Pru p 7 sensitization is a predominant cause of severe, cypress pollen-associated peach allergy.

BACKGROUND: Peach is a common elicitor of food allergic reactions. Peach-induced immediate reactions may occur as benign pollen-food syndromes, usually due to birch pollen-related PR-10 cross-reactivity in temperate climates, and as potentially severe primary food allergies, predominantly related to nsLTP Pru p 3 in Mediterranean regions. The newly described peach allergen Pru p 7 has gained recent attention as a potential peach allergy severity marker. Sensitization to Pru p 7 and its allergenic homologues of the gibberellin-regulated protein family occurs in areas with high Cupressaceae tree pollen exposure. OBJECTIVE: We sought to investigate the distribution, clinical characteristics and molecular associations of Pru p 7 sensitization among subjects with suspected peach allergy in different regions of France. METHODS: Subjects with suspected peach allergy (n = 316) were included. Diagnostic work-up was performed according to current guidelines, including open food challenge when required. IgE antibody measurements and competition experiments were performed using the ImmunoCAP assay platform. RESULTS: Sensitization to Pru p 7 was present in 171 (54%) of all subjects in the study and in 123 of 198 (62%) diagnosed as peach allergic, more than half of whom were sensitized to no other peach allergen. Frequency and magnitude of Pru p 7 sensitization were associated with the presence of peach allergy, the clinical severity of peach-induced allergic reactions and the level of cypress pollen exposure. Cypress pollen extract completely outcompeted IgE binding to Pru p 7. Pru p 7 was extremely potent in basophil activation tests. CONCLUSION AND CLINICAL RELEVANCE: A subtype of Cupressaceae pollinosis, characterized by Pru p 7 sensitization, can be an underlying cause of severe peach allergy.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Series of 49 French Pediatric Cases.

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal adverse reaction. It can be difficult to diagnose, even more so among children, because symptoms may mimic other commonly encountered pediatric conditions. OBJECTIVE: To describe clinical and laboratory features of DRESS syndrome in the pediatric population (age ≤18 years) and establish causative agents and treatment modalities. METHODS: This was a multicenter retrospective study of probable and definite DRESS cases (Registry of Sever Cutaneous Adverse Reaction score ≥ 4) in children hospitalized in 15 French university hospitals between 2000 and 2020. RESULTS: We included 49 cases. All children had fever and rash, 69.4% had lymphadenopathy, and 65.3% had facial edema. The most common organ affected was the liver (83.7%). Treatment consisted of topical corticosteroid in only 30.6% and systemic corticosteroid in 55.1%; 12.2% received intravenous immunoglobulin. Among probable and likely culprit drugs, 65% were antibiotics and 27.5% were antiepileptics, median time to DRESS symptom onset after initiation of 15 days (13 days with antibiotics and 21 days with antiepileptics). Twenty-seven children had allergy assessment for causative agents, 65.4% of whom had positive tests. CONCLUSIONS: Culprit drugs are frequently antibiotics and antiepileptic drugs, and onset is often less than 2 weeks after treatment starts, especially with antibiotics. Treatment with topical corticosteroids appears to be sufficient in the least severe cases. Treatment by systemic corticosteroid therapy remains the reference treatment in case of severe organ damage.

Aucun n'est recommandé et ne remplace la désobstruction rhino-pharyngée.

Use of inhaled treatments in acute viral bronchiolitis in infants. Inhaled therapies are widely used by practitioners for treating acute viral bronchiolitis. Therefore, their efficacy has a low level of proof that does not sustain their use. Even if they need to be better studied in atopic infants, beta-2 agonists have no effect, excepted side effects. Anticholinergic drugs are not recommended. Adrenaline, despite some positive effects, is not recommended too. Corticosteroids are not useful, both for treating the acute problem and for preventing a possible post-viral asthma. Ribavirine, an antiviral agent, is reserved to very precise indications. At last, hypertonic saline, which has given some hopes, nowadays cumulates negative studies, and is no longer recommended. At all, in 2016, any inhaled treatment is recommended for treating acute viral bronchiolitis in infants..

Place des traitements inhalés dans la bronchiolite aiguë du nourrisson. Les traitements inhalés sont largement proposés en pratique clinique en cas de bronchiolite aiguë du nourrisson. Cependant, les niveaux de preuve d'efficacité sont en défaveur de ces traitements. Même s'ils méritent d'être mieux étudiés chez l'enfant atopique, les bêta-2-agonistes ne semblent pas avoir d'autres effets que latéraux. Les anticholinergiques ne sont pas recommandés. L'adrénaline, même si quelques effets positifs sont notés, non plus. Les corticoïdes ne sont utiles ni en aigu ni en prévention d'un potentiel asthme viral. La ribavirine, agent antiviral, est réservée à des indications très ciblées. Le sérum salé hypertonique, après avoir été un espoir, accumule les études négatives et n'est pas non plus indiqué. Au total, en 2016, aucun traitement inhalé n'est recommandé dans la bronchiolite aiguë du nourrisson.