Bronchite à éosinophiles

Eosinophilic airway inflammation may be encountered in asthma and in non asthmatic eosinophilic bronchitis, which is a recently identified and common cause of chronic cough. Non asthmatic eosinophilic bronchitis may be differentiated from asthma by the absence of airflow limitation and of bronchial hyperreactiveness (potentially reflecting the different localization of mast cells within the airway wall). Diagnosis is based on the confirmation of eosinophilic airway inflammation, usually by induced sputum, in the absence of other causes of chronic cough or of radiological and lung function abnormality. The cough is generally improved by inhaled corticosteroids. The long-term outcome is still not known; non asthmatic eosinophilic bronchitis may lead to the onset of fixed airway obstruction or asthma.     

L’évaluation des pratiques professionnelles dans les pays francophones: L’expérience suisse

Evaluation of the swiss medical doctors, members of the national society “Federatio Medicorum Helveticorum” (FMH), has been organized according to a national regulation. Its application has been delegated to each specialized society that has elaborated its own protocol. The control is based on certification of both, the manifestation and the participation. Each manifestation has been evaluated by the participants. After a period of three years, each member of the FMH has to carry out a document describing his educational activities in details, and to join the certificates of participation to obtain a diploma. The diploma of sustained training has a validity of three years and gives the licence to mention the title of specialist. The Swiss system is based on the individual trust and honesty. For the moment there is no need to pass an examination. But the most important remaining questions are the criteria of good practice, sustained training, and its cost-effectiveness.     

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.     

Quoi de neuf en allergologie pédiatrique en 2006-2007 ? Partie 3: Allergie cutanée, alimentaire, médicamenteuse et aux insectes (une revue de la littérature internationale d’octobre 2005 à septembre 2007)

Most sensitizations in children with atopic dermatitis are non pathogenic. Thus, responses in prick-tests, specific IgE determinations and patch-tests should be carefully evaluated based on the clinical history of the children or responses in challenge tests. Moreover, although atopy patch-tests are highly specific, they have a low sensitivity. Food eviction is indicated in a few children only, since they may be responsible for anaphylactic reactions induced by accidental ingestion of the food or oral challenge tests. The predictive value of serum specific IgE to foods depends on the food investigated, the age of the children, their allergic disease (atopic dermatitis, urticaria/angioedema, anaphylaxis) and, may be, on their ethnical origin. The prevention of food-induced severe reactions is based on eviction. However, several studies suggest that oral desensitization to foods may be efficient. Most frequent reactions in children hypersensitive to antalgics, antipyretics and nonsteroidal antiinflammatory drugs are oedema (facial oedema especially) and urticaria. Usually, the severity of the reactions increases from one treatment to another one and with the dose of drug administered to the children. Diagnosis is based on a convincing clinical history or on challenge tests. Skin tests with vaccines should be performed according to a standardized procedure because they may give false positive responses. Most latex sensitizations detected by skin prick-tests and, especially, specific IgE determinations are non pathogenic. The prevention of reactions to latex is based on eviction. However, preliminary results suggest that sublingual desensitization with a latex extract is efficient and well-tolerated.