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The fifth Jack Pepys Workshop on Asthma in the Workplace focused on the similarities and differences of work-related asthma (WRA) and non-work-related asthma (non-WRA). WRA includes occupational asthma (OA) and work-exacerbated asthma (WEA). There are few biological differences in the mechanisms of sensitization to environmental and occupational allergens. Non-WRA and OA, when due to high-molecular-weight agents, are both IgE mediated; it is uncertain whether OA due to low-molecular-weight agents is also IgE mediated. Risk factors for OA include female sex, a history of upper airway symptoms, and a history of bronchial hyperresponsiveness. Atopy is a risk factor for OA due to high-molecular-weight agents, and exposure to cleaning agents is a risk factor for both OA and non-WRA. WEA is important among workers with preexisting asthma and may overlap with irritant-induced asthma, a type of OA. Induced sputum cytology can confirm airway inflammation, but specific inhalation challenge is the reference standard diagnostic test. Inhalation challenges are relatively safe, with the most severe reactions occurring with low-molecular-weight agents. Indirect health care costs account for about 50% of total asthma costs. Workers with poor asthma control (WRA or non-WRA) are less likely to be employed. Income loss is a major contributor to the indirect costs of WRA. Overall, asthma outcomes probably are worse for adult-onset than for childhood-onset asthma but better for OA than adult-onset non-WRA. Important aspects of management of OA are rapid and proper confirmation of the diagnosis and reduction of exposure to sensitizers or irritants at work and home.

À ce jour, aucune étude clinique n'a mis en évidence l'efficacité des masques médicaux dans l'asthme induit par le pollen de bouleau. Suite à la généralisation de l'utilisation des masques dans le monde afin de limiter la propagation du SARS-CoV-2, il a été choisi de démontrer l'efficacité des masques chirurgicaux chez des patients allergiques au pollen de bouleau, en suivant les mêmes principes que les études cliniques avec médicaments. 24 patients asthmatiques au pollen de bouleau ont été exposés à 60 ng/m3 de Bet v 1 dans la chambre d'exposition environnementale ALYATEC. Tous les patients avaient des tests cutanés et des taux d'IgE spécifiques au pollen de bouleau positifs lors de la visite de sélection. Les patients présentant une réponse asthmatique pendant l'exposition baseline de 1 h ont été randomisés en 2 groupes : avec et sans masque chirurgical KOLMI® (OP-Air), pour une exposition de 6 h aux allergènes de pollen de bouleau. Le temps médian d'apparition d'une réponse bronchique immédiate dans le groupe sans masque était de 37 minutes, et de 67 min dans le groupe avec masque (p = 0,219). À 1 h d'exposition, le nombre de patients dans le groupe avec masque encore présents dans la chambre d'exposition environnementale était deux fois plus important que dans le groupe sans masque. Cette étude pilote a montré une tendance des masques à retarder le temps d'apparition des symptômes allergiques. Currently, there is no clinical evidence that face masks are efficient in birch pollen-induced asthma. As the use of face masks has become widespread worldwide to limit the spread of SARS-CoV-2, it was chosen to demonstrate the clinical efficacy of medical masks in patients allergic to birch in the same way that clinical trial with drugs. 24 birch-related asthmatic patients, were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC environmental exposure chamber. All patients had positive skin prick tests and specific IgE to birch at screening visit. Patients with asthma response during 1-hour baseline exposure were randomized into 2 groups: with and without a KOLMI® surgical face mask (OP-Air), for a 6-hour exposure to birch allergen. The median time to obtain an early asthma response in the group without mask was 37 minutes, and 67 min in the group with mask (P = 0.219). At 1 hour-exposure, patients with masks still present in the environmental exposure chamber was twice as much as the group without masks. This pilot study showed a tendency of face masks to increase the time to develop allergic symptoms. [ABSTRACT FROM AUTHOR]

The dominant allergen in cat dander, Felis domesticus allergen 1 (Fel d 1), is a persistent trigger for allergic rhinitis and asthma symptoms. We evaluated the efficacy of Fel d 1 monoclonal antibodies (REGN1908/1909) in preventing cat allergen–induced early asthmatic responses (EARs) in cat-allergic patients with mild asthma. Patients were randomized to single-dose REGN1908/1909 600 mg (n = 29) or placebo (n = 27). The FEV 1 was measured for up to 4 hours in a cat allergen environmental exposure unit up to 85 days after dosing. Assessments included between-group differences in change from baseline in FEV 1 area under the curve (AUC; 0-2 hours) and incidence of EAR (FEV 1 reduction ≥20%). Trial registration: NCT03838731. Single-dose REGN1908/1909 significantly prevented reductions in FEV 1 on days 8, 29, 57, and 85. Most REGN1908/1909 patients did not have an EAR by 4 hours (the last time point tested). In contrast, placebo-treated patients experienced a ≥20% mean FEV 1 reduction on days 8, 29, 57, and 85 after dosing, with most experiencing an EAR within 1 hour. REGN1908/1909-treated patients tolerated 3-fold higher allergen quantities (P <.05 at all time points) versus placebo. REGN1908/1909 substantially reduced skin test reactivity to cat allergen versus placebo at all time points tested (nominal P <.001). REGN1908/1909 was generally well tolerated; no serious adverse events or deaths were reported. Single-dose REGN1908/1909 significantly prevented reductions in FEV 1 in cat-allergic patients with mild asthma on cat allergen environmental exposure unit exposure at 8 days and up to 85 days after dose. [ABSTRACT FROM AUTHOR]

If allergen immunotherapy (AIT) is to be considered as a treatment option for allergic asthma, it must undergo the same developmental steps as other antiasthmatic drugs. The bronchial allergen challenge model has demonstrated excellent negative predictive value for the development of new therapies for asthma. Subcutaneous immunotherapy appears to have a clinical and significant effect on the early asthmatic response to mite, cat, and birch and grass pollens in children and adults. Use of AIT in children with asthma is widely practiced but not supported by as strong a level of evidence as in adults. House dust mite sublingual immunotherapy tablets demonstrate efficacy in asthma exacerbations and other outcomes when used as add-on therapy in adult patients. Using a biologic to improve the patient's lung functions and asthma control before initiating AIT can transform unsuitable candidates for AIT into appropriate candidates. Because AIT is a form of personalized medicine, phenotyping the most suitable patient is necessary. Field studies of adults and children have suggested that polysensitized patients with rhinitis and Global Initiative for Asthma class 2 to class 4 asthma appear the most likely to be good responders. We hypothesized that AIT responders are those who demonstrate a high eosinophilic response to natural or experimental exposure. [ABSTRACT FROM AUTHOR]

Une nouvelle entité clinique présente chez certains patients atteints d'œsophagite à éosinophiles a été décrite récemment : « Food-induced Immediate Response of the Esophagus syndrome » (FIRE syndrome). Nous rapportons l'observation d'un patient chez qui le diagnostic de syndrome oral, puis de crise aiguë d'asthme a été posé initialement, alors qu'il s'agissait d'un FIRE syndrome faisant retarder le diagnostic d'œsophagite à éosinophiles. Nous détaillons les caractéristiques de ce nouveau syndrome. A new clinical entity, named Food-induced Immediate Response of the Esophagus syndrome (FIRE syndrome), has been recently described in a subgroup of patients suffering from eosinophilic oesophagitis. We report the observation of a patient in whom the diagnosis of oral syndrome and then asthma attack were initially made when it was a FIRE syndrome delaying the diagnosis of eosinophilic esophagitis. We detail the characteristics of this new syndrome. [ABSTRACT FROM AUTHOR]

Les allergies touchent 25 % de la population générale avec une augmentation des allergies sévères. Le développement en France de structures de soins transversales en allergologie pour une prise en charge pluridisciplinaire des patients répond à un besoin de santé publique. Notre travail a pour but de faire un état des lieux de ces structures. Enquête descriptive par questionnaire envoyé aux chefs de services de structures de soins soit avec une activité principale en allergologie, soit avec une activité variée en allergologie. L'enquête portait sur l'organisation administrative, les équipes médicales et paramédicales, l'offre de soins et les moyens techniques des structures. Trente-sept structures ont pu être analysées dont 27 avec une activité principale en allergologie et 10 avec une activité variée en allergologie. Pour les premières, le nombre de médecins varie de 1 à 16 et les équivalents temps pleins infirmier de 0,8 à 5,9. Les nombres d'hospitalisations de jour et de consultations annuelles sont respectivement de 1049 (220 à 3275) et 3561 (609 à 13 674). Un tiers du recrutement des patients est hors département. Toutes les structures avec une activité principale en allergologie réalisent des explorations sur les allergies alimentaires, médicamenteuses et aux pneumallergènes mais seulement 81 % et 74 % assurent respectivement la prise en charge des allergies aux hyménoptères et des eczémas de contact. Cette étude constitue un premier état des lieux des structures hospitalières transversales en allergologie en France afin de permettre de guider le développement d'Unités transversales d'allergologie. Allergies affect 25% of the general population with an increase in severe allergies. The development in France of cross-disciplinary allergology care structures for multidisciplinary management of patients meets a public health need. The aim of our work is to provide an overview of these structures. Descriptive survey by questionnaire sent to the heads of health care facilities either with a main activity in allergology or with a varied activity in allergology. The survey covered the administrative organisation, the medical and paramedical teams, the care offer and the technical means of the facilities. Thirty-seven facilities were analysed, 27 of which had a main activity in allergology and 10 with a varied activity in allergology. For the former, the number of doctors varies from 1 to 16 and the full-time equivalent nurses from 0.8 to 5.9. The numbers of day hospitalisations and annual consultations are respectively 1049 (220 to 3275) and 3561 (609 to 13,674). One third of patient recruitment is outside the department. All the structures with a main activity in allergology carry out investigations on food, drug and pneumallergen allergies but only 81% and 74% respectively provide care for allergies to hymenoptera and contact eczema. This study constitutes a first inventory of cross-disciplinary hospital structures in allergology in France in order to guide the development of cross-disciplinary allergy units. [ABSTRACT FROM AUTHOR]

À la suite de la reconnaissance de l'allergologie comme spécialité, la FFAL a travaillé avec le ministère des Solidarités et de la Santé dans le but d'élaborer une cartographie de l'offre de soins en allergologie en France. Un questionnaire électronique a été diffusé par le biais des newsletters des différentes instances de l'allergologie française. Les résultats de ce questionnaire sont présentés et analysés dans cet article. Following the recognition of allergy as a full specialty, the FFAL worked with the Ministry of Solidarity and Health in order to draw up a map of the supply of allergy care in France. An electronic questionnaire was disseminated through newsletters from the various authority of French allergology. The results of this questionnaire are presented and analyzed in this article. [ABSTRACT FROM AUTHOR]

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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.)

Bien que l'évaluation de l'inflammation bronchique, par expectoration induite, permette d'identifier différents phénotypes, chez les patients asthmatiques, il n'y a que peu d'informations sur le déterminant du pattern d'inflammation bronchique chez les patients présentant un asthme professionnel par sensibilisation. Déterminer si le pattern d'inflammation bronchique, déterminé par expectoration induite, permet de définir des phénotypes cliniques distincts. Cette étude multicentrique rétrospective a été réalisée auprès de 372 patients, présentant un asthme professionnel diagnostiqué par test d'exposition spécifique, qui étaient recrutés par le biais de la cohorte du groupe European network for Phenotypique of Ocupational Asthma. Chaque patient a bénéficié d'une expectoration induite avant et après test d'exposition spécifique. L'éosinophilie bronchique était définie par un pourcentage d'éosinophiles supérieur ou égal à 3 % dans l'expectoration induite, après test d'exposition spécifique, alors que la neutrophilie bronchique était définie par un pourcentage de neutrophiles supérieur ou égal à 76 %. Au total, 268 (72 %) et 42 patients (11 %) présentaient respectivement une éosinophilie et une neutrophilie bronchique. Les analyses de régression logistique ont mis en évidence une association entre l'éosinophilie bronchique et l'exposition aux agents de haut poids moléculaire (odds ratio [OR], 1,89 ; IC 95 % 1,18–3,04), l'asthme persistant modéré (OR, 3,17 ; IC 95 %, 1,43–7,0) et l'asthme persistant sévère (OR, 2,39 ; IC 95 %, 1,06–5,43). La neutrophilie bronchique était associée à l'âge (OR pour chaque année supplémentaire, 1,04 ; IC 95 % 1,01–1,08), au genre masculin (OR, 2,83 : IC 95 %, 1,14–6,87), à l'asthme persistant léger (OR, 3,26 ; IC 95 %, 1,24–8,88), et à la dysphonie (OR, 2,83 ; IC95 %, 1,14–6,87). La majorité des patients avec un asthme professionnel par sensibilisation présentait une éosinophilie bronchique post-test d'exposition spécifique. L'éosinophilie et la neutrophilie, dans les expectorations induites, permettaient de définir des phénotypes cliniques différents, notamment en termes de sévérité et selon l'agent causal. Although the non-invasive assessment of airway inflammation through the induced sputum (IS) technique identified distinct asthma phenotypes, there is few information on the determinants of airway inflammatory pattern in sensitizer-induced occupational asthma (OA). To investigate whether the pattern of airway inflammation in IS is associated with distinct clinical phenotypes of OA. This retrospective multicentric study was conducted among 372 patients with OA confirmed by a positive specific inhalation challenge (SIC) who were recruited in the European network for the Phenotyping of OCupational Asthma cohort (2006–2018). Each patient underwent an analysis of IS before and 24 hours after the SIC. Sputum eosinophilia and neutrophilia were defined by the presence of ≥ 3% eosinophils and ≥ 76% neutrophils in sputum samples collected after the SIC. In total, 268 (72%) and 42 patients (11%) exhibited sputum eosinophilia and neutrophilia, respectively. Multivariate logistic regression analysis revealed that eosinophilia was associated with exposure to a high molecular weight agent (odds ratio [OR], 1.89; 95% CI, 1.18–3.04), moderate asthma (OR, 3.17; 95% CI, 1,43–7.0) and severe asthma (OR, 2.39; 95% CI, 1.06–5.43). Sputum neutrophilia was associated with age (OR for each additional year, 1.04; 95% CI, 1.01–1.08), male gender (OR, 2.74; 95% CI, 1,21–6.8), mild asthma (OR, 3.26; 95% CI, 1.24–8.88), and dysphonia (OR, 2.83; 95% CI, 1.14–6.87). Sputum eosinophilia post-SIC was predominant in OA patients. Sputum eosinophilia and neutrophilia were associated with distinct clinical phenotypes of OA, especially in terms of causal agents and asthma severity. [ABSTRACT FROM AUTHOR]

We report a case of an exceptional syndromic association of apparently congenital rhinobronchial dystrophy associated with congenital anosmia and common variable immunodeficiency in a twelve-year-old girl. This young girl, born in 2000, consulted for the first time in 2012 for recurrent respiratory tract infections, refractory to all forms of treatment, starting in early childhood, associated with congenital anosmia and severe atrophic rhinitis as well as common variable immunodeficiency. The laboratory work-up essentially revealed IgG4 deficiency and imaging demonstrated bronchiectasis (lingula), multiple tracheobronchial diverticula, atrophic rhinitis and congenital anosmia with agenesis of the olfactory bulbs and sulci. After eliminating a number of differential diagnoses, we were left with the problem of the aetiology, the possible links between these various symptoms and the genetic basis for this apparently congenital complex rhinobronchial disease associated with common variable immunodeficiency. Do these various symptoms correspond to a chance association or an exceptional congenital syndrome that has not yet been identified in the literature? A review of the clinical and genetic literature did not enable us to propose a single diagnosis for these symptoms or this complex syndrome. [ABSTRACT FROM AUTHOR]