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Résumé De plus en plus de personnes dans les pays développés attribuent à une intolérance alimentaire diverses manifestations cliniques de types troubles gastro-intestinaux, douleurs articulaires voire polyarthrite rhumatoïde (PR), migraine ou fatigue chronique. Plusieurs auteurs ont rapporté une fréquence plus importante de la positivité des IgG anti-aliments chez les patients souffrant de syndrome de l’intestin irritable (SII), de maladies inflammatoires chroniques de l’intestin (MICI) ou de PR comparés aux témoins sains. Depuis une décennie, ces dosages de recherche sont disponibles en routine sur prescription médicale mais aussi en accès libre sans avis médical via internet. Ces dosages sont utilisés pour établir des régimes d’éviction des aliments pour lesquels la recherche d’IgG est positive, dans l’espoir d’une amélioration des symptômes supposés être en relation avec la consommation de ces aliments par le biais d’une réaction d’intolérance faisant intervenir les IgG. L’objectif de ce travail est de rappeler les mécanismes impliqués dans les intolérances et allergies alimentaires, et le rôle physiologique des réponses immunitaires à IgG. Les techniques de dosage des IgG anti-aliments commercialement disponibles sont passées en revue. Les principales études basées sur le dosage des IgG anti-aliments appliqué à diverses pathologies font l’objet d’une analyse critique, suivie d’une discussion. Il en ressort que l’intérêt clinique des dosages d’IgG anti-aliments est l’objet d’une vive polémique en raison de leur mauvaise valeur prédictive positive. Les recommandations établies sur la base de ces dosages sont susceptibles de faire prendre un risque au patient en retardant quelquefois le bon diagnostic ou en lui faisant suivre un régime alimentaire d’éviction le plus souvent inutile et parfois délétère pour sa santé. Les coûts directs liés aux dosages et indirects occasionnés par les régimes d’éviction, souvent élevés, peuvent être évités au profit d’autres stratégies diagnostiques. En conclusion, dans l’état actuel des connaissances médicales, les dosages d’IgG anti-aliments ne devraient plus être pratiqués en routine pour établir un diagnostic d’intolérance ou allergie alimentaire à IgG, ni mettre en place un régime d’éviction. Leur utilisation devrait être réservée à des fins de recherche. There is an increasing tendency in western countries to attribute to food intolerance various clinical types of gastrointestinal disorders, joint pain or rheumatoid arthritis (RA), migraine and chronic fatigue. Several authors have reported a greater frequency of positive anti-food IgG in patients presenting irritable bowel syndrome (IBS), chronic inflammatory bowel disease (IBD) and RA compared to healthy controls. Over the last decade, screening tests have become routinely available on prescription but are also freely available over the Internet. These assays are used to create diets that avoid IgG-positive foods in the hope of improving symptoms thought to be related to the consumption of these foods associated with IgG-mediated intolerance reactions. The purpose of this study is to review the mechanisms involved in food intolerance and the physiological and pathological role of IgG immune response. Commercially available assays for food IgG are reviewed. Studies based on anti-food IgG determination applied to various diseases are reviewed and discussed. Considerable controversy surrounds the clinical relevance of anti-food IgG assays because of their poor positive predictive value. The recommendations made on the basis of these assays are likely to jeopardize the health of patients by delaying correct diagnosis or encouraging them to follow a mostly useless and occasionally harmful diet. The frequently high direct and indirect costs of assays and avoidance diets may be avoided in favor of other diagnostic strategies. Finally, in the current state of medical knowledge, anti-food IgG tests should not be performed routinely to establish a food intolerance diagnosis or to devise an avoidance diet. They should be used solely for research purposes. [ABSTRACT FROM AUTHOR]

Résumé Une hyper-IgE peut être retrouvée dans un grand nombre de situations pathologiques. Le rôle des IgE est essentiellement associé à la survenue des manifestations allergiques qui peuvent s’accompagner d’une augmentation de leur taux sérique. Une élévation des IgE totales a aussi été décrite en association avec la survenue de certains déficits immunologiques rares d’origine génétique appelés syndromes d’hyper-IgE. D’autres circonstances, telles que des maladies infectieuses, tumeurs ou maladies auto-immunes peuvent également conduire à une synthèse d’IgE en excès. Du fait de la diversité de ces situations, la discussion de la valeur pronostique des IgE totales est utile pour l’interniste. Hyper-IgE may be found under many pathological conditions. The role of IgE is essentially associated with the occurrence of allergic manifestations, which may be accompanied by an increase of their serum levels. Elevation of total IgE has also been reported in association with certain rare genetic immune deficiencies called hyper-IgE syndromes. Other circumstances such as infectious diseases, tumors or autoimmune diseases may also be accompanied by an excessive synthesis of IgE. Considering the diversity of these situations, discussion of the prognostic value of total IgE is useful to the internist. [ABSTRACT FROM AUTHOR]

Résumé Les mastocytes sont des cellules granulaires du système immunitaire stratégiquement localisées au sein des tissus connectifs et des muqueuses, où ils participent à la régulation des processus inflammatoires. La caractéristique principale des mastocytes est leur capacité à externaliser rapidement leur contenu granulaire cytoplasmique enrichi en molécules bioactives et immunomodulatrices, en réponse à différent signaux activateur. Mieux comprendre comment ces cellules régulent leur dynamique de sécrétion en fonction du récepteur activé est d’un intérêt majeur pour appréhender les réactions inflammatoires dépendantes des mastocytes. Nous nous sommes particulièrement intéressés à l’activation des mastocytes par deux récepteurs jouant un rôle majeur dans divers processus inflammatoires : le FcɛRI (le récepteur de haute affinité aux IgE) et MRGPRX2 (le récepteur des mastocytes aux substances cationiques). Pour pallier aux contraintes technologiques actuelles, nous avons développé une nouvelle approche permettant de visualiser, en temps réel et à l’échelle cellulaire, la dynamique de dégranulation des mastocytes en utilisant la microscopie confocale in vitro et biphotonique in vivo. Nous avons démontré qu’en réponse à une activation par FcɛRI ou MRGPRX2, les mastocytes mettent en place des stratégies de dégranulation bien spécifiques à chaque récepteur, permettant l’externalisation du contenu granulaires avec des caractéristiques physiques distinctes et le développement de réactions inflammatoire de différentes intensités. Nous proposons ici une synthèse des connaissances nouvelles sur les différentes stratégies de dégranulation des mastocytes. Mast cells are granular immune cells strategically located among connective tissues and mucosa, where they participate to the regulation of diverse inflammatory processes. The principal characteristic of mast cells is their capacity to rapidly exteriorize intracellular granular content enriched in bioactive molecules in response to different activation signals. A better understanding of how these cells regulate their secretion dynamics under different stimulatory conditions is crucial to apprehend mast cell-dependent inflammatory reactions. We particularly focused on mast cell activation via two major receptors involved in diverse pathophysiological processes: FcɛRI (the high affinity receptor for IgE) and MRGPRX2 (the mast cell receptor for cationic molecules). To circumvent existing technical constraints, we developed a new approach that permits to monitor, in real-time and at the single cell level, mast cell degranulation dynamics using in vitro confocal microscopy and in vivo two-photon microscopy. We found that mast cell translate FcɛRI- or MRGPRX2-mediated signals into distinct degranulation strategies leading to the release of granular content with specific physical characteristics and the development of mast cell-dependent reactions of different intensities. Here we propose a synthesis of new concept on how mast cells regulate their degranulation strategy in response to activation via different receptors. [ABSTRACT FROM AUTHOR]

Résumé Certaines allergies immédiates à la pêche ne sont pas élucidées sur le plan moléculaire par l’exploration des IgE spécifiques utilisées en routine : extrait de pêche, Pru p 1 (PR-10), Pru p 3 (protéine de transfert lipidique), Pru p 4 (profiline) et groupements glucidiques à réactivité croisée, et ce malgré des tests cutanés fortement positifs et une histoire clinique convaincante. L’exploration de ces patients par un test d’activation des basophiles en présence d’extrait de pêche est fortement positive, suggérant l’implication d’un allergène moléculaire de la pêche, absent des outils diagnostiques in vitro actuels. Nous rapportons ici la forte prévalence de la sensibilisation vis-à-vis de la peamacléine (Pru p 7) chez les patients méditerranéens allergiques à la pêche (région de Marseille), ainsi que les caractères épidémiologiques, cliniques et biologiques associés à ce nouvel allergène. Molecular-based allergy diagnostic kits using standard IgE reagents such as peach extract, Pru p 1 (PR-10), Pru p 3 (non-specific lipid transfer protein), Pru p 4 (profilin), and cross-reactive carbohydrate determinants, are unable to identify the offending allergen in certain patients with peach allergy in Southern France, despite positive skin tests and a convincing clinical history. The constant and high positivity of the basophil activation test with peach extract in such patients suggests the involvement of a molecular peach allergen not included in existing in vitro diagnostic kits. Herein we report that peamaclein (Pru p 7) is a major allergen in peach-allergic patients in the Mediterranean (Marseille) region and we describe the epidemiological, clinical and laboratory characteristics associated with this novel allergen. [ABSTRACT FROM AUTHOR]

Résumé Les mastocytes sont capables de libérer, après activation, de nombreux médiateurs contenus dans des granules cytoplasmiques ou synthétisés de novo (médiateurs lipidiques, cytokines, chimiokines, facteurs de croissance). Si ces cellules sont impliquées de manière importante dans les réactions d’hypersensibilité de type I (principalement de par la libération de leur contenu granulaire), elles jouent un grand nombre de rôles positifs dans l’organisation de la réponse immunitaire et dans la réparation tissulaire constitutive de la réaction inflammatoire. Des approches thérapeutiques nouvelles en allergologie ciblant de manière sélective la dégranulation mastocytaire pourraient permettre de maintenir des fonctions physiologiques essentielles de ces cellules tout en enrichissant la pharmacopée antiallergie. Nous avons identifié la Phospholipid Scramblase 1 (PLSCR1) comme un amplificateur des signaux d’activation responsables de la dégranulation mastocytaire induite par agrégation du récepteur aux immunoglobulines E. Nous faisons ici le point sur nos connaissances relatives au rôle de la redistribution des phospholipides membranaires ( scrambling ) et de la Phospholipid Scramblase 1 dans les mastocytes activés. Following activation, mast cells can release an array of mediators stored in their cytoplasmic granules or synthesized de novo (lipid mediators, cytokines, chemokines, growth factors). While these cells are critically involved in type I hypersensitivity reactions (mainly through the release of their granule content), they also play a number of positive roles in organizing the immune response and in tissue repair constitutive of the inflammatory reaction. New therapeutic approaches in allergology selectively targeting mast-cell degranulation could enable the essential physiologic functions of these cells to be maintained while expanding available antiallergy therapeutic options. We have identified phospholipid scramblase 1 (PLSCR1) as an amplifier of mast-cell degranulation induced by immunoglobulin E receptor aggregation. Herein, we review current knowledge on the role of membrane phospholipid scrambling and of phospholipid scramblase 1 in activated mast cells. [ABSTRACT FROM AUTHOR]

A broad spectrum of paraneoplastic dermatoses is associated with lung cancer. We report herein a 56-year-old man who presented an association of erythroderma, acquired ichthyosis, palmo-plantar keratoderma, hypereosinophilia and hyper IgE. In light of these clinical and biological assessments an underlying malignancy had been suspected. A thoracic, abdominal and pelvic computed tomography showed a left hilar mass. The patient underwent a left pneumonectomy and the histological study had confirmed a non-small cell lung cancer. Recognition of cutaneous paraneoplastic syndromes is important since it leads to prompt diagnosis of an underlying malignancy and consequently a better management and prognosis of the disease.

Résumé Nous avons entrepris une étude rétrospective des 1314 tests aux venins et composants de 10 laboratoires en France. Les résultats montrent que le test pour P. dominulus (i77) était plus sensible que le test Polistes spp. (i4). Seulement 10 % de patients sensibilisés à 2 guêpes semblaient reconnaître des allergènes identiques. Une valeur pour Ves v5 bien supérieure que pour Vespula doit faire suspecter Pol d5 et inversement. Près de 25 % des tests dans le Nord de la France étaient positifs pour Polistes spp. mais une réaction croisée avec Vespula est probable. Les sensibilisations à Ves v1 ou Api m1 étaient bien corrélées au venin entier respectif. Api m1 n’expliquait que la moitié des sensibilisations au venin d’abeille. Les doubles sensibilisations guêpe et abeille étaient rarement corrélées. Les rares cas où une sensibilisation aux carbohydrates excédait celle à un venin, une sensibilisation plus forte existait pour un autre venin. We carried out a respective study on 1314 sIgE tests for venoms and their components done in 10 laboratories in France. The results showed that the test for P. dominulus (i77) is more sensitive than the test for Polistes spp. Only 10% of the patients sensitized to two wasps were found to recognize identical allergens. Some patients who had higher sIgE to Ves v5 compared to Vespula spp. frequently had even higher sIgE to Pol d5, and vice versa. Nearly 25% of the sIgE tests in Northern France were positive for Polistes spp., but cross-reactivity to Vespula is likely in these cases. Sensitization to Ves v1 or Api m1 was highly correlated to whole honey bee venom sensitization in both cases. Double sensitizations to wasp and bee venom were poorly correlated. In the rare cases where sensitization to carbohydrates exceeded that to a venom, an even higher sensitivity to a different venom was observed. [ABSTRACT FROM AUTHOR]

Résumé Le rôle des réactions immuno-allergiques aux aliments au cours du syndrome de l’intestin irritable (SII) reste controversé, en raison d’une symptomatologie peu spécifique et des méthodes diagnostiques limitées par l’accessibilité difficile du tube intestinal. Dans la pratique clinique, les manifestations au niveau du tractus gastro-intestinal des allergies alimentaires sont difficiles à évaluer et à les différencier des plaintes à expression gastro-intestinale d’autre origine. Les hypothèses physiopathologiques concernant l’hypersensibilité allergique aux aliments reposent sur des mécanismes immunologiques immédiats (IgE et non IgE) et retardés, incluant les mastocytes et les éosinophiles. Les concepts physiopathologiques récents dans le SII suggèrent l’existence d’altérations de l’intégrité de la barrière épithéliale intestinale qui favoriseraient une présentation accrue d’antigènes luminaux, le développement et le maintien d’une activation définie de « bas grade » de l’immunité muqueuse et du système nerveux entérique, potentiellement à l’origine des troubles de la motricité/sensibilité et des douleurs digestives. Les tests diagnostiques utilisés en pratique clinique pour objectiver les réactions aux aliments rapportées par les patients (tests cutanés et IgE spécifiques sériques) sont souvent négatifs, comme le test de provocation par voie orale. Des manifestations d’atopie (rhinite, dermatite, asthme) semblent être le terrain favorisant le SII, au moins dans le sous-groupe de patients qui rapportent des symptômes cliniques après l’ingestion de certains aliments. The role of immuno-allergic reactions to food in patients with irritable bowel syndrome (IBS) remains controversial because of non-specific symptoms and of diagnostic methods limited by difficult accessibility to the gut. In clinical practice, the manifestations of food hypersensitivity in the gastro-intestinal tract are difficult to assess and to differentiate from digestive symptoms due to other causes. Pathophysiological hypotheses based on immunological mechanisms of immediate hypersensitivity (IgE and non IgE) and of delayed hypersensitivity, including mast cells and eosinophils, have been proposed. Recent pathophysiological concepts concerning IBS suggest the existence of alterations in the integrity of the intestinal epithelial barrier that would promote increased presentation of luminal antigens, with the development and maintenance of “low grade” mucosal inflammation with involvement of the enteric nervous system, potentially being the origin of these sensitive motility disorders and the abdominal pain. The diagnostic tests used in clinical practice (skin tests and specific IgE serum) to identify the source of self-perceived reactions to food reported by patients are often negative, as are oral provocation tests. Classic manifestations of atopy (rhinitis, dermatitis, asthma) seem to be the background favoring IBS, at least in the subgroup of patients reporting clinical symptoms after ingestion of certain foods. [ABSTRACT FROM AUTHOR]

Résumé: Les polynucléaires basophiles forment une population myéloïde rare, représentant moins de 1 % des leucocytes sanguins. Il a longtemps été pensé, du fait de la difficulté à les identifier, que les polynucléaires basophiles avaient un rôle similaire à celui des mastocytes tissulaires dans leur fonctionnalité. Cependant, du fait du développement de nouvelles technologies, il a été démontré que les polynucléaires basophiles avaient des fonctions non redondantes avec les mastocytes, et pouvaient être divisés en sous-populations fonctionnelles différentes. Il est maintenant acquis que les polynucléaires basophiles peuvent réguler l’immunité innée et adaptative, et jouer un rôle important dans la protection contre les parasites, mais également un rôle délétère en participant au développement et au maintien de désordres immunologiques comme les réactions allergiques et les maladies auto-immunes. Cependant, malgré leurs multiples fonctions, l’exploration biologique de ces cellules n’est à ce jour essentiellement réalisée que dans le cadre du diagnostic des réactions allergiques, par la mise en évidence de leur activation ou leur sécrétion d’histamine après stimulation par les allergènes. [Copyright &y& Elsevier]

Résumé: L’hyperéosinophilie (HE) sanguine est définie par une augmentation du nombre d’éosinophiles circulants au-dessus de 0,5G/L. Cette anomalie hématologique peut avoir de multiples étiologies mais la grande majorité d’entre elles correspondent à des HE secondaires dite « allergiques », que l’on rencontre très fréquemment au cours des helminthiases. En effet, lors d’une agression vermineuse, des cytokines dites « alarmines » sont sécrétées et vont aboutir à une surproduction d’IL-5, d’IL-13 et d’IL-4 responsables de l’HE et de l’augmentation des immunoglobulines de type E. Un haut niveau d’HE évoluant sur une longue période peut être responsable de dommages tissulaires liés à l’activation des polynucléaires éosinophiles conduisant souvent à des manifestations cliniques sévères. L’exploration d’une HE nécessite le recueil des données anamnestiques, épidémiologiques, et cliniques pour donner une orientation diagnostique et cibler au mieux le panel d’examens à réaliser. Les techniques de diagnostic optique demeurent la première ligne des investigations à exécuter, car ces examens peuvent conduire rapidement à un diagnostic de certitude lorsqu’ils sont exécutés par des opérateurs expérimentés. Les immunodiagnostics des helminthiases représentent un apport majeur dans certaines situations mais ces techniques restent complémentaires des investigations optiques classiques et sont souvent d’interprétation délicate. [Copyright &y& Elsevier]

Résumé: L’allergie aux drogues et stupéfiants illicites est rarement rapportée dans la littérature. Pourtant, ces dernières années il semble qu’il pourrait bien y avoir une hausse considérable de leur prévalence, en particulier l’allergie aux Cannabis sativa (chanvre indien) semble croître. Cette revue a comme but de décrire la connaissance actuelle de cette allergie émergente. Après une brève introduction, la première partie décrit les manifestations cliniques courantes. La seconde partie récapitule les allergènes et décrit le ű syndrome cannabis–fruits/légumes Ƈ. Finalement, les outils diagnostics sont présentés et discutés. [ABSTRACT FROM AUTHOR]

Résumé: La rareté des allergies aux Liliacées justifie cette relation de cinq cas d’anaphylaxie alimentaire sévère à l’oignon et à l’ail. Trois femmes ont présenté un choc anaphylactique de grade 3, deux ont présenté une diarrhée aiguë. La fréquence, évaluée sur 1300 cas d’anaphylaxie alimentaire enregistrés est de 0,38 %. L’allergie est isolée. Le diagnostic est porté par l’anamnèse relevant la fréquence d’épisodes allergiques et l’interrogatoire permettant d’identifier la responsabilité de l’oignon. Les prick-tests à l’oignon natif et la recherche d’IgE spécifiques sont négatifs quatre fois sur cinq, et trois fois sur quatre. Les auteurs avancent l’hypothèse que l’allergène majeur, l’alliine lyase, est en quantité trop faible dans l’oignon pour que les tests avec la source allergénique puissent être efficients. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The allergens responsible for wheat food allergy are beginning to be characterized. Nevertheless, animal models that produce highly-specific IgE and clinical symptoms comparable to those observed in allergic patients are of great interest for precise studies of allergens and of the mechanisms involved in wheat allergy. The aim of our research was to develop, in the first instance, a mouse model of allergy to a total extract of gliadins, then to use this model to study two major wheat allergens involved in wheat food allergy on children and adults, namely, the lipid-transfer protein (LTP) and the omega-5 gliadins. Methods: First, we determined the mouse strain and the allergen dose required to induce an optimal allergic reaction to wheat. Three strains of mice (Balb/cJ, B 10.A ND c3h/hEj) received four successive intraperitoneal injections of a total-gliadin extract (10 or 20μg) adsorbed on alum. The level of sensitization was determined by assay of gliadin-specific IgE and IgG1 and by the level of cytokines secreted by splenocytes activated in vivo by the gliadins; in vitro basophil (RBL) degranulation tests were also done. In addition, the intensity of the allergic reaction was evaluated in vivo by analysis of the production of type Th2 cytokines and the influx of eosinophils in bronchoalveolar fluid (BAF) after intranasal gliadin extract provocation. Sensitization assays and provocation tests with LTP and omega-5 gliadins were done subsequently. Results: The highest level of sensitization was observed in the Balb/cJ mice, whatever the dose of gliadins used. After the provocation test, these mice developed an intense-allergic reaction, as demonstrated by the strong production of type Th2 cytokines and the influx of eosinophils in the BAF. In contrast, a weak or no reaction was observed in the other two mouse strains. While sensitization of Balb/cJ mice by omega-5 gliadins was not very effective, administration of LTP induced significant production of specific IgE and IgG1 as well as specific degranulation of RBL cells, but little or no secretion of type Th2 cytokines by activated splenocytes. Induction of an allergic response after intranasal introduction of LTP was not very effective, in spite of the cellular influx in the BAF. Conclusion: Balb/cJ mice, sensitized by intraperitoneal injection of a total-gliadin extract, appeared to produce some of the markers of wheat allergy, but the results of the sensitization studies with the purified allergens appear to be more complex. [Copyright &y& Elsevier]

Abstract: Aim of the study: We tested here a new cytometric method based on the use of two activation markers (CD63 and IgE) and result''s expression in activation index (AI). Material and methods: Twenty-six allergic patients and 23 controls having received a neuromuscular blocker (NMB) have been selected on the basis of clinical history, skin tests and specific IgEs. NMB were tested mixed (n =26) or alone (injectable form, (n =30) and allergens commercialized for flow cytometry (n =9)). Concentrations used were the same than for IDR according to the recommandations of the French Society of Anaesthesia and Resuscitation (SFAR). The cytometric protocol used was the IgE/CD63 protocol, results being expressed in percentage CD63 and in AI calculated by a specific algorithm involving the mean fluorescence intensity (MFI) of the IgE+ and the CD63+ and − populations. Results: In the technical described here NMB exhibited no toxicity even for concentretions 10 times higher than concentrations used for diagnosis. With the injectable form, the respective sensitivities observed for CD63 alone and the AI were 68 and 100% for the mixture of NMB and, 67 and 100% for the isolated NMB. With the NMB commercialized for flow cytometry, sensitivities were 47 and 100%. Specificities were 100% for CD63 alone and 98% for the AI. The link (Chi2) between skin tests and flow cytometry was significant for the two markers and the two allergen types. Correlation between AI and specific IgEs was not significant. Conclusion: The new flow cytometric protocol described here has the necessary characteristics of a biological test which could be included in the pre-anaesthetic check up. [Copyright &y& Elsevier]

Abstract: The program of the European Congress of Allergology EAACI 2007 (Goteborg 9-13 June) covered many current problems dealing with general allergy as well as those in different specialized sectors of our discipline. Among the questions considered were the role of virus infection in the course of asthma, the production of IgE and phylogenesis, the predictive value of the production of IgE in the newborn and older children, T lymphocytes, anaphylaxis, pro filins, and non-invasive markers of allergic inflammation. The importance of these the topics continues to be explored. The answers might explain the similarity between asthma in humans and in cats, the relation between hyper-IgE and exacerbations of asthma (where the risk is multiplied by two with rhinovirus infections), the importance of certain food allergens causing anaphylaxis (shelled nuts, especially peanuts, and exotic nuts), the importance of measuring exhaled NO in asthmatics, etc. [Copyright &y& Elsevier]

Abstract: In a paediatric context, ocular allergy has some specificities, namely concerning its atopic aspects and its clinical forms, being mainly IgE-dependent. First, a description of the clinical workup to be carried out in children. Then, comments on the last consensus conferences on diagnosis and therapeutic orientation. The principal clinical aspects of ocular allergy in children will be detailed, with comments on seasonal acute conjunctivitis, perennial chronic conjunctivitis, vernal keratoconjonctivitis and blepharitis. Therapy with mast cell degranulation inhibitors, antihistamines, corticoids, and immunomodulators as well as local washing and allergen avoidance will be discussed. A review of current treatment for chronic and acute ocular allergies will provide a basis for appropriate and effective management. It will undoubtedly be improved further by the arrival of new treatments such as topical cyclosporine or other drugs which will act by new therapeutic mechanisms. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Formaldehyde is an industrial and domestic pollutant that has several effects on the respiratory system. In exposed workers, formaldehyde can trigger asthma, although this does not occur very frequently. Indoor exposure to formaldehyde can promote sensitization to common aeroallergens, the development of asthma, and it may increase the bronchial response to allergen in asthmatic individuals. In the present article, we review the mechanisms that may explain these respiratory effects. The reactivity of formaldehyde and its capacity to form adducts with proteins can explain the IgE immune response that occurs in some exposed workers. They may also allow formaldehyde to enhance the immunogenicity of aeroallergens, thus explaining the increased risk of sensitization and of asthma associated with indoor exposure to this substance. Formaldehyde is also a potent irritant. This property, which may cause neurogenic inflammation, mast cell degranulation, inhibition of mucociliary clearance and an increase in the permeability of the airway epithelium, may explain most of the respiratory effects of formaldehyde. Formaldehyde is able to activate structural cells to induce pro-inflammatory cytokine production, adhesion molecule expression and oxidative stress, effects which can also contribute to the development of asthma or to exacerbation of the bronchial response to aeroallergens. Thus, published data suggest that the respiratory activity of formaldehyde involves several different mechanisms. However, further investigation is necessary to confirm and to characterize these mechanisms more fully. [Copyright &y& Elsevier]

Abstract: Peranesthetic anaphylactic shock (an IgE-dependant immediate hypersensitivity reaction) is caused most often by myorelaxants. Depending on the sequence of events, immediate laboratory tests are done to demonstrate histamine release, mast cell degranulation and, eventually, IgE specific for the causative agent. An elevated plasma histamine concentration can be due to an allergic mechanism or to non-specific histamine release. The blood sample must be obtained rapidly (<30min in mild reactions and <2h in severe reactions). An increased tryptase concentration, between 15min and several hours after the reaction, is evidence of mast cell activation and favors an allergic mechanism. For moderate reactions, comparison with a base-line level is recommended. The level of myorelaxant-specific IgE remains constant from the moment of the reaction to a much later time. [Copyright &y& Elsevier]

Abstract: Immediate hypersensitivity reactions, including both those that are mediated by IgE and those that are non immune mediated, occurring during the course of anesthesia, remain a major subject of preoccupation for anesthetists. These reactions often occur unpredictably, can be life threatening, and respond poorly to usual treatments. Epidemiological data obtained in New Zealand, England, Scandinavia and France allows us to estimate the incidence of IgE-mediated immediate hypersensitivity reactions at 1/10,000 to 1/20,000 anesthesias. Among the substances incriminated, muscle relaxants are the most frequent, followed by latex and antibiotics. Reactions caused by modern hypnotics, morphinomimetics and local anesthetics are rare. Concerning the incidence of reactions to muscle relaxants, there are important regional differences in Scandinavia, suggesting the existence of environmental factors related to cross-reactivity. In nearly one-third of cases, reaction to latex can be avoided by improved identification of the risk factors. Clinical diagnosis is sometimes made difficult because of the frequency of shock not accompanied by muco-cutaneous signs. Carrying out an immediate and a later examination in close collaboration with allergists and anesthetists is essential to establish the basis for recommendations for future anesthesias. [Copyright &y& Elsevier]

Abstract: Ten-to-twenty percent of hospitalised patients experience secondary drug reactions, and a third of these reactions may be allergic in nature. Multiple immune mechanisms may be at the base of these reactions. Antibiotics (especially β-lactams) are the principle type of drugs concerned, and they most often induce IgE-mediated allergic reactions. Information on the risk factors for drug allergies is limited, and few studies on genetic polymorphisms have been reported, except those involving certain enzymes that participate in drug metabolism or those concerning certain HLA haplotypes. Data coming from immunogenetic investigations should result in new diagnostic tools and, certainly, in better prediction of these events. Nevertheless, the results of such studies will vary depending on the population involved. Identification of genetic markers that are sufficiently predictive in clinical practice is going to require screening of hundreds of single nucleotide polymorphisms in the genome to be able to identify the subpopulation of patients that are at risk for each class of drugs. [Copyright &y& Elsevier]

Abstract: Asthma and allergic diseases are conditions with variable clinical presentations that run in families. The positional cloning of five new susceptibility genes (ADAM33, PHF11, DPP10, GPRA, and TIM1) and the (sometimes inconsistent) association of increased susceptibility to asthma with variants of more than 60 genes suggest that genetic heterogeneity underlies asthma. Many of these polymorphic genes are involved in innate immunity to microbial factors, the initiation of a polarized T-cell response to common allergens, the expression of the IgE Fc receptor, and the production of and response to pro-inflammatory mediators, or their expression is limited to the bronchial mucosa. Genetic inheritance of alleles of modest effect, epigenetic allele-specific gene expression, interactions among genes, and between genes and environmental triggers appear to drive the onset and severity of asthma. [Copyright &y& Elsevier]

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IgE is produced mainly by plasma cells in diffuse mucosal-associated lymphoid tissues. Its synthesis is the result of three sets of tightly-regulated processes: activation of antigen-specific B cells in lymph nodes, class-switch recombination to IgE and survival of B&epsiv; memory cells and plasma cells. Triggered by specific T lymphocytes that have migrated to regional lymph nodes, the switch to IgE within follicular areas of these nodes is driven by the interaction of the CD40 receptor with its ligand on activated T cells, acting together with IL-4 and IL-13, whereas TGF-β specifically blocks C&epsiv; germline transcription to keep the rate of IgE synthesis far lower than that of other immunoglobulin classes. Disproportionate maturation of dendritic cells exposed to non-replicating environmental antigens, promoting the differentiation of specific T cells into effectors that produce type 2 cytokines instead of inducing regulatory T cells, is essential for the initiation and maintenance of IgE responses beyond the sensitization phase. Feedback regulation via IgE receptors (e.g., Fc&epsiv;RI) and inflammatory mediators compartmentalizes IgE synthesis in the mucosa by orchestrating the cooperation of dendritic cells, memory lymphocytes, and mast cells. [Copyright &y& Elsevier]

The genetic approach has allowed identification of chromosomal loci and candidate genes involved in predisposition to atopic dermatitis. Some are skin-specific, while others are common with other atopic disorders. However, results may be discordant because of genetic heterogeneity and uncertainties about the relative importance of environmental and genetic factors in phenotype expression. The relative risk for atopic dermatitis in relatives of affected patients may be defined, and a better understanding of the pathogeny of atopic dermatitis is expected. [Copyright &y& Elsevier]

Immediate reactions to radio contrast media are rather well documented, but their physiopathological mechanism (hypertonicity, direct histamine release from mast cells and basophils, complement activation, anaphylaxis), remains a debated question. The authors report two anaphylactic shocks (grade 3, classification of Ring and Messmer) during coronary angiography with ioxaglate. Anaphylaxis is suggested by clinical history: chronology of accidents, symptoms, strong positivity of intradermal tests for ioxaglate (diluted 1:10000 and 1:1000) and in one case, recurrence of the symptoms. It appears that an allergological control must be performed after a severe reaction with radio contrast media, in order to prevent the occurrence of further accidents. Premedication may only provide apparent safety: it did not prevent a severe reaction in one of the two cases. [Copyright &y& Elsevier]

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Copyright of Bio Tribune Magazine is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bio Tribune Magazine is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Les allergies aux médicaments concernent environ 7 % de la population et pourtant les mécanismes physiopathologiques sont encore mal connus. Ici sont résumés les principaux mécanismes de présentation de l’antigène au système immunitaire adaptatif. Drugs allergies affect more than 7 % of the population and yet the pathophysiological mechanisms are still poorly known. Herein, we summarize the main mechanisms of antigen presentation to the adaptive immune system. [ABSTRACT FROM AUTHOR]