[Omalizumab for the treatment of chronic urticaria: Real-life findings]. / Traitement de l'urticaire chronique par omalizumab : données en vie réelle.

OBJECTIVE: Assessment of the efficacy and safety of omalizumab in chronic urticaria refractory to conventional treatment (H1-antihistamines at high dosage and montelukast) in real-life practice. PATIENTS AND METHODS: A retrospective, descriptive, single-centre study was performed of the data for all patients presenting refractory chronic spontaneous urticaria or inducible urticaria and receiving omalizumab (300mg every four weeks) from November 2012 to June 2016. RESULTS: In all, 23 patients were included. Omalizumab led to complete or significant remission in 19 patients (83%) with chronic urticaria, with remission in 9 patients (47%) occurring within 72hours of the first injection. One patient had a partial response and 3 (13%) showed no response. Only 2 patients (9%) in complete remission stopped their treatment at 1 and 3 years. 52% of patients presented non-serious adverse events, which in one case resulted in treatment withdrawal. CONCLUSION: Omalizumab exhibited good real-life efficacy in a small series of chronic urticaria patients in France.

Five cases of contact dermatitis to a trendy pet.

Skin contact with animal hair may induce contact urticaria (syndrome) or protein contact dermatitis. We report here 5 cases of dermatitis due to contact with ferrets kept as pets. The nature of the skin lesions, i.e. eczematous dermatitis, as well as the history of our 5 cases point to protein contact dermatitis. Further studies are requested to confirm this hypothesis and to identify the mechanisms and allergens. Physicians must be aware of the possibility of contact dermatitis with ferrets, especially when the patient has no previous history of atopic dermatitis and presents dermatitis of the neck, arm and around mouth.

Head and neck atopic dermatitis and malassezia-furfur-specific IgE antibodies.

BACKGROUND: Atopic dermatitis of the head and neck (HNAD) has been recognized as a separate entity. Malassezia furfur, a lipophilic yeast, is considered to be a pathogenic allergen in this form of atopic dermatitis. OBJECTIVE: The purpose of this study was to determine the level of IgE anti-M.-furfur antibodies and their relation to the severity of the disease. METHODS: IgE anti-M.-furfur antibodies were assayed in 106 patients with HNAD. Controls included 25 patients with non-HNAD, 20 with nonatopic dermatitis and 16 with seborrheic dermatitis (including 4 with AIDS). RESULTS: There was a highly significant correlation between the level of anti-M.-furfur IgE and clinical severity. Furthermore, there was a significant but smaller correlation between total IgE and clinical severity. In patients with HNAD, total IgE was higher amongst men. CONCLUSION: IgE anti-M.-furfur antibodies are a good and specific marker for HNAD. IgE M. furfur levels are strongly correlated with the severity of the disease.

[Chronic urticaria, thyroiditis and autologous serum test]. / Urticaire chronique, thyroïdite auto-immune et test au sérum autologue.

INTRODUCTION: The autoimmune nature of certain forms of chronic urticaria remains debatable. Aim of the study. To find a correlation in terms of autoimmune pattern between chronic urticaria and thyroiditis using the autologous serum test and the search for anti-thyroid antibodies. PATIENTS AND METHODS: Study in a single center of 59 patients having consulted for urticaria that had progressed for more than six weeks and without precise etiology. An autologous serum test was conducted and anti-thyroid autoantibodies were searched for in the serum stored after the test. RESULTS: Out of 59 patients, 51 had an interpretable autologous serum test and 57 underwent research for anti-thyroid antibodies. Twelve patients out 57 (21 p.cent) exhibited one or more types of positive (n=10) or borderline (n=2) anti-thyroid antibodies, and eight out of 12 (66.6 p.cent) had a known thyroid disease before the onset of urticaria. The systematic blood test permitted the discovery of 4 cases of unknown anti-thyroid antibodies. The symptoms regressed in two of these patients without any specific treatment, one patient was treated with L thyroxin for hyperthyroidism without any improvement in the symptoms and one other patient had normal thyroid function. Among these 12 patients, 11 underwent autologous serum tests, but only 3 of them exhibited clearly positive results and one was doubtful. CONCLUSIONS: Within the limits of this study, we found a 21 p.cent rate of patients with chronic urticaria exhibiting one or more anti-thyroid antibodies. The positivity of the autologous serum test does not appear to be related with autoimmune thyroid disorders.

[Spontaneous ecchymosis disclosing acquired factor VIII inhibitor]. / Ecchymoses spontanées révélatrices d'un inhibiteur acquis du facteur VIII.

An 81-year old woman suddenly developed extensive ecchymosis. A factor VIII:c inhibitor was detected. She received porcine factor VIII, corticosteroids, intravenous immunoglobulins and cyclophosphamide. Normalization of factor VIII level was achieved in 1 month. The patient died, 3 months later, of congestive heart failure. Spontaneous development of factor VIII inhibitors is an extremely rare event which usually occurs in dramatic bleeding. Many associated diseases have been reported. Patients with serious bleeding should be given porcine factor VIII. Immunosuppressive therapy consists of corticosteroids, cyclophosphamide and intravenous immunoglobulins.

Primary neuroendocrine carcinoma of the skin. Clinicopathologic study of 18 cases.

The clinical and pathologic features of primary neuroendocrine carcinoma of the skin in 18 elderly patients are reported. The carcinomas arose in the dermis and subcutaneous tissues, particularly on the head and the upper extremities. One tumor occurred in an irradiated area. Using Gould's clinicopathologic classification, we have found four trabecular types, eleven intermediate cell types, and two small cell types. One tumor could not be classified. Other noteworthy pathologic features were association with invasive squamous cell carcinoma, lentiginous melanocytic hyperplasia, and presence of intratumoral melanocytes. Immunoreactivity for cytokeratins (56 kD), neurofilaments, neuron-specific enolase, and epithelial membrane antigen was observed. The paranuclear globular staining pattern of cytokeratins and neurofilaments was conspicuous. The ultrastructural features revealed paranuclear intermediate filament aggregates (fibrous bodies), neurosecretory granules, and cell junctions. In two metastatic tumors, high levels of catecholamines were found. The trabecular types were characterized by localized disease and a good prognosis. The patients with the small cell types died of distant metastases. Postoperative radiotherapy seemed to reduce the rate of local recurrences.