Comment faciliter l'accueil des enfants asthmatiques à l'école. Le projet d'accueil individualisé (PAI)

In France, nearly 10% of children in primary school and 15% of junior high school students are asthmatic. It is important for these children to be able to continue their schooling or to be admitted [en collectivité = elsewhere?] and to have access to continued medical care or to a special diet required by their condition. The Individualized Reception Project (IRP) is aimed at establishing a partnership between parents, school-based physicians, school authorities and the children's private doctors. The proposed arrangements would allow children 1) to eat in the school cafeteria with meals prepared by their families, 2) to take their medicines orally, by inhalation and/or by injection, 3) to benefit from specific modifications that ameliorate their well-being at school, and 4) to have access to emergency care. The interministerial circular N^o 2003-135, September 8, 2003, is the text on which personnel of the National Education System, those of the Agriculture Ministry and local communities depend for this arrangement. This circular makes recommendations, but they are not obligatory. The success of the project depends on the willingness of each individual, and it should be noted that over the years, progress has been made and that collaboration between generalists, specialists, school physicians and teachers has been very productive.     

Le GINA 2006 et l’asthme : quoi de neuf en thérapeutique par rapport aux éditions antérieures ?

The 2006 revision of Global Initiative for Asthma (GINA) included several modifications which concern both adults and children. GINA was established in 1995 and its principal objectives were described then in the NHBLI/WHO Report, Global Strategy for Asthma Management and Prevention. This widely distributed report was revised in 2002 and then again in 2006. GINA 2006 is a document written in a simple fashion, mainly adapted for primary care physicians. It insists on the control of asthma in both children and adults, because that asthma symptoms and their consequences (trouble sleeping, limitation of daily living activities, reduction of respiratory function, use of rescue medications) can be controlled by appropriate treatment. In 2006, GINA proposed to abandon the notion of severity in favour of the concept of control, a concept already adopted in France in 2004 by the Haute Autorité de santé (HAS) in its recommendations on the management of asthmatic patients, both adults and adolescents. Control is defined by the presence or absence of asthma, defined essentially by clinical criteria that take into account the patient's activities over the several weeks (from one week to three months) before the consultation. Control includes three stages: for GINA, the three stages are “controlled”, “partially controlled” and “uncontrolled”, whereas for the Agence nationale d’accréditation et d’évaluation en santé (Anaes) they are “optimal”, acceptable” and “unacceptable”, which mean more-or-less the same thing. This concept is easier for primary care physicians to use. The therapeutic consequences of the GINA revisions will be considered in the present review.     

L'histamine,une nouvelle cytokine du lymphocyte T ?

Histamine is a chemical mediator with, in addition to its well-known effects in the acute inflammatory and allergic responses, a less known role in the regulation of the immune response. Indeed, histamine regulates the activation of T cells and notably affects Th1/Th2 balance by interfering with the cytokine network and by controlling their production. However, the numerous studies dealing with the effect of histamine during this control have given rise to several conflicting datas. These discrepancies might primarily be explained by the existence of four types of histamine receptors and their differential function and expression on cells that may therefore vary with the experimental setup. In this review, we thus highlight the complexity of this system and the existence of interactions between histamine, T cells and cytokines.