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.

[Cannabis and crossed allergy with food]. / Cannabis et allergie croisée alimentaire.

Cannabis use has increased over the last decade. At the same time, we see cannabis allergies appearing, ranging from simple rhinoconjunctivitis to anaphylactic-type reactions, some of which are severe since fatal cases have been described, but we also see allergic-induced food allergies cross-linked in the family of lipid transfer proteins (LTP). Indeed, cannabis contains an LTP called Can s 3. The LT are very widespread in the vegetable kingdom and are present in many vegetables and fruits. LTPs have a similar chemical structure and therefore cross-allergy is common. Thus, by becoming aware of the LTP of cannabis, it is possible to become allergic by a mechanism of cross-allergy to the other LTPs present in fruits and vegetables. This syndrome is referred to as cannabis-fruit-vegetable syndrome.

[Foetomaternal erythrocyte incompatibilities: from immunohaematologic surveillance of pregnant women to haemolytic disease of the newborn]. / Incompatibilités foetomaternelles érythrocytaires (IFME): de la surveillance immunohématologique des femmes enceintes à la maladie hémolytique du nouveau-né (MHNN).

Despite the generalization of prevention measures against foetomaternal alloimmunization with anti-D immunoprophylaxis since 1970s, retrospectively 30 years later, its complications (new-born child's severe haemolytic disease, foetal death by anemia or nuclear icterus by bilirubin encephalopathy) have not disappeared. At the same time, alloimmunizations against antigens other than D increase with no possible prevention. As part of the set up in France of regional files analysing and making an inventory of serious foetomaternal incompatibilities requiring in utero or neonatal transfusion, we felt the need to synthesize current data, biological profiles (early screening of erythrocytic alloimmunization and its follow up during pregnancy, father's immunohaematologic status, evaluation of in utero immune haemolysis and impact of new non invasive techniques of diagnosis-RH1 foetal genotypage from ADN foetal of RH1--mothers' maternal plasma), clinical and paraclinical data (evaluation of foetal haemolysis by echography, recording of foetal movements and foetal cardiac rhythm), therapeutic indicators (in utero foetal transfusions or exsanguinotransfusions, neo and postnatal transfusions or exsanguinotransfusions, induced premature labour, newborn's intensive continue phototherapy and Rhesus immunoprophylaxis) in order to enable medical and paramedical professionals to carry out the specific supervision of pregnancies with foetomaternal incompatibility, the in utero, neo- and postnatal treatment of child and the efficient therapeutic prevention of anti-D alloimmunization, in a cooperative way.

[The platelet/leukocyte ratio in red blood cell concentrates is an essential indicator of leukocyte removal filter efficiency which limits their use]. / Le rapport plaquettes/globules blancs dans les concentrés de globules rouges est un élément essentiel de l'efficacité des filtres à déleucocyter qui limite leur utilisation.

Performances of filter systems for leucocyte removal (Pall BPF4 and Sepacell RZ 200 B) have been studied following the preparation of red blood cell concentrates (RBCCs) obtained either by a soft-spin centrifugation at 2967xg (n = 438) or by a hard-spin centrifugation at 5275xg (n = 187). After deleucocytation, 43, i.e., 9.8% of RBCCs obtained following a soft-spin centrifugation contained a number of residual leucocytes higher than 1 x 10(6) leucocytes/RBCC which represents the legal upper limit in France, whereas RBCCs obtained following a hard-spin centrifugation always contained a number of residual leucocytes lower than this limit. Our results strongly suggest that the quality of deleucocytation depends on an adequate ratio of platelets to leucocytes, which favours the capture of leucocytes by filters. In fact, this ratio was higher in RBCCs obtained following a hard-spin centrifugation. Our results demonstrate that the use of these filters does not allow the removal of leucocytes complying with the legal limit of leucodepletion for all preparations of RBCCs.

[Conjunctivitis and contact allergy]. / Conjonctivite et allergie de contact.

Allergologic testing is more and more practiced in etiologic research in conjonctivitis, especially patch testing may improve diagnosis. It is possible to draw up a list of frequent allergens and enough, informations about exposure and use of these as mercurial compounds or ammoniums.

[Contact allergy to sulfites: contact allergens, sources of exposure, and clinical profile]. / Allergie de contact aux sulfites: allergènes de contact, sources d'exposition et profil clinique.

Contact allergy to sulphites has been discovered recently. This study considers the data necessary to make an accurate clinical profile that gives the possibility of such sensitization. Exposure sources are recalled to suggest avoidance by affected patients.

[Food allergens]. / Les allergènes alimentaires.

Perhaps more than any other kind of allergen, search for a food allergen seems to be difficult. There should be no bias about the usual allergens found in our food, that are a source of pathology that is less spectacular than shocks or giant urticaria that are provoked by easily recognised causes. Crossed allergies must be recognised in their overall features. This may give decisive aid in the etiological approach by facilitating understanding of the symptoms and the discovery of potential triggering allergens which are systematically sought.

[Allergy to diphenylmethane diisocyanate: apropos of a case]. / Allergie au diisocyanate de diphénylméthane: à propos d'une observation.

In this observation, an association is described between contact eczema and asthma, by sensitization with diaminophenylmethane and isocyanates, following a review of the chemistry of polyurethanes and their use.

[Food allergens]. / Les allergènes alimentaires.

Perhaps more than any other kind of allergen, search for a food allergen seems to be difficult. There should be no bias about the usual allergens found in our food, that are a source of pathology that is less spectacular than shocks or giant urticaria that are provoked by easily recognised causes. Crossed allergies must be recognised in their overall features. This may give decisive aid in the etiological approach by facilitating understanding of the symptoms and the discovery of potential triggering allergens which are systematically sought.

[Clinical diagnosis of asthma]. / Diagnostic clinique de l'asthme.

Paroxysmal wheezing dyspnea, asthma may evolve from a simple crisis to an asthmatic attack that repeats several crises daily with duration up to several weeks, in some months when the asthmatic illness becomes life-threatening. Chronology of asthma is related to bronchial inflammation without knowing how to avoid the development of complications. Childhood types and those of subjects of more than 65 years are well characterised by mechanisms of bronchial hyper-reactivity that are always found and are identical to the type found in young adults. There are "limited" types that need respiratory function tests for confirmation of asthma.

[Atopic dermatitis. Epidemiology]. / La dermatite atopique. Epidémiologie.

It was in 1923 that Coca and Cooke made a distinctive entity of a group of diseases of allergy, including asthma, and hay fever. They remarked that these affections were frequently associated and/or preceded by eczema localised to certain regions (flexor folds), sometimes generalised, perhaps appearing suddenly, from the third month in infants. In effect, the majority of constitutional eczema is in infants of 6 months, 75% of the cases are in one-year-old children. There is recovery in 5 years following the start of the affection in 90% of cases. Only 5% of cases persist to adulthood.

[Open trial on the tolerance to Rhinaaxia in allergic rhinitis]. / Essai ouvert sur la tolérance du Rhinaaxia dans la rhinite allergique.

Forty-four patients, most of them with strong symptoms, were included in this study of the tolerance and efficacy of Rhinaaxia in the treatment of allergic rhinitis. Thirty two patients had good or very good tolerance. Others reported nasal irritation and sneezes after the sprays and one left the study for this reason. The efficacy on nasal symptoms is also very clear. On the third day of treatment the decrease of the nasal trouble was already significant.

[Anti-histamines]. / Les anti-histaminiques.

The use of anti-histamines remains the therapy of choice for the ensemble of allergic pathologies with a reaginic mechanism. Knowledge of the metabolism of histamine gives an understanding of a number of allergic symptoms and also clarifies the mechanism of action of the anti-histamines. Many molecules are appearing on the market, each with a more precise action on the specific H1 receptors and also carrying other pharmacological specificities of better and better study. Observance of contra-indications, in particular cardio-vascular, allows their use without reserve, whilst knowing that there are always problems of specific tolerance, that are variable from one individual to another, specially on drowsiness. The importance of stopping anti-histamines must be remembered, every time that this is possible, before making an allergic diagnosis by skin tests.

[Anaphylaxis induced by exercise]. / L'anaphylaxie induite par l'exercice.

Exercise-induced anaphylaxis EIA is a syndrome most often initiated by food allergy. Objective or diagnostic proof of the condition is shown by a provocation test from ingestion of a food before or after exercise, according to clinical history, with assay of plasma histamine and spirometry or rhinamometry. The original part of this work is evidence of EIA linked to food allergy to wheat, with cross reactivity to grass pollens.

[Specific immunotherapy using Alpha-Fraction-Retard-D. pteronyssinus. Double-blind study in asthma]. / Immunothérapie spécifique par l'alpha-fraction-retard-D. ptéronyssinus. Etude en double aveugle dans l'asthme.

A multicenter, double blind clinical study on two homogeneous, treated and untreated groups, has allowed an objective appreciation of the results of specific immunotherapy using the alpha-fraction of D. pteronyssinus in asthma. A statistically significant difference was seen of the consumption of drugs in the treated group and in infants of less than 5 years (p = 0.047). Tolerance, evaluated as a function of local and secondary effects was excellent and comparable in the two groups.

[General considerations on desensitization by the sublingual route]. / Considérations générales à propos de la désensibilisation par voie sublinguale.

A favourable action by a new method of therapy and in particular desensitization by the sub-lingual route is sometimes difficult to confirm. To make a sensible study requires a maximum of prior knowledge and this is not easy to acquire. How to select the patients? What method of administration is possible? What should be the dose adopted? What might be the secondary effects? Desensitization by the sub-lingual route seems to us to be a technique for the future. Impressions and thoughts on the new method route for desensitization must lead to controlled studies, very objective, which will confirm or invalidate it.

[Allergy survey in genital contact dermatitis]. / Enquête allergologique dans les dermatoses de contact génitales.

Contact eczema is one of the most frequent dermatological affections, regardless of age and sex. In typical cases, the diagnosis is usually easy, but it may be less so where there are atypical factors, in particular locations and with complications or unusual etiological data. In fact, the first condition in making a diagnosis is to suspect that there is the possibility of contact allergy. As an example, it should be remembered that allergy to benzalkonium can be diagnosed after a mean time of 87 months of evolution. The present availability of standardised allergens for testing for contact allergens has greatly changed the diagnostic possibilities. The allergens that are most often the cause in the genital region are perfumes, chlorhexidine, hexamidine, benzylalkonium chloride and latex. Only recognition of the allergen and its removal are used and sufficient to obtain recovery.

[Refractory vaginal candidiasis]. / Les candidoses vaginales rebelles.

Genital candidiasis is a poorly-studied pathology, certainly because there is often a favourable result after treatment, at least in times past. If the diagnosis of acute vulvo-vaginitis is easy, it is not the same in relapse or second attack. The correct treatment of refractory vaginal candidiasis and/or second attacks needs a knowledge of their etiology, the mechanisms that encourage their appearance (and maintenance), the field where they occur. Recent data on the action of Candida on immunity may introduce new physiopathological perspectives and treatments.

[Survey of pathologies caused by sulfites in allergology]. / Enquête sur pathologies induites par les sulfites en allergologie.

Increased use of sulphites as a preservative for foods and drugs is partly the origin of increasing prevalence of allergy to this anti-oxidant. All organs that are concerned with allergic problems may be affected, especially skin and the digestive tract. We have noted a frequent association between the pathology to aspirin (ORL, bronchial, skin) and that of sulphites: 30.8%. The history is fundamental and compensates for the lack of effectiveness of skin tests.

[Management of suspected allergy to lidocaine]. / Conduite à tenir dans les suspicions d'allergie à la lidocaïne.

General Anaesthetics are potentially more dangerous than local anaesthetics. Among the achievement of 25 provocation tests, it always shows good tolerance of the local anaesthetic, included in patients who had presented serious disorders after a previous local anaesthesia. Consequently, the local anaesthetic wasn't the real cause. However, there is to say that in one case 45 minutes after challenge, hand oedema (occurred). Research of hypersensitivity, remains very necessary in every doubtful case.