Intérêt de l'anti-interleukine-5 dans le traitement du syndrome hyperéosinophile et des maladies allergiques

The hypereosinophilic syndrome, and asthma and other allergic diseases are characterized by a proliferation and/or activation of polynuclear eosinophils, the production, maturation and activation of which are mediated by interleukin-5 (IL-%). In recent years, several preparations having anti-IL5 activity, aimed at regulating the activity of eosinophils, have been developed and evaluated. Still, there have been few clinical studies. Two molecules, STI-571 and SB-240563 have been found to have interesting results in phase I/II studies in the hypereosinophilic syndrome, with amelioration of clinical and biological parameters. One phase III study of SB-240563 in this condition is presently underway. In asthma, in spite of a significant reduction of infiltration of eosinophils in the blood and tissues, no molecule has as yet shown clinical benefit.     

Résultats à court et long terme du remplacement valvulaire mitral par prothèse mécanique à bille et à ailettes (à propos d’une série de 236 patients consécutifs avec un suivi moyen de 11 ans)

Objectives

To study the early and late results of mitral valve replacement (MVR) by Starr-Edwards caged-ball and bileaflet mechanical prosthesis.

Material and methods

We retrospectively analyzed 236 MVR performed in 236 patients: 127 by Starr-Edwards prosthesis (group 1) and 109 by bileaflet prosthesis (group 2).

Results

During the early period (30 days), the mortality rate was higher in group 1 (6.3 % vs 1.8 %; p = 0.0001), while hemorrhagic, thromboembolic and infectious complications were comparable in the two groups. In the late period (> 30 days) and with an average follow-up of 11.5 ± 5.7 years, mortality was higher in group 1 (9.4 % vs 4.6 %; p < 0.0001). The same was true for thromboembolic complications (20.8 % vs 6.4 %; p < 0.0001), hemorrhagic complications (13.4 % vs 7.3 %; p = 0.02), infectious complications (3.1 % vs 0.9 %; p = 0.02) and cardiac complications that were not due to the prosthesis (32.3 % vs 14.7 %; p = 0.02). The hemodynamic profile of the bileaflet prostheses was better than that of the Starr-Edwards prostheses (average functional prosthetic surface area was 2.37 ± 0.44 cm² and average pressure gradient was 5.6 ± 1.1 mmHg vs 2.04 ± 0.52 cm² and 7.6 ± 4.9 mmHg).

Conclusion

Our work confirms the superiority of bileaflet mechanical prostheses, with rates of early and late mortality, thromboembolic and hemorrhagic complications lower than those of the Starr-Edwards prostheses in more than 11 years of follow-up. However, one should not forget that the prevention of infective endocarditis, good observance of oral anticoagulant treatment and early surgery before left ventricular dysfunction occurs remain the best guarantee a good result of the MVR.     

Quoi de neuf en allergologie pédiatrique en 2005 ? Partie 1 : épidémiologie,diagnostic précoce et prévention (une revue de la littérature internationale d'octobre 2004 à octobre 2005)

The most important notions published in 2004–2005 concern a positive relationship between the risk of in utero sensitization and allergen levels in maternal blood, a neonatal deficiency of immune responses to microbial components in atopy-prone children, varying patterns of sensitization to aeroallergens, with frequent remittance of early sensitizations to seasonal allergens, in contrast with persistence of sensitizations to perennial allergens, an increased risk of sensitization to aeroallergens in children exposed to long-term background ambient air pollutants, an increased risk of polysensitization in siblings of polysensitized children, and a low efficacy of rigorous dietary egg exclusion during gestation and breastfeeding. The relations between the risk of childhood atopy and maternal parity, neonatal and perinatal conditions, vaccinations and infectious diseases in infancy, and early exposure to pets remain controversial. The predictive value of biological tests in newborns (total serum IgE determination and eosinophil count) is still disputed. Finally, several studies confirm the end of the allergy « epidemics » in Europe, although the prevalence of childhood allergic diseases is still increasing in Eastern European countries.     

Quoi de neuf en allergologie pédiatrique en 2005 ? Partie 4. Allergie cutanée,alimentaire, médicamenteuse et aux insectes (Une revue de la littérature internationale d'octobre 2004 à octobre 2005)

Allergological work-up and treatment of french children with atopic dermatitis have been the subject of a recent consensus. Food avoidance is useless for prevention of atopic dermatitis, and should be indicated in children with severe atopic dermatitis associated with food allergy only. Exposure, sensitization and allergy rates to nuts increase with age, and avoidance of nuts (even tolerated) is recommended in young children allergic to one or several nuts to prevent the risk of sensitization and allergy to an increasing number of nuts. Threshold values of skin prick-tests and specific IgE determinations with a 90-100% predictive value for food allergy are highly variable from one study to another one, and depend on numerous factors such as age of the children, the allergens used, etc. The diagnostic value of patch-tests and skin application food tests remains controversial. Treatment of food allergy is based on the eviction of the allergenic foods. However, probiotics and « desensitization » to foods may be efficacious in some patients. In children that have outgrown their food allergy, tolerance should be maintened by regular consumption of the foods. However, the parents should be informed that relapses requiring an emergency treatment may occur. Finallly, in children as in adults, repeated mosquito bites induce a desensitization, and most children outgrow their allergy between five to fourteen years.     

Quoi de neuf en allergologie pédiatrique en 2006–2007 ?: Partie 1 : épidémiologie,diagnostic précoce et prévention. (Une revue de la littérature internationale d’octobre 2005 à septembre 2007)

A very large number of epidemiological studies on allergy and/or asthma in children have been published during the two last years. Some of these studies have been performed in a low number of highly selected children. Other studies are multicenter and multinational studies performed in very large numbers of children, adolescents and young adults. Major risk factors are familial history of allergy and/or asthma, early childhood eczema and/or sensitizations, and passive smoking during pregnancy and early life. The risk for atopy and/or asthma is decreased in rural children, especially farm children, and in children living in anthroposophic families, except for children living near swine feeding farmings. However risk and « preventive » factors do not work equally in all children, and their effects are modulated by complex interactions with other genetic and/or environmental factors. The results of epidemiological studies should be interpreted with caution, since they may be affected by a « prudent lifestyle » in atopic and atopy-prone families, leading to eviction of passive smoking, prolonged maternal breast-feeding, delayed introduction of solid foods, and eviction of pets. Epidemiological studies should also take into account the parental understanding of allergy and wheeze, which is affected by educational and socioeconomical level and ethnic origin, and its impact on allergy and asthma prevalence estimates. Finally, the « programmed death » of the « allergy and asthma epidemics » is probably a reality in most developed countries, but the prevalence of allergy and asthma is still increasing in developing countries.     

Le syndrome de Lucie Frey et ses variantes (syndrome des flushs gustatifs unilatéraux). Revue à propos d'une observation pédiatrique

The gustatory sweating syndrome in children, which is nearly always unilateral, is closely related to the auriculo-temporal syndrome, also known as Frey’s Syndrome, that occurs in adults. It is characterized essentially by intense post-prandial sweating. Having encountered a child with this syndrome, we undertook a critical review of the literature, since Frey’s Syndrome is often confused with food allergy. Diagnosis is based on the following criteria: I) the unilateral character of flushing in the facial nerve area, coming on while eating or shortly thereafter; II) its rapid regression; III) absence of associated symptoms. A history of prior trauma or infection in the facial nerve area confirms the diagnosis; complementary examinations, in particular, allergy tests, are then not necessary, except in cases with the very rare bilateral form. In children, there is a clear preponderance of boys (boy/girl ratio 4/1) and histories of difficult delivery requiring forceps (63%), in cases where the neonatal conditions are known. Allergists merit being reminded of this classic syndrome.     

Mise en évidence de moisissures des ambiances intérieures par la mesure des (1→3)–β–D–glucanes

The interest which the measurement of glucans, a constituent of fungal wall, can represent to estimate the exposure to indoor moulds is evaluated in this article. In most studies, the estimate of moulds exposure is based on viability. This approach is limited because only a small proportion of the fungal spores grows in culture. LAL test applied to glucans detection is an extremely significant method and quantities as small as some picograms (a few tens of fungal spores) can be detected. Airborne glucans sampling can be prolonged during several days, which makes it possible to appreciate in a satisfactory way moulds exposure. On the other hand, glucans are not specific to moulds, they are also present in vegetable cells (of which pollen) and some bacteria. The measurement of indoor glucans, as indicator of the fungal biomass, to evaluate moulds exposure constitutes an interesting approach. However this method is still used in a too reduced number of studies to be validated.     

Exposition aux particules atmosphériques fines et développement des maladies allergiques de l’enfant. Résultats épidémiologiques issus de l’étude des six villes (ISAAC-2 France)

To evaluate whether fine air particles could be involved in the occurrence of atopy and allergic diseases, we performed a cross-sectional epidemiological survey involving primary schoolchildren living in six French towns with contrasted air pollution levels. Air pollution was measured during a week in the schoolyards and by standard air monitoring networks. Children get an examination in school looking for atopic dermatitis and bronchial hyperresponsiveness assessed by a standardized run test. Besides, parents or guardians provided past medical history and environmental data, especially on passive smoking. Overall, 5338 children, aged 10.4 (± 0.7) years, coming from 108 different schools and 401 different classes were included in the survey. Taking into account potential confounders, high exposure to proximity PM_2.5 was linked to a higher-point prevalence of atopic dermatitis and hyperresponsiveness, to a higher cumulative prevalence of allergic asthma and a higher sensitization rate to common indoor allergens. Thus, these data suggest that chronic exposure to urban fine particles could be a risk factor for atopy, hyperresponsiveness and asthma.