Pigeon tick bite: A neglected cause of idiopathic nocturnal anaphylaxis.

Anaphylaxis is a serious systemic allergic reaction with rapid onset and potentially life-threatening. We report in detail a case of severe nocturnal anaphylaxis due to pigeon tick bite showing the diagnostic value of the extract and the recombinant allergen in the diagnostic procedures (basophil activation test, IgE immunoblot, and experimental ImmunoCAP). Apart from the presented case, we describe that during the last 10 years, we have collected 28 cases of allergy to Argas reflexus from several European countries. We suspect that this allergy is underdiagnosed because of the lack of diagnostic reagents. Because of the growing number of pigeons in Middle and Southern Europe cities, some cases of idiopathic anaphylaxis could potentially be caused by A. reflexus in those countries. The identification of pigeon ticks as a trigger of anaphylaxis would greatly improve medical care and advice for these patients as the parasite can be exterminated by eradication measures to avoid further incidents.

The prevalence of sensitization to lupin flour in France and Belgium: a prospective study in 5,366 patients, by the Allergy Vigilance Network.

OBJECTIVES: To determine the prevalence of sensitization to lupin flour in patients consulting allergists, in order to evaluate the risk of primary and secondary allergies to lupin. METHODS: A prospective study carried out by members of the Allergy Vigilance Network, using prick-tests with a commercial lupin flour extract in patients with various allergic symptoms. The study design classified patients into four groups: peanut allergy, current atopic disease, latent atopy, no atopy. Data were collected and analysed by Network coordinators. RESULTS: Over a two-month period, 88 French and Belgian allergists tested 5,366 patients: 2,680 children and 2,686 adults aged over 16 years. Of the 2,680 children, 11.15% presented with peanut allergy. The frequency of cross-reactivity with lupin was 17.1% for patients with peanut allergy, 2.5% for children with current atopic disease and 1.7% for healthy children with latent atopy. In the 2,686 adults, peanut allergy was diagnosed in 1.86% of patients with cross-reactivity to lupin in 14.6%. Sensitization to lupin was detected in 3.7% of patients with current atopic disease and in 1.8% of those with latent atopy. CONCLUSION: The relative frequency of latent sensitisation to lupin in patients of all ages presenting with atopic disease is a new factor indicating the likelihood of an increase in primary food allergies to lupin flour. This justifies the recent decision requiring mandatory labelling of lupin, and shows the need to inform consumers who may be unaware that this ingredient is being used increasingly. Sensitization to lupin should be searched by prick-tests in any case of peanut allergy. Prick-test to lupin may be valuable whenever a food allergy is suspected when no current food allergens have been identified.

A randomized study comparing a high and a standard dose of cisplatin in combination with etoposide in the treatment of advanced non-small-cell lung carcinoma.

We conducted a randomized trial comparing a high (120 mg/m2 day 1) v a standard (60 mg/m2 day 1) dose of cisplatin in combination with etoposide (120 mg/m2 days 3, 5, and 7) in advanced non-small-cell lung carcinoma (NSCLC). Two hundred forty-one patients were evaluable for survival and 207 for response. We obtained a 25% objective response rate in the standard-dose arm and 29% in the high-dose arm; this difference was not statistically significant. There was no significant improvement in the overall survival or survival of responders with the high-dose regimen. However, toxicity (mainly myelosuppression) was significantly increased in the patients receiving the higher dose of cisplatin. An analysis of prognostic factors showed that disease progression, loss of body weight, performance status, and prior therapy were predictive parameters of survival.

Frequency of cystic fibrosis transmembrane conductance regulator gene mutations and 5T allele in patients with allergic bronchopulmonary aspergillosis.

STUDY OBJECTIVE: To assess the frequency of cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in patients with allergic bronchopulmonary aspergillosis (ABPA). DESIGN: Case-control study. All subjects in the study were screened for the presence of 13 mutations in the CFTR gene (R117H, 621 + 1G(-)>T, R334 W, Delta F508, Delta I507, 1717-1G(-)>A, G542X, R553X, G551D, R1162X, 3849 + 10kbC(-)>T, W1282X, and N1303K). Moreover, they were also screened for the presence of the 5T variant in intron 8. SETTING: University hospital and community-based hospital. PATIENTS: Twenty-one white patients with ABPA participated in the study. The presence of CFTR mutations was also investigated in 43 white subjects with allergic asthma who did not show sensitization to Aspergillus fumigatus and in 142 subjects seeking genetic counseling for diseases other than cystic fibrosis (CF). RESULTS: Six patients with ABPA were found to be heterozygous for one CFTR mutation, including Delta F508 (n = 2), G542X (n = 1), R1162X (n = 1), 1717-1G(-)>A (n = 1), and R117H (n = 1). The 5T allele was not detected in ABPA patients. None of the ABPA patients showed sweat chloride concentrations > 60 mEq/L. The frequency of CFTR mutation carriers was significantly higher in ABPA patients (6 of 21 patients; 28.5%) than in control asthmatic subjects (2 of 43 subjects; 4.6%; p = 0.01) and in subjects seeking genetic counseling (6 of 142 subjects; p < 0.001). CONCLUSION: These findings indicate that in patients without a clinical diagnosis of CF, CFTR gene mutations could be involved in the development of ABPA, in association with other genetic or environmental factors.

[Asthma to green coffee of environmental origin]. / Asthme au café vert d'origine environnementale.

A case of rhinitis and environmental asthma caused by unroasted coffee has been reported in an adolescent living in a building in which there is an installation for roasting coffee. The diagnosis, suggested by the case history, is confirmed by the presence of specific IgE, by the positive result of the skin test using unroasted coffee extract and also of a broncho-provocation test entailing the manipulation of dust from the coffee roasting room. An amelioration of the room and work conditions is recommended.

[Triton's malignant intrapulmonary tumor]. / Tumeur triton maligne intrapulmonaire.

The authors report a case of an intrapulmonary tumour which on histological analysis was found to be a malignant Triton tumour after surgical excision. The tumours proved to be of nervous tissue origin and was a rare variant of malignant tumours of the surrounding of peripheral nerves with rhabdomyoblastic heterologous differentiation which is rarely described in the lungs. The characteristics of the tumour as well as therapeutic approaches are discussed followed by a review of the literature. A particular aspect of the case presented was to realise that there was a right to left shunt and this is also discussed.

[Hyalinizing granuloma of the lung]. / Le granulome hyalinisant du poumon.

The authors report a case of a 44 year old patient with bilateral nodular lesions with a slow but progressive evolution and associated with a non-specific clinical picture. A thoracotomy enabled the diagnosis of a hyalinising granuloma of the lung to be made. Subsequently the appearance of a new lesion, and the risks of mediastinal extension suggested the use of corticotherapy and this rapidly led to a normalisation of the clinical and biological picture; as regards the radiology a partial regression of the nodular lesions was noted, and after 36 months of treatment there were no new lesions.

[Pulmonary alveolar proteinosis]. / Lipoprotéinose alvéolaire pulmonaire.

Pulmonary alveolar proteinosis (PAP) is a rare, diffuse infiltrative lung disease of unknown etiology characterized by accumulation of abnormal lung surfactant in the alveoli and distal airways. Although it was first described in 1958, few large scale studies have been published. The diagnosis is conventionally based on lung biopsy and the value of less invasive procedures such as bronchoalveolar lavage (BAL) remains controversial. A multi-center retrospective study was conducted in an attempt to update epidemiological, clinical and long term outcome and to assess the usefulness of chest CT scan and BAL in the management of a large homogeneous series of 41 patients. Inclusion criteria required a clinical picture compatible with PAP and either histological confirmation, or a BAL with a milky macroscopic appearance coupled with positive staining to PAS. Mean age was 48.8 years with a 4: 1 male predominance. The prevalence of smokers (80%) and occupational exposure to various inhaled dusts (39%) was high. The clinical, roentgenographic and functional features were in keeping with previous series. Worsening dyspnea was the most common symptom. Other common manifestations were dry cough, recurrent lung infections, weight loss, finger clubbing, crackles and cyanosis. LDH serum levels were increased in 51% of cases. Lung function tests usually showed a mild restrictive ventilatory defect with hypoxemia and reduced DLCO. Chest X ray revealed bilateral ground glass opacities with consolidation or air bronchogram involving peri-hilar or lower lobes. Chest CT scan, performed in 38 patients, revealed a similar pattern in most of them with diffuse intra-alveolar ground glass opacities (33/38) and interlobular thickening (35/38), resulting in a crazy paving appearance in the typical geographic pattern (32/38). This latter aspect was highly suggestive of the diagnosis. Segmental BAL led to a definitive diagnosis in 62% and lung biopsy was only required in 38% of cases. These data suggest that careful BAL analysis can be sufficient to provide a diagnosis without the need for a lung biopsy. During follow-up, spontaneous remission or improvement was reported in 26%. Segmental (n=3) or whole lung lavage (n=22) was required in 62.5% with a favorable course (complete remission 37%, improvement 34%, stable course 21%) in 92% of the cases. In this series the overall prognosis for PAP remained good, although unpredictable.

[Polychemotherapy of undifferentiated small cell bronchial cancer. Long-term results]. / Polychimiothérapie du cancer bronchique indifférencié à petites cellules. Résultats à long terme.

Long-term results of 2 studies combining etoposide and adriamycin with cisplatin (CAV) or cyclophosphamide (AVE) in small cell lung cancer indicate a 2-year survival rate of 22% and 18% respectively. The complete response rate 2 years after the onset of chemotherapy was 8% (8/98) : 11% (4/36) with CAV and 5% (4/62) with AVE. Among these 8 patients, 2 had a late relapse and one died of an unrelated cause. The actual long-term survival rate was 6% with CAV and 5% with AVE.

[Allergy and fishing activities]. / Allergie et activités halieutiques.

Diagnosis of allergy diseases is at first linked to a detailed history, in which professional activities as well as the environment take an important place. Fishing activity as well as aquarium-related activities may be the origin of a symptomatology which is, often IgE-mediated, respiratory and skin localised: the responsible agents are most often insects in their larval form, crustaceans and worms.

[Accelerated desensitization for hymenoptera venom allergy in 30 hours: efficacy and safety in 150 cases]. / Désensibilisation accélérée au venin d'hyménoptères en 30 heures: efficacité et sécurité sur 150 cas.

In this study, we performed 150 desensitizations in 139 Hymenoptera venom allergic patients (109 Yellow jacket allergic patients, 19 Honey bee allergic patients and 11 patients sensitized to both insects, who received a dual desensitization). We used a rush protocol, allowing injection of a total cumulated dose of 125,1 (Honey bee) to 175,1 (Yellow jacket) microgram of venom in 30 hours. Patients were hospitalized, with all emergency precautions for treating systemic reactions. The protocol was well tolerated in 147/150 cases; 3 patients had a benign systemic reaction. Patients received monthly maintenance doses of 100 micrograms venom. 39 patients experienced a field sting during immunotherapy; 2 of them (5%) had a benign systemic reaction. Thus, our rush desensitization protocol seems to be safe and effective.

[Clinical pathological consultation: lung mass]. / Seance anatomo-clinique: masse pulmonaire.

The anatomoclinical exercise consists in the discussion of the etiology of an isolated pulmonary nodule in an asymptomatic patient.

[Pulmonary edema secondary to the intravenous administration of iodized contrast. A clinical case with high-resolution tomodensitometry studies]. / Oedème pulmonaire secondaire à l'administration de contraste iodé. Un cas clinique avec analyse tomodensitométrique en haute résolution.

Contrast media related reactions are numerous and of variable gravity. We report a case of pulmonary edema related to the intravenous administration of contrast media. Cardiogenic and non cardiogenic pulmonary edema are pathophysiologic possibilities. High resolution CT findings associate patchy ground glass areas and smooth thickening of subpleural septa, both rapidly disappearing.

[Endobronchial lipoma: a potential CT diagnosis]. / Lipome endobronchique: diagnostic TDM possible.

Bronchial lipomas are rare and benign neoplasms. Computed tomography can provide a powerful adjunct to conventional modalities in determining the nature of an endobronchial lesion. The reflex vasoconstriction can also be nicely depicted.

[Pneumopathy caused by nitrofurantoin]. / Pneumopathie à la nitrofurantoïne.

Two cases of nitrofurantoin induced acute pneumopathy are reported. The characteristics of the pulmonary reactions to this drug are described, and currently accepted pathogenic mechanisms, and diagnostic and therapeutic means discussed.

[Diagnosis and staging using spiral computed tomography of an endobronchial carcinoid tumor]. / Diagnostic et staging par tomodensitometrie spiralée d'un carcinoïde endobronchique.

The authors emphasize the effectiveness of spiral CT in the diagnosis of typical endobronchial carcinoid. The tumor was found in a 25-year-old man referred for evaluation of steroid-resistant asthma. Successful diagnosis and complete local staging of the right intermediate bronchus tumor were obtained by two successive single apnea spiral acquisitions: a high resolution series (HRCT) with Multiplanar Reconstruction (MPR) and 3D virtual endoscopic views was completed by a dynamic angiographic series (angio-CT) with multiplanar Maximal Intensity Projections (MIP). The CT findings are compared with macroscopic anatomic views and major features of bronchial carcinoid are shortly addressed.

[Function studies of an atropine derivative--ipratropium bromide in an aerosol device--in patients with chronic obstructive bronchopneumopathies]. / Etude fonctionnelle d'un dérivé atropinique--le bromure d'ipratropium en aérosol-doseur--chez des patients atteints de bronchopneumopathie obstructive chronique.

Ipratropium exerted marked bronchodilating effects in 22 patients with chronic obstructive lung diseases. The tolerance of the drug was excellent. In long-term treatment the patients do not get accustomed to the drug.

[Azygos continuation of the inferior vena cava: apropos of 3 cases]. / Continuation azygos de la veine cave inférieure: A propos de 3 cas.

The authors report 3 cases of azygos continuation of the inferior vena cava. This congenital malformation is due to the atresia of inferior vena cava in the retrohepatic segment. The abnormalities encountered on the chest film are described. The interest of TDM, ultrasound and cavography is discussed.