Allergie à l'érythromycine et la josamycine chez un enfant

Allergy to macrolides is rare. Here we report the case of a two-year old atopic child who had an episode of urticaria after taking erythromycin. Josamycine, given in an oral provocation challenge, also induced urticaria. This raises the question of cross-reactivity between these macrolides, which has rarely been reported previously.     

Résultats de tests cutanés intradermiques sur un groupe de sujets contrôles avec le rocuronium et le cis-atracurium à la concentration de 1/10

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.     

Diagnostic et fréquence de la rhinite allergique chez l'enfant asthmatique

This prospective study aimed to: 1) validate a paediatric questionnaire score from which allergic rhinitis (AR) could be diagnosed, 2) estimate its prevalence in asthmatic children, and 3) ascertain if AR is an additional risk factor for the severity of asthma. The questionnaire, modified from the adult form of the SFAR, was administered to 352 asthmatic children seen in consultation between June 2005 and April 2006. AR was diagnosed in 200 of these children (56.8%). AR was mild and intermittent in 45% of cases, moderate-to-severe and intermittent in 11%, mild and persistent in 27% and moderate-to-severe and persistent in 17%. A total score ≥ 9 was discriminant for AR (sensitivity = 90.5%, specificity = 94.7%, positive predictive value = 95.8%, negative predictive value = 88.3%, Youden's Index = 0.86). The proportion of children having mild or moderate-to-severe asthma was independent of the presence of AR (43.5% vs 48.6% and 56.5 vs 51.3%, respectively).     

Moisissures et aspects psychologiques : à propos de cas extrêmes,les inondations de la Somme

The flooding in the Somme valley in the spring of 2001 was an exceptional event in that the water level remained raised for several weeks and entire families had to be evacuated for several months. A cross-sectional study carried out in partnership with several institutions had three principal objectives: to measure the impact of the flooding on the state of health and the quality of life of the affected population, to determine potential factors associated with the existence of psychological disturbances, and to identify the psychological elements at stake. Information obtained from three populations (those evacuated, those inundated, and those unharmed) in the zone studied revealed differences between the three groups: on the impact of flooding on their social life, on the behaviour of the children, on their general state of health, and on their mental health. Accordingly, an increase in the level of stress was found in those who were evacuated compared to those who were only inundated. Likewise, the data also showed a risk for the appearance of more anxiety and insomnia in those who were evacuated and those who were inundated compared to those who were unharmed. The level of danger played an essential role, as shown for example in terms of depression. In addition, this study also revealed that the affected people anticipated and had need for moral support and for a listener, for both of which there was a bigger demand than could be met. In conclusion, the results of this study will help us to decide which courses of action to take should such events reoccur in the future.     

Allergies croisées : de la théorie à la pratique

The notion of allergic cross-reactions must from now on be regarded by allergists as an indispensable element of the diagnostic and therapeutic approach. Indeed, knowledge of proteins and of mechanisms involved in this type of phenomenon is of interest to physicians not only in with regard to pathophysiology but also as an aid in interpretation of certain clinical history data and the results of skin or biological tests. Moreover, it makes the management of patients more rational, and probably in therapy of the future when recombinant allergens will be more widely used.     

Chirurgie du canal atrioventriculaire partiel : résultats à court et à moyen terme à propos de 56 patients opérés

Between January 1991 and December 2006, 56 patients having a partial atrioventricular septal defect (AVSD) were operated. The purpose of this retrospective study is to analyze the immediate and long-term results of the surgery by granting of the importance to two main problems which are the disturbances of the rhythm and the conduction and the residual mitral regurgitation (MR). The mean age of our patients is of 10 and a half years with a net feminine ascendancy. Ninety-three percent of the patients were in regular sinus rhythm. No case of complete atrioventricular block (AVB) was noted. The MR was of grade I in 28,5% of the cases, grade II in 60% of the cases and grade III and IV in 7,5% of the cases. The MR was mild in 4% of the cases. The correction was made under cardiopulmonary bypass (CPB) and consisted of a suture of the mitral cleft in most of the cases with lock of the ostium primum by a patch of pericardium. The perioperative mortality was 1,8% of the cases. The disturbances of the rhythm and the conduction were noted in 34% of the cases. All the patients were controlled with a mean follow-up of six years and seven months. The secondary mortality was nil. The MR, at mid-term follow-up, was mild in 78% of the cases. The partial AVSD is a congenital heart disease, the spontaneous evolution of which can be burdened by complications, notably the disturbances of the rhythm and the conduction, as well as the heart failure. This justifies a premature surgical repair.