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Allergy to furry animals is a frequent health issue, and should be suspected when investigating any yearlong rhinoconjonctivitis or asthma. A detailed medical history and skin prick tests are usually sufficient for diagnosis, and if necessary, specific IgE testing may be performed. In case of proven hypersensitivity, avoidance of animal allergens is the main therapeutic measure, primarily by removing the animal from the patient's environment, in association with symptomatic treatment. If animal removing is impossible, other measures exist to decrease allergen load, but not with the same -efficacy as removing the animal, particularly for asthma. Immunotherapy is available for cat and dog allergy, but indication is to be carefully discussed.Les allergies aux mammifères à poils sont une problématique ­répandue, et une hypersensibilité aux phanères d’animaux est à rechercher devant toute rhino-conjonctivite ou tout asthme ­perannuels. Une anamnèse soigneuse associée aux prick-tests permet d’orienter le diagnostic, qui sera en cas de doute complété par des dosages d’immunoglobulines E (IgE) spécifiques. Face à une hypersensibilité avérée, l’éviction est la pierre angulaire de la prise en charge, associée à un traitement symptomatique. En cas d’impossibilité pour le patient de se séparer de son animal, des mesures existent pour diminuer la charge en allergènes, bien qu’elles soient insuffisantes pour prévenir toute ­exacerbation des symptômes, surtout en cas d’asthme. Des ­désensibilisations existent pour l’allergie au chat et au chien, à discuter au cas par cas.

Asthma is a chronic disease that is still frequently poorly controlled, despite recent advances in understanding its pathophysiology. Poor compliance and ineffective inhalation technique remain the main causes of treatment failure. The comorbidities associated with asthma, such as obesity and chronic rhinosinusitis, are other elements to consider in the management of patients. Biological treatments targeting inflammation mediators show encouraging results in recurrent asthma exacerbations despite optimal management. However, their benefit remains limited to certain patients, thus requiring the study of predictive biomarkers to better delineate their indication.L’asthme est une maladie chronique encore souvent mal contrôlée, et ce, malgré les récents progrès concernant la compréhension de sa physiopathologie. Une mauvaise adhésion aux traitements et une technique d’inhalation inefficace restent les causes principales d’échecs thérapeutiques. Les comorbidités associées à l’asthme, telles que l’obésité et la rhinosinusite chronique, sont d’autres éléments à considérer dans la prise en charge des patients. Lors d’exacerbations asthmatiques récidivantes, malgré une prise en charge optimale, des traitements biologiques ciblant les promoteurs de l’inflammation montrent des résultats encourageants. Leur bénéfice reste toutefois limité à certains patients, ce qui impose à l’avenir l’étude de biomarqueurs prédictifs de réponse à ces traitements ciblés.

Allergic diseases are currently amongst the most frequent diseases of our time. Of all the allergies in the Western countries, allergic rhinoconjunctivitis is the most common. Its diagnosis is based mainly on the history and the correlation between symptoms and contact with the allergen. A step-by-step approach helps optimize diagnostic resources and minimize costs.Les allergies font partie des maladies les plus fréquentes de notre époque. Parmi toutes les allergies dans le monde occidental, la rhinoconjonctivite allergique est la plus fréquente. Son diagnostic repose principalement sur l’anamnèse et la corrélation entre symptômes et contacts avec l’allergène. Une démarche par étapes aide à optimiser les ressources diagnostiques et à minimiser les coûts.

Food-dependent exercise-induced anaphylaxis (FDEIA) is a potentially severe food allergy. Physical exercise, NSAID, alcohol, infectious diseases and estrogens are recognized cofactors, able to reduce the amount of allergen needed to achieve a threshold for the induction of anaphylaxis. Various kinds of causative food but only a few responsible proteins have been identified. The best known is wheat ω5-gliadine. An oral food challenge remains the gold standard to prove the diagnosis. Its clinical application remains difficult and includes an allergen challenge, a cofactor challenge and a third step which integrates both of them in a single test. Gluten flour and NSAID + alcohol combination seem more efficient than respectively wheat flour and physical exercise in a provocation test condition.L’anaphylaxie alimentaire à l’effort est une allergie alimentaire potentiellement sévère. L’exercice physique, les AINS, l’alcool, les infections et les œstrogènes sont des cofacteurs reconnus, capables de diminuer la quantité d’allergènes nécessaire à l’atteinte d’un seuil anaphylactique. Si le panel d’aliments incriminés est large, seules quelques protéines responsables ont été à ce jour identifiées. La plus connue est l’ω5-gliadine du blé. En cas d’incertitude diagnostique, un test de provocation est indiqué. Son application clinique reste difficile et inclut de tester l’allergène de manière isolée et le cofacteur puis d’intégrer les deux dans un même test. La farine de gluten et la combinaison AINS + alcool ont une sensibilité supérieure respectivement à la farine de blé et à l’exercice physique en situation de provocation.

In severe asthma, there is a real need for new effective therapies offering a good safety and tolerance profile. Mepolizumab is a humanized anti-interleukin-5 monoclonal antibody, available in Switzerland since 2016 for treatment of severe adult eosinophilic asthma. Other monoclonal antibodies, such as dupilumab, are being developed in the field of asthma.Dans l’asthme sévère, il existe un réel besoin de nouvelles thérapies efficaces offrant de bons profils de sécurité et de tolérance. Le mépolizumab est un anticorps monoclonal humanisé dirigé contre l’interleukine 5, disponible en Suisse depuis 2016 pour le traitement de l’asthme éosinophilique sévère de l’adulte. D’autres anticorps monoclonaux, comme le dupilumab, un anti-IL-4R, sont actuellement en cours de développement dans cette indication.

Vasculitis like Horton's disease, some autoinflammatory syndromes (Behcet's, Still's diseases) often require long term treatment with steroids, and therefore are associated with non acceptable adverse events, especially when resistant to treatment. Recently, a number of controlled prospective clinical trials are supporting the interest of the anti-IL-6 receptor monoclonal antibody tocilizumab in these chronic inflammatory conditions et may soon be recognized as second intention therapeutic approach.Certaines vasculites comme la maladie de Horton en particulier, certaines pathologies auto-inflammatoires (maladies de Behcet, de Still) imposent aux patients des traitements de longue durée par les stéroïdes et donc les exposent à des effets secondaires à long terme souvent inacceptables dans les formes résistantes. Depuis peu, quelques études contrôlées, prospectives sont venues soutenir l’intérêt de l’antirécepteur de l’IL-6 monoclonal dans ces pathologies, et laissent penser qu’il puisse prochainement devenir un traitement de seconde intention dans le Horton notamment.

Food allergy in children has increased unexpectedly during the last decades and is now the leading cause of anaphylaxis in Europe. The impact on quality of life is significant; a reliable diagnosis is therefore of critical importance. The diagnostic approach includes an initial clinical evaluation followed by allergy testing (in vivo and/or in vitro). Determination of molecular allergens (recombinants) has emerged as a complementary tool in the diagnosis of food allergy allowing a better prediction of systemic reactions and identifying markers of persistence or resolution. With recent developments, a more proactive approach is being adopted, which includes oral food challenges in order to avoid unnecessary exclusions.

Itchy skin rashes are a frequent reason to seek medical advice. The symptoms may be caused by hypersensitivity reactions to arthropod bites, waterborne parasites or setae from moth caterpillars and are sometimes mistaken for spontaneous urticaria or eczema. Some of these pests are resurging in Switzerland and elsewhere and increasingly responsible for emergency consultation. In this article we review itchy skin rashes caused by bed bugs, scabies, lice, cercariae, Pyemotes spp, caterpillars and harvest mites, which may be confounded with urticaria and allergic contact dermatitis. We detail here clinical manifestations, topographical distribution of skin lesions, epidemiology, treatment and preventive measures.

Although most delayed drug hypersensitivity reactions are mild and show rapid improvement after drug discontinuation, there are severe systemic and/or cutaneous drug reactions which may be life-threatening. These entities are discussed here, namely DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms), acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). Early detection of warning signs and symptoms may help to take appropriate measures precociously.

Although not specific, an increased in peripheral blood eosinophils may contribute substantially to the diagnosis of numerous infectious, allergic and inflammatory diseases. The scope of this article is to detail pathologies associated with peripheral eosinophilia by order of frequency and to guide further investigations.

Mast cell disorders are defined by the accumulation of mast cells in one or more organ systems. Cutaneous forms are mainly observed in children whereas systemic forms are predominant in adults. Mast cells cause symptoms by the release of proinflammatory mediators or by infiltration of various organs. The measurement of serum tryptase has opened the possibility of screening for mastocytosis, which must be taken into consideration in case of severe anaphylactic reactions. Definite diagnosis is established based on a biopsy of skin or bone marrow. An activating mutation of stem cell factor receptor c-kit is often found. Treatment is based on control of the symptoms triggered by mast cell degranulation. Moreover, novel treatment options targeting mast cell proliferation become available for clinical use.

Autoantibodies are frequently determined in unclear clinical situations and in the context of an inflammatory syndrome. The aim of this article is not to review all autoantibodies in details, but to discuss those used in clinical practice by describing their methods of detection and interpretation. Thus we will focus on antinuclear antibodies (ANA), which are typically associated with connective tissue diseases, as well as anti-neutrophil cytoplasmic antibodies (ANCA), which are useful in the diagnosis of ANCA-associated vasculitides. Due to its high sensitivity indirect immunofluorescence is used as a screening test; when positive, ELISA is performed to search for antibodies more specifically associated with certain auto-immune diseases.

Idiopathic inflammatory myopathies, such as polymyositis and dermatomyositis, share common clinical features such as progressive, symmetrical muscle weakness prevailing in the lower limbs, associated sometimes with muscle pains. High CK and typical biopsy insure the diagnosis. Possible causes for secondary myopathies and associated diseases should be actively investigated. The search for autoantibodies helps to better classify inflammatory myopathies and to better define the prognosis of the myopathy. Glucocorticoids are the cornerstone of the early phase therapy. Glucocorticoid-sparing agents, such as azathioprine and methotrexate, are second line agents but can be readily prescribed. In case of therapeutic resistance, a rescue treatment (ciclosporine, immunoglobulins, rituximab, cyclophosphamide) could be considered.

Rhinitis and allergic conjunctivitis are frequent and may have severe impact on quality of life. Moreover risks of evolution of rhinitis to asthma are high, whereas conjunctivitis may either lead to eye-related complications when some topical drugs (such as steroids) are used, or when severe ailments are belatedly diagnosed. This article enables to review the treatment of allergic rhino-conjunctivitis. It also presents recent progress realized in the domain of allergen specific immunotherapy. In particular, this review underlines the search for hypoallergenic formulations that may minimize the risk of systemic allergic side effects as well as the use of new adjuvants to improve the efficiency of treatment and reduce its duration.

Giant cell arteritis (GCA) and Takayasu arteritis (TA) are both chronic granulomatous vasculitis of unknown aetiology that involve large vessels. Signs and symptoms are related to the affected vessels: the primary branches of the aorta in TA and the extra-cranial branches of the external carotid artery in GCA. TA affects women under 40 of all ethnic origins with a greater prevalence in Asia, whereas GCA affects elderly of caucasian ancestry. In both diseases the diagnosis and follow up are rendered difficult by the absence of specific marker but advances in imaging technologies such as angio-MRI and PET/CT are very promising. Corticosteroids still represent the basis of treatment, most often alone in GCA and usually in association with another immunosuppressive drug in TA.

Immediate, short- and long-term adverse events of classical immunosuppressor drugs strongly stimulate novel, but less toxic approaches. Combined or sequential use of cyclophosphamide, mycophénolate mofétil and/ or azathioprine should improve clinical tolerance and avoid severe adverse events (infections, infertility, amenorrhea), regularly associated to long term therapies with classical immunosuppressive schemes. Among novel developments based on biologicals, the anti-CD20 monoclonal antibody rituximab (anti-B cells) appears encouraging in open studies, in association or not with cyclophosphamide, and is generally well tolerated. Further information is expected from the inhibitor of T cell/B cell co-stimulation CTLA4-Ig, or from strategies aiming to inhibit key cytokines in SLE pathogenesis such as interferon-alpha, IL-1 or IL-6.