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.

[Prevention of allergic diseases]. / La prévention des maladies allergiques.

Within the purview of a formation day in Allergy for General Practitioners, this presentation on prevention recalls recent data obtained by the expedient of epidemiological studies, the aim of which was to aquaint the treating physicians with the growth in prevalence of the diseases of allergy and to alert them to the need of present advice on the elementary preventative measures for their patients at risk. These elementary measures are a healthy interior environment that is low in pneumoallergens, with especially a fight against passive tobacco smoking, and a differential and progressive introduction of solid foods to infants.

[Fernand Widal syndrome and sulfite intolerance. Therapeutic problems in general and ORL problems in particular]. / Syndrome de Fernand Widal et intolérance aux sulfites. Problèmes thérapeutiques en général et ORL en particulier.

Asthma from intolerance of sulphites has been the subject of clinical work by our team since 1984. In 1986, we advised that asthma from sulphite intolerance was more frequent in patients who presented with illness from aspirin or the Fernand Widal syndrome. So it has emerged that there are clear therapeutic problems since sulphites as preservatives are present in other forms in some anti-allergy drugs, anti-histamines used for ORL.