[Interest of lung scintigraphy for the follow-up of cystic fibrosis (CF) and other chronic obstructive pulmonary disease (COPD). Two case reports in children]. / Intérêt de la scintigraphie pulmonaire dans le suivi de la mucoviscidose et de la bronchite chronique obstructive chez l'enfant: à propos de 2 cas cliniques.

INTRODUCTION: Lung scintigraphy provides a regional, functional test of pulmonary ventilation and perfusion. It allows an early detection of pulmonary damage or dysfonction, in particular in cystic fibrosis (CF) and other chronic obstructive pulmonary disease (COPD) in childhood. CASE REPORTS: We report two cases in children suffering from CF and COPD (of undefined aetiology), who had a major localized ventilation disorder. They have been detected by lung scintigraphy before the development of clinical or radiological symptoms. An obstructive bronchial cast in the corresponding lobar bronchus was then revealed and withdrawn by bronchial fiberscopy. CONCLUSION: Lung scintigraphy allows early detection of local pulmonary abnormalities, sometimes undetectable with a chest X-ray or even with a chest tomodensitometry. It can reveal bronchial obstructive plugs, avoiding thus the development of bronchectasies thanks to a quick suitable treatment.

[Past and future of allergen immunotherapy]. / Immunothérapie spécifique: acquis et avenir.

Specific immunotherapy involves the administration of allergen extracts to achieve clinical tolerance of the allergens which cause symptoms in patients with allergic conditions. Immunotherapy has been shown to be effective in patients with mild forms of allergic diseases, specially in upper airway diseases. Recent studies suggest that specific immunotherapy may also modify the course of allergic disease, by reducing the risk of developing new allergic sensitizations, and also inhibiting the development of clinical asthma in children treated for allergic rhinitis. The traditional subcutaneous route is burdened with the risk of severe adverse events, therefore, local routes have been investigated and developed. The sublingual route is supported by numerous controlled trials showing its efficacy in rhinitis. The safety profile, assessed in clinical trials studies, is satisfactory. Several points still need to be elucidated, including mechanisms of action, optimal dosage, cost-effectiveness, and adherence. New approaches using mimic bacterial DNA vaccines alone or associated to modified allergen, which enhances immunogenicity in terms of eliciting a Th1-type response vaccines, are also undergoing serious consideration.