entre le 20 janvier et le 8 avril 2021, les patients étaient adressés via la hot line téléphonique mise en place spécialement pour les avis vis-à-vis de la vaccination pour les centres de vaccination d’Ile de France, médecins traitants ou allergologues. Jusqu’au 12/03/21, la vaccination était réalisée avec voie d’abord veineux, arrêt des bêtabloquants, surveillance des constantes toutes les 30 min et totale de 2 h. Le protocole a ensuite été allégé, sans voie veineuse et surveillance de 1 h. Résultats Un total de 225 patients supposés à haut risque allergique ont été vaccinés (1re dose), 48 hommes et 177 femmes, avec un âge moyen de 73 ans. Quatre-vingt-dix-huit avaient un terrain atopique (43,6 %). Deux cent trois patients avaient des antécédents allergiques suspectés ou prouvés à type d’hypersensibilité immédiate (90,2 %), seize d’hypersensibilité retardée (7,1 %), deux avaient une mastocytose systémique indolente sans réaction médicamenteuse spécifique et pour quatre la réaction n’était pas connue. Les molécules en cause étaient en majorité les produits de contraste (32,4 %) ou les antibiotiques (27,5 %). Trois réactions post vaccinales ont été notées (patients 1 à 3) sans anaphylaxie de grade II ou plus. Il faut noter que les réactions urticariennes étaient toutes retardées de plus d’1 heure ce qui est peu évocateur d’anaphylaxie IgE médiée. Parmi les 225 premières doses, 217 patients ont eu une deuxième dose (dont 75 dans le service), 7 n’étaient pas éligibles ayant eu une infection Covid-19 et 1 patient a été perdu de vue. Deux patients ont présenté une réaction (patients 4 et 5). Aucune anaphylaxie n’a été rapportée. Par ailleurs la hotline a permis d’autoriser la vaccination en centre de vaccination d’environ 2000 patients. Discussion Malgré le petit effectif, principalement lié à une pénurie de vaccin dans la même période et des capacités d’accueil limitées, nous n’avons pas observé de réactions anaphylactiques chez les patients étiquetés « à haut risque allergique ». Cette étude nous a permis de modifier nos pratiques et restreindre les indications de vaccination sous surveillance « allergologique » et cette mobilisation d’équipe a été d’une grande aide sanitaire pour vacciner des patients récusés par les centres de vaccination.