[How I explore... suspicion of insect venom allergy in children]. / Comment j'explore une suspicion d'allergie aux piqûres d'insecte chez l'enfant.

Suspicion of allergy to insect venoms following bites (mosquito, bee, wasp, …) is a frequent reason for consultation in pediatric allergology. Very often, these are local or locoregional reactions, which do not justify any other additional examinations. Biological analyses are performed when desensitization is recommended. Preventive measures should be explained to the patient and his/her parents. Symptomatic treatment with antihistamine, alcohol swabs and local corticosteroids is prescribed for local or locoregional reactions. If the child has a history of generalized anaphylactic reaction, an emergency kit containing an antihistamine and two auto-injectable epinephrine pens should be prescribed. Desensitization is indicated in case of a severe anaphylactic reaction.

La suspicion d'allergie aux piqûres d'insecte (moustique, abeille, guêpe, …) est un motif fréquent de consultation en allergologie pédiatrique. Très souvent, il s'agit de réactions locales ou locorégionales ne justifiant pas d'autres examens complémentaires. Les analyses biologiques sont réalisées lors d'une indication de désensibilisation. Des mesures de prévention doivent être expliquées au jeune patient et à ses parents. Un traitement symptomatique à base d'antihistaminiques, de compresses imbibées d'alcool et de corticoïdes locaux est prescrit lors de réactions locales ou locorégionales. Si l'enfant a présenté une réaction généralisée anaphylactique, une trousse d'urgence contenant un antihistaminique et deux stylos d'adrénaline auto-injectable est prescrite. Une désensibilisation est prescrite lors d'une réaction anaphylactique importante.

Evaluation of T-lymphocyte subtypes in the diagnosis of celiac disease.

The objectives of this study were to verify comparatively clinical age reported antecedents and the morphological aspect of the intestinal mucosa in patients sensitive to gluten, hospitalised at IOMC ("Alfred Russescu" Hospital) in the last 7 years. Celiac disease is an inflammation most frequently affecting the proximal small intestine, depending on the presence of gluten in the diet, whose pathogenesis seems to be immunological in nature. 107 cases were divided in three groups following clinical manifestations types at hospitalisation time: typical digestive, untypical digestive and extra digestive manifestations. Intestinal biopsies, made with Crosby probe, in children aged between 1.3 and 8 years (one single case was diagnosed as late as at the age of 15), regardless of gender. Then we analysed morphologically (HE usual and PAS histochemical staining) and immunohistochemically (lymphocytes B, T with possible subtypes). The lesions were counted at the first biopsy according to the Marsh score. The immunohistochemical tests have indicated the prevalence of T lymphocytes (UCHL1, CD3, CD4, CD8, gamma-delta) both in the luminal epithelium with various degrees of aggression in lamina propria and also spread in stroma. B-lymphocytes (L26) are distributed prevalently nodular in stroma. In conclusion, it is CD4 T cells that are present in particular in the control of the gluten immune response in patients with Marsh I and Marsh III lesions.