[Immunology of the eye]. / Immunologie de l'oeil.

Due to its vascularisation and system of lymphatic drainage, the eye is privileged territory for development of immunological phenomena. The tears, because of lactoferrin, lysozymes, mucins, different immunoglobulins: IgA (CALT), IgG and IgM, are the first line of defence against physical, chemical, infectious and extra-ocular antigenic attack. ACAID, "Anterior Chamber Associated Immune Deviation", by its type of defence against intra-ocular aggressors, assures some protection of the eye and explains the development of some intra-ocular tumours and tolerance to corneal grafts.

[Complementary examinations in atopic dermatitis]. / Les examens complémentaires dans la dermatite atopique.

The complementary assessment of atopic eczema involved a biological assessment: one part in vitro (total IgE, specific IgE, T4/T8 immunoregulator index); one part in vivo (skin tests: skin reaction intradermal reaction, patch test).

[Physiopathology of food allergy]. / L'allergie alimentaire définition-physiopathologie.

Food allergy is defined by a mixture of digestive and or extra-digestive clinical symptoms, "rhinitis, asthma, eczema, etc" secondary to contact with a food and/or a preservative and/or addition to the immune system of the organism, with its origin in an excessive humoral and/or cellular response, called HYPERSENSITIVITY. For this to occur, food allergy needs conjunction of several parameters. Predisposing factors Genetics, with facility to produce IgE. Reduction of the defences of the digestive system. Usual foods

[Food allergy: definition--physiopathology]. / L'allergie alimentaire: définition--physiopathologie.

Food allergy is defined by a mixture of digestive and or extra-digestive clinical symptoms, "rhinitis, asthma, eczema, etc" secondary to contact with a food and/or a preservative and/or addition to the immune system of the organism, with its origin in an excessive humoral and/or cellular response, called HYPERSENSITIVITY. For this to occur, food allergy needs conjunction of several parameters. Predisposing factors Genetics, with facility to produce IgE. Reduction of the defences of the digestive system. Usual foods.

[Importance of realistic tests for drug allergy: apropos of a clinical case]. / Intérêt des tests réalistes en allergie médicamenteuse: à propos d'un cas clinique.

Drug allergy is the most difficult area in Allergology because: Clinical polymorphism and specially physiopathology (IgE-dependent hypersensibility reaction, cyclo-oxygenase inhibitor, etc.). Feeble specificity and sensitivity in the basic immunoallergic investigation (Skin tests, specific IgE). Very frequently his necessitates recourse to REALISTIC TESTS of drug re-introduction under clinical and biological surveillance (HSI mediators: histamine/tryptase/urinary methyl histamine) to produce a diagnosis.

[Cross allergies]. / L'allergie croisée.

The first descriptions of crossed allergenicity were concerned with the associations between Pollen/Food allergy: birch pollen/apple, grass pollen/wheat-tomato etc. Since then other crossed reactions have been described, involving pneumoallergens, tropallergens, drugs, hymenoptera venoms. Crossed reactions are the combination of an antigen with a recognition molecule other than that which stimulated its synthesis, because of epitope(s) that are common or sufficiently close between two antigens. The techniques of immunoprints and RAST inhibition give confirmation of crossed reactions that are suspected clinically.

[Gelatin allergy]. / Allergie aux gélatines.

Allergy to the gelatin used as a plasma filler product has not been recognised until now. Methods used have not been validated but are composed of specific serum IgE, skin tests and histamine release by leucotrienes. The clinical observation that we report has the merit of showing the reality of an allergy that is dependent on plasma filler products due to development of a protocol which includes firstly, during anaphylactic shock, measurement of the mediators of immediate hypersensitivity and secondly, after the clinical accident, test of the activation of basophils by flow cytometry (TAB) and measurement of leucotrienes.

[Corticosteroids]. / Les corticoïdes.

The corticosteroids or glucocorticoids have a preponderant place in the treatment of allergic manifestations. They are used to ward of the inflammatory process triggered and auto-maintained by some mediators (histamine, tryptase, leucotrienes, prostaglandin, ECP, MBP ...) that are released by some cells (mastocytes, basophils, eosinophils ...) during the contest of antigen--antigen receptor site. It is essential to understand the mechanism of action of the glucocorticoids as well as their secondary effects to adapt prescriptions better.

[Anaphylaxis caused by a mosquito: 2 case reports]. / Anaphylaxie au moustique: à propos de 2 cas cliniques.

Allergy to mosquitoes that produces anaphylaxis is very exceptional. We present two observations of anaphylaxis to mosquitoes with good correlation between the clinical history and the immunological indications of which the basophil activation test proved to be effective. The many allergens of mosquitoes are contained in the juices and salivary glands and their molecular weights are between 22 and 95 kD. Specific immunotherapy, which uses whole body extracts of mosquito, gives good results of protection that induces excellent tolerance and has very good efficacy.

[Non-allergic rhinitis or intrinsic rhinitis? Unusual features of nickel allergy]. / Rhinite non allergique ou rhinite intrinseque? Aspects inhabituels de l'allergie au nickel.

The clinical expression of nickel is known for its great diversity, from classical contact eczema to rhinitis, including work-related allergy, and by secondary hyperthermia to a metallic heart valve. Very often, hypersensitivity which may be of type I or type IV is secondary to contact of the hapten with sensitive cells, however some authors have reported the possibility of reactivation of lesions, especially dermatological (urticaria-eczema) by tests of oral ingestion. However, review of the literature does not mention the possibility of O.R.L. problems of the rhinitis type, from rhinosinusitis following ingestion of nickel and the two clinical cases that we report that involve one child of 11 years and one patient of 59 years, both of whom presented a serious rhinitis with a tendency to surperinfection, developing to perennial, where a patch-test to nickel was strongly positive, and who have seen an improvement in their clinical problems with a strict diet without this hapten. This confirms that the need is eventually physiopathological and suggests the necessity to search systematically for a possibility of hypersensitivity to haptens by the patch test technique in rhinitis that is labelled "non-allergic", by a negative reaginic history to pneumoallergens and trophallergens.

[Predictive value of the allergologic profile in anesthesia and resuscitation]. / Valeur prédictive du bilan allergologique en anesthésie-réanimation.

The allergic history to anaesthetics in general and especially to synthetic myorelaxants, poses few etiological diagnostic problems in practice, because of on one hand the excellent collaboration between Anesthetists and Allergologists in the CHU at Angers and on the other because of the great sensitivity of skin testing. Why then have a predictive history for myorelaxants? The results of a study at the CHU at Angers on 15 patients showed sensitivity to anaesthetics in general (myorelaxants 86%, Diprivan) and/or an antibiotic, latex were very encouraging. One 15 new general anaesthetics a single minor incident was seen: the 15 patients had benefited from a predictive history.

[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.

[Sublingual specific immunotherapy for rhinoconjunctivitis caused by grass pollens]. / Immunothérapie spécifique par voie sublinguale de la rhinoconjonctivite aux pollens de graminées.

Fifty eight patients with rhino-conjunctivitis caused by grass pollen were included in a double-blind study in which they received, by the sub-lingual route over 5 months, either a solution of purified and standardised allergen or a placebo. Assessment of the effect of this immunotherapy, which was done with drops of Stallergenes "5-grass pollen" was by clinical symptoms and the use of authorized drugs and treatments. Compared with the placebo group, the patients on active treatment showed significantly less (P = 0.05 to P = 0.01) rhinitis symptoms (sneezing and rhinorrhea) and conjunctivitis (reddening and tears) during the pollen season. Consumption of nasal cromoglycate solution, of betamethasone and dexchlorpheniramine was significantly lower (p = 0.01) in the desensitised group. Secondary effects were negligible. From this study, it can be concluded that immunotherapy with grass pollen extract, by the sub-lingual route, of patients with rhino-conjunctivitis who were sensitive to these allergens, is efficacious, easy to do, economic and sure.

[The wasp-mosquito syndrome: extension of cross-allergenicity to the horsefly]. / Le syndrome guêpe/moustique: extension de l'allergénicité croisée au taon.

The crossed allergenicity between wasp venom and mosquito extract was shown during recent work based on clinical observations and correlation studies between different biological parameters, indicating an IgE-dependent biological mechanism. A common protein was identified by Immunoblot. From observation of one of our patients involved in this work, we examined the possibility of the extension of crossed reactivity between wasp, mosquito and horsefly. In effect, our patient presented an anaphylactic reaction with neurological complications from attack on the central grey nucleus, shown by IRM; the immunological study showed a common protein between wasp venom and the total extracts of mosquito and horsefly.

[The wasp/mosquito syndrome]. / Le syndrome guêpe/moustique.

The authors describe for the first time the Wasp/Mosquito syndrome. The allergenic cross-reactivity between Vespula wasp venom and mosquito extract and the reverse rest objectively on several criteria. The frequency of the association between sensibilization to Vespula wasp venom and mosquito: In 10 subjects who had specific IgE to Vespula wasp venom 3 also had mosquito-specific IgE (30%), but out of 11 subjects with positive mosquito-specific IgE 10 also were positive with Vespula wasp venom specific IgE (about 91%). Three observations were documented showing a clinical and biological relationship between sensitisation to mosquito and wasp venom. A first patient had an anaphylactic reaction after a dozen mosquito bites. The allergy assessment confirmed sensitisation to the mosquitos, but also to Vespides (wasp, hornet) venoms. A second patient had an anaphylactic reaction after a wasp sting in 1997. From that date, he had local reactions, indeed loco-regional, to mosquito bites. The allergy assessment confirmed the double sensibilization to mosquito and wasp venom. Finally, a third patient at first had local reactions, also loco-regional, to mosquito bites, then two systemic reactions after mosquito bites. A first allergy assessment, made exclusively to hymenoptera venoms (not to mosquitos), showed a sensitivity to wasp venom and the patient, by mistake, was desensitised to wasp venom, which did not prevent recurrence after mosquito bites. After a second time, the allergy assessment for hymenoptera and mosquito, confirmed a double sensitisation (mosquito and Vespula wasp). Indirect criteria such as parallel increase in specific IgEs to Vespula wasp venom and mosquito in a patient who was desensitised only to mosquito and who had not been re-stung by wasps. Finally on direct criteria, such as: The inhibition technique by CAP RAST, which was positive in two ways: Vespula wasp--specific IgE was inhibited by mosquito extract, and vice versa. Electrophoresis, which showed a protein common to Vespula wasp venom and mosquito extract of M.W. of the order or 42KD and isoelectric point between 4.5 and 5. An immunoblot study identified this common protein with a M.W. of 44KD which is the same as hyaluronidase.

[Dynamic diagnosis of allergy by the sequential measurement of mediators: apropos of a case of food allergy]. / Du diagnostic dynamique de l'allergie par le dosage séquentiel des médiateurs: à propos d'une observation d'allergie alimentaire.

Objective improvement in the diagnosis of immuno-allergology can only be obtained by application of reliable and reproducible immuno-biological methods, but until now, only measurements of total and specific IgE can be used and this has certain limitations. Presence of specific serum IgE, correlated with skin tests, favours a sensitization and implies nothing about the responsibility of the allergens. This is why we must consider if a definite improvement of diagnostic methods can be obtained by measurement of mediators. From an observation of food allergy to pork meat, we now show that it is possible to use sequential measurements of the mediators plasma histamine and urinary methylhistamine, ECP and serum tryptase to refine the diagnosis and provide proof of the responsibility of the food allergen. We report here a didactic observation which is characterised by reproducibility and specificity of the measurements. It illustrates the progress in diagnostic methods in allergy: we give a statistical diagnosis by measurement of antibodies and a dynamic diagnosis by measurement of mediators.

[Immunological causes of male infertility]. / A propos des causes immunologiques de l'infertilité masculine.

Sperm (spermatozoa and the various secretions of the accessory glands) with its very complex antigenic system is only produced from puberty and thus at a time when the body has already had a for a long time the facility to respond to an antigenic stimulation with an immune reaction. Because of this, the spermatozoa, in contrast to other cells of the organism, are considered as strangers and may behave as auto-antigens. However, the existence of a haemato-testicular barrier, that prevents all contact between the sperm and the immune system must be recognized in man, its rupture has the consequence of formation of anti-spermatozoa antibodies. It is estimated that 5% of cases of sterility are of immunological origin and linked to the presence in man and/or woman of anti-sperm antibodies. The production is greater in man than in women because of the roles, in the first of macrophages and in the second of polynuclear neutrophils in the destruction of the spermatozoa. Anti spermatozoal antibodies play a part in sterility by: Spontaneous agglutination in ejaculation, thus preventing their progression in the female genital tract. Free spermatozoa, charged with antibody are retained at the level of the cervical secretion = SHAKING phenomenon. The anti-spermatozoal antibodies mask some antigens, so preventing penetration of the spermatozoa into the ovule. Contact of spermatozoa with antibody fixed to the uterine tissue is followed by secretion of histamine and this encourages the expulsion of an implanted egg. This is before the existence of: Spontaneous agglutination in ejaculation, Oligospermatosis, Indeterminate cause sterility, Immobilisation of the spermatozoa in the cervical secretion, Failure of repetition.

[Allergy to mosquitoes and use of new immunobiological parameters]. / A propos de l'allergie aux moustiques et de l'utilisation des nouveaux paramètres immuno-biologiques.

With regard to an observation of anaphylaxis after a mosquito bite, we have shown by new immunobiological parameters and clinical investigations: Skin tests, specific IgE, Tests of Activation of basophils by flow cytometry (on basophils and total blood) and measurement of Leucotriene LTC4, the objective reality of the mechanism of IgE-dependent hypersensitivity (HS). This observation is correlated with rare work in support of true IgE-mediated allergy to mosquito 9 authors having used skin tests, PK in 1984 and immunoblot.

[Postoperative allergic complications: the role of the anesthetist in conducting the immuno-allergic investigation]. / Complications allergiques péri-opératoires: rôle du médecin Anesthésiste-Réanimateur dans la conduite du bilan immuno-allergique.

When peri-anaesthesia anaphylactic and/or anaphylactoid reactions occur, anaesthetist is the first investigator: the quality of immuno-allergological investigations depends on these initial investigational procedures. We have used sample kits for several years in order to make easier the immediate investigation. From retrospective analysis of the allergic complications which happened in 1997, the importance of these sample kits as well as the anaesthetist's part in the immuno-allergological management are examined. Nine observations were itemized (0.047%): 3 generalized erythema observations (grade I), in which atracurium was incriminated twice, and propacetamol once; 2 observations of grade II, in which vecuronium (elevated tryptase) and atracurium were incriminated; 4 anaphylactic shocks, in which three neuromuscular blocking drugs (suxamethonium, vecuronium and pancuronium), and one antibiotic (cloxacilline) were incriminated. The use of sample kits allowed an early diagnosis approach, confirmed by skin tests. Diagnosis should be thought closely between anaesthetists and immunologists for investigations.

[Histamine liberation (or histamine release HR): study of the positivity threshold in hymenoptera venom allergy]. / Histamino-libération (ou histamine release HR): étude au seuil de positivité dans l'allergie aux venins d'hyménoptères.

Dialysis of Hymenoptera venoms for measurement of HR by the radioimmunoassay technique (RIA, Immunotech) lowers the threshold of positivity of the HR titre from 30% to 12%. This modification of dialysis of the venoms significantly improves the sensitivity and specificity of the technique.