L’asthme professionnel aux poussières de bois

Wood-related work has been recognized during the past thirty years as a source of respiratory diseases. The prevalence of occupational asthma has been estimated to be between 5 and 15% of all asthma, but its frequency is difficult to evaluate because it is underestimated. Indeed, there is no simple, specific diagnostic test, and monitoring of workers is difficult. The pathophysiology of these reactions is diverse and has not been elucidated for certain types of wood. The case that will be presented illustrates the importance of early diagnosis of occupational asthma. It was possible as a result of teamwork between the occupational physician, the respiratory specialist/allergist and the attending physician.     

La rhinite allergique au latex : du diagnostic à la prise en charge

In spite of numerous publications on occupational lung diseases, latex allergy, and the relationship of nose-to-bronchi, the particularities of the clinical, epidemiological and therapeutic aspects of latex allergic rhinitis (LAR) are very little considered in the literature. Based on our own experience and on a review of the literature, we will examine the environmental context of LAR and try to define its most important diagnostic and therapeutic criteria. An early diagnosis of LAR and reduction of exposure to latex allergens before its evolution to asthma, can limit the socioeconomic impact of this condition.     

Évaluation de l'influence des recommandations OMS–ARIA sur la prise en charge de la rhinite allergique en pratique de ville en France. Enquête ERNANI

Introduction

The WHO–ARIA allergic rhinitis recommendations are evidence-based.

Objectives

To determine the percentage of doctors who know and follow the WHO-ARIA guidelines and to evaluate their influence on medical practices.

Methods

A cross sectional analysis based on a questionnaire was performed between April and July 2005 on randomly chosen general practitioners (943) and ENT doctors (277).

Results

54.4% of the doctors claimed to know the WHO-ARIA guidelines. 4.7% knew but did not follow them. Patients whom doctors knew the guidelines benefitted more frequently (p < 0.0001) from an allergen search (42.2 vs 31.7%), a nasal endoscopy (38.3 vs 26.0%), a follow-up consultation (64.9 vs 52.6%) and written informations on rhinitis (30.7 vs 14.1%). There was no difference in terms of asthma search, first line treatment and duration of treatment.

Conclusions

When the WHO–ARIA guidelines are known by doctors (half), they seem to be followed. They favor: allergy testing, nose examination, repeat visit, written information but paradoxically do not influence search for asthma and first line treatment strategy and duration.     

Sensibilisation cutanée au cyprès à Casablanca

The cypress is a conifer with persistent sheets, present in the Mediterranean area, where it is responsible of pollinosis. In order to specify the share of the allergenicity of the pollen of cypress, among others pneumallergenes, present under our climates, and to clear up the profile of patients sensitized to the cypress, we carried out a prospective study from November 2003 to November 2004. It included 154 patients, with a mean age of 30, 12 years old, with a female predominance in 95 cases (61, 7%). All the subjects profited of a meticulous history, a clinical examination and a chest ray. Allergological skin tests for the main pneumallergenes were practiced with a positive control (histamine) and a negative control (glycerosaline). The extracts used are those marketed by the Stallergene's laboratories. Cutaneous sensitisation to cypress was present in 32 patients (20.78%). The prevalence of the cutaneous sensitisation to cypress came in 5th position after the dust mites, Grasses, Mimosa and Cockroach. The sensitisation was isolated in only one case, and associated to one ore more sensitisation to others pneumallergenes at the remaining 31 cases: DP (80, 65%), DF (71%), 5 Grasses (74,19%), Mimosa (58, 06%), cockroach (48,39%) and Blomia Tropicalis (45, 16%). Among these patients allergic to cypress, the rhinitis is found in 26 cases (81, 25%), insulated in 3 cases (9, 37%) associated on asthma alone in 6 cases (18, 75%), with asthma + conjunctivitis is 8 cases (25%), associated a conjunctivitis + cutaneous diseases in 3 cases (9, 37%). Asthma is found in 22 cases (68, 75%), insulated in 5 cases (15, 63%), and associated to conjunctivitis in one case (3, 13%). The rhinitis is classified intermittent mild in 6 cases (23, 07%), intermittent moderate to severe in 9 cases (34, 62%), persistent mild in one case (3, 85%), persistent moderate to severe in 10 cases (38, 46%). Asthma is intermittent in 7 cases (31, 82%), persistent mild in 5 cases (22, 73%), persistent moderate in 9 cases (40, 9%) and persistent severe in one case (4, 55%). These results confirm the relative high frequency of sensitisation to cypress in Casablanca, and the frequency of the rhinitis and asthma among sensitized patients. The treatment is especially symptomatic with ousting of the allergens.     

Asthme et rhinite d’origine professionnelle causés par le séné

The authors report a case of occupational allergy by senna: a 28-year-old female developped an IgE-mediated asthma and rhinitis caused by senna in a phytopharmaceutical factory: the skin prick test gave a 12-mm wheal reaction, the CAP-RAST Phadia with senna was positive (2.9 kU/L) and in the bronchial challenge test, she exhibited a strong reduction of FEV1 (48 %).     

Quoi de neuf en allergologie pédiatrique en 2005 ? Partie 2. Allergie respiratoire : épidémiologie (une revue de la littérature internationale d'octobre 2004 à octobre 2005)

Risk factors for asthma are genetic factors, parental history of atopy and asthma, conditions of pregnancy and delivery, maternal smoking and frequent use of paracetamol during pregnancy, personal history of atopy and infectious diseases of the respiratory tract, and in utero exposure to high levels of domestic pollutants. Farm children are less prone to develop asthma, except for children exposed to pigs during the first years of life. The impact of allergen exposure on asthma risk depends on allergens. As far as cat allergens are in concern, the risk of asthma is increased in children exposed to low to moderate levels, but decreased in heavily exposed children. However, this effect is highly variable from one child to another one. Allergic rhinitis is underdiagnosed and undertreated in asthmatic children, and increases the risk and the severity of asthma. Risks of asthma persistence and relapse are influenced by the timing, severity and persistence of early wheezing. A large number of young adults are in clinical remission but have persistent abnormalities of their respiratory functions, suggesting that these patients are at risk of subsequent relapse. Finally, several studies suggest the end of the asthma "epidemics" in most European countries. However, other studies show that, although declining in adolescents, the incidence of asthma is still increasing in young children.