Angio-oedema induced by oestrogen contraceptives is mediated by bradykinin and is frequently associated with urticaria.

BACKGROUND: Hereditary C1-inhibitor (C1-Inh) deficiency is associated with 'bradykinin-mediated angio-oedema' (BK-AO) and is believed not to be associated with urticaria. Acquired AO has been related to oestrogen contraceptives. OBJECTIVE: To demonstrate that AO precipitated by oestrogens and characterized by nonfunctional C1-Inh is mediated by BK and to evaluate the occurrence of urticaria in these patients. METHODS: A retrospective evaluation of patients referred for AO related to oestrogen was undertaken. Circulating C1-Inh, high molecular weight kininogen (HK) and enzymes involved in the metabolism of bradykinin were investigated. RESULTS: Fifteen patients were included. HK cleavage concurrent to oestrogen intake was demonstrated in 10 patients with available plasma. Eight patients reported recurrent or chronic urticaria. Discontinuation of the contraceptive resulted in a return to native C1-Inh and HK in all cases studied and to normal kininogenase activity in all but one. The clinical manifestations completely disappeared in 6 patients and improved in 7 after the withdrawal of oestrogen. CONCLUSION: Patients display extensive cleavage of HK in the plasma, which supports that AO precipitated by oestrogen contraception is BK-mediated. Recurrent urticaria may have been underestimated in this context. The presence of recurrent urticaria should not systematically rule out the diagnosis of BK-AO when the history is suggestive.

Cutaneous manifestations in Hymenoptera and Diptera anaphylaxis: relationship with basal serum tryptase.

OBJECTIVES: To compare the clinical presentation of systemic anaphylaxis to Hymenoptera and Diptera with regard to basal serum tryptase (BT) and to evaluate mastocytosis in patients with elevated tryptase. PATIENTS AND METHODS: The medical records of 140 patients with a history of a systemic reaction to venom were retrospectively reviewed. Symptoms and severity of anaphylaxis and BT were recorded. Most patients with elevated tryptase were screened for mastocytosis: a dermatological examination with a skin biopsy was performed in 19 cases and a bone marrow biopsy in 14 cases. RESULTS: Tryptase was elevated in 23 patients. These patients reported fewer usual skin reactions (urticaria in 26.1% of cases with raised tryptase vs. 76.1% of cases with normal tryptase), more flushing (52.2% vs. 4.3%) and frequently did not present skin reaction (26.1% vs. 9.4%). They presented a more severe reaction (mean grade of severity: 3.48 vs. 2.69). Mastocytosis was diagnosed in seven patients with elevated tryptase: indolent systemic mastocytosis in six cases and cutaneous mastocytosis without systemic involvement in one case. In five cases, mastocytosis was previously undiagnosed. Lesions of cutaneous mastocytosis, diagnosed in five patients, consisted of urticaria pigmentosa in all cases and were often inconspicuous. CONCLUSION: These results demonstrate particular clinical features of the allergic reaction in patients with elevated BT and the higher frequency of mastocytosis in this population. In patients with a severe anaphylactic reaction without urticaria, but with flushing, tryptase should be assayed and an underlying mastocytosis should be considered.

[Allergy to iodinated contrast media]. / Allergie aux produits de contraste iodés.

Iodinated contrast media are responsible for immediate or delayed adverse reactions. Because of the wide use of these products, one must consider them as drugs. The delay and nature of the undesirable events must be carefully recorded because in some selected cases, a true allergic mechanism can be proved. Cutaneous skin tests identify the culprit drug and find safe alternative for the patient.

[Heat contact urticaria: apropos of a case]. / Urticaire de contact à la chaleur: à propos d'un cas.

Heat contact urticaria is a rare condition. We describe a case report and overview the literature about diagnosis and treatment of this pathology.

[Anti-allergy therapy in children]. / Les thérapeutiques anti-allergiques chez l'enfant.

The discovery of the physiopathological mechanisms of asthma and the diseases of allergy has allowed the development of many symptomatic therapeutical perspectives. We review below the mechanisms of actions, routes of administration, secondary effects, dosages and indications for different commercialised anti-allergy medications. A better understanding of the pharmacology of the different medications should produce optimisation of the treatment of the allergic child.

[Assay of IgE specific to dog epithelia by the Pharmacia CAP RAST technique: comparison of the two CAP RAST e2 and e5]. / Dosage des IgE spécifiques aux épithélia de chien par technique CAP Rast Pharmacia: comparaison des deux Cap Rast e2 et e5.

We present a comparative study of measurement of dog-epithelium-specific IgE by two Pharmacia CAP Rast techniques e2 and e5. For both measurements the technique is identical, but the allergen extracts are different: e2 = dachshund extract whilst e5 = a mixture of squames of german shepherd and poodle. We show that the e5-specific IgE seems to be more sensitive than the e2-specific IgE.

[Delayed hypersensitivity to heparins and heparinoids]. / Hypersensibilité retardée aux héparines et heparinoïdes.

Delayed hypersensitivity to heparins and heparinoïd is a problem for prophylaxis of thrombo embolic diseases. The hirudins did not seem to have any cross-reactivity with the two others groups of anticoagulants. We present two clinical cases of delayed type reactions to heparins and heparinoïd and we reviewed the literature about adverse reactions to low molecular weight heparins and the alternative possibilities.

[Anaphylactic shock due to patent blue: four case report and review of literature]. / Choc anaphylactique et bleu patente: à propos de quatre cas et revue de la littérature.

OBJECTIVES: Description of four cases of anaphylactic shock with blue dye injection (bleu patenté V Guerbet 2.5%) during sentinel node biopsy for breast cancer. PATIENTS AND METHODS: Women with breast carcinoma and combined approach with radioactive tracer and blue patent injection. RESULTS: Four cases were observed, which means an incidence of 0.57%. We report one case of grade II anaphylactic reaction and three cases of grade III requiring active reanimation and adrenaline perfusion. One patient developed a pulmonary embolism during the postoperative period, but no death was observed. DISCUSSION AND CONCLUSION: We find an incidence of 1.06% of allergy but only 0.25% of anaphylactic shock (grade III). These rare but serious cases must weigh up the benefits and risks of using blue dye. We suggest using blue dye injection only in case of radioisotope detection failure. Of course, this approach must be evaluated.