[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.

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.

[Delayed hypersensitivity to heparins and heparinoids]. / Hypersensibilité retardée aux héparines et heparinoïdes.

Delayed hypersensitivity to heparins and heparinoïd is a problem for prophylaxis of thrombo embolic diseases. The hirudins did not seem to have any cross-reactivity with the two others groups of anticoagulants. We present two clinical cases of delayed type reactions to heparins and heparinoïd and we reviewed the literature about adverse reactions to low molecular weight heparins and the alternative possibilities.

[Fatal anaphylaxis after eating wild boar meat in a patient with pork-cat syndrome]. / Anaphylaxie mortelle après ingestion de sanglier chez un patient porteur du syndrome porc-chat.

Crossed allergy between pork and cat epithelia was described by us in 1994. It is due to serum albumin. Nowadays, other bio-chemical observations allow "completion" of the syndrome by extension of the crossed reactivity between other mammal meats and other epithelia of dog and horse. The authors report an observation of the pork-cat syndrome (developing in the form of anaphylaxis, and then ending in the death of the patient), following consumption of wild boar meat. Co-factors, such as effort, taking alcohol or hormonal condition may complicate the picture to make diagnosis more difficult.

Allergic contact dermatitis from hydrangea--is it so rare?

8 cases of allergic contact dermatitis from hydrangea seen in Angers, France, during the last 15 years are reported and compared to other cases found in the literature. In this review, allergic contact dermatitis from hydrangeas appears to be an occupational dermatosis among nursery workers, presenting as an eczema involving the hands and especially the first 3 fingers, with chronic features of fissuring and scaling and with a chronic course. Differential diagnosis from irritant contact dermatitis may be difficult. Patch tests with the stem as well as the leaf of hydrangeas gave strong positive reactions in all patients, and hydrangenol, the allergen of hydrangea, when tested, always also gave a positive reaction. Sensitization seems to occur after close and prolonged contact with the plant, which could explain the relative frequency in Angers because it provides almost 90% of hydrangea seedling production in France.

[Prevention of allergic diseases]. / La prévention des maladies allergiques.

Within the purview of a formation day in Allergy for General Practitioners, this presentation on prevention recalls recent data obtained by the expedient of epidemiological studies, the aim of which was to aquaint the treating physicians with the growth in prevalence of the diseases of allergy and to alert them to the need of present advice on the elementary preventative measures for their patients at risk. These elementary measures are a healthy interior environment that is low in pneumoallergens, with especially a fight against passive tobacco smoking, and a differential and progressive introduction of solid foods to infants.

[Chronic urticaria caused by cow's milk allergy: immediate or delayed allergy? (apropos of a case)]. / Urticaire chronique par allergie au lait de vache: allergie immediate ou retardee? (a propos d'un cas).

Chronic urticaria has multiple etiologies, amongst them food allergy, which is not the most frequent. We report a clinical case of chronic urticaria due to cow milk, where paradoxically the responsibility of the food was shown by an epidermo test when the prick test was negative. Development confirmed the responsibility of cow milk. We discuss the mechanisms that relate chronic urticaria to delayed hypersensitivity.

[Environment and serum IgE]. / Environnement et IgE sériques.

Immunobiological diagnosis of allergy by measurement of total and specific IgE (by the technique of the CAP System on UNICAP) remains very valuable, especially if it is possible to repeat the measurements to follow the development of the patient. Concerning an observation of one patient who presented a rhinotracheitis that developed over 10 years and was linked clinically to guinea pig hair, the measurement of total and specific IgE confirmed the diagnosis and favourable clinical development was corroborated by the significant parallel diminution of total and specific IgE.

[Skin tests for general anesthetics]. / Tests cutanés aux anesthésiques généraux.

During a meeting between anaesthetists and allergists, skin tests were presented to show their value and the difficulties to which they give rise when they are weak. General principles, techniques and readings are described first. As usual, it is sensitivity, specificity and negative predictive value that are at the centre of attention. Selected clinical cases are given as examples. The high prevalence of cases who show a latent sensitisation to curare indicates an increase in allergological tests to patients who present risk factors.

[Systemic contact dermatitis]. / Dermatoses de contact systémiques.

The field of systemic contact dermatitis is particularly interesting for an allergist. To think of an allergen with cross-reaction and monosensilization should be the first reflex when an enquiry into a skin problem involves an allergic symptom. The three examples quoted involve Peruvian balm as the sensitizing agent. The causal triggering medicines are all vegetal extracts.

[Clinical signs of food allergy]. / Signes cliniques dans l'allergie alimentaire.

To investigate the clinical signs of food allergy is to open new horizons for the understanding of worrying acute symptoms for the patients and too often only symptomatic treatment. It is also possible to take control in a more logical way of illnesses that are classified as chronic and so incurable. The clinical examination requires great attention and much listening. Urticaria, eczema, rhinitis, asthma, colitis are the most frequent symptoms. More rarely, there may be certain migraines or lipoid nephrosis in children.

[Clinical signs of food allergy]. / Signes cliniques dans l'allergie alimentaire.

To investigate the clinical signs of food allergy is to open new horizons for the understanding of worrying acute symptoms for the patients and too often only symptomatic treatment. It is also possible to take control in a more logical way of illnesses that are classified as chronic and so incurable. The clinical examination requires great attention and much listening. Urticaria, eczema, rhinitis, asthma, colitis are the most frequent symptoms. More rarely, there may be certain migranes or lipoid nephrosis in children.

[Does the pork/cat syndrome constitute a predisposition to heparin allergy?]. / Le syndrome porc/chat constitue-t-il une prédisposition à l'allergie à l'héparine?

Observations are reported of two heparin-allergic patients (in one case, urticaria and in the other urticaria and asthma). These two patients show a curious association of the pork/cat syndrome, previously described (1, 2), that is an association of sensitivity to cat epithelia and pork meat. Since the heparins used nowadays are of porcine origin, the question is raised of a possible causal link that may exist between these 2 allergies. It seems that the possibility of association of these two allergies is much more likely than chance encounter.

[Prevalence of latex allergy among personnel at a hospital]. / Prévalence de l'allergie au latex parmi le personnel d'un hôpital.

The aim of this study was to compile a register of all the employees of a University Hospital Centre who complained of dermatosis of the hands due to latex. Recruitment was made by their spontaneous presentation in the service of the Workers Doctor (Médecine de Travail). The prevalence of clinical signs of contact eczema or professional urticaria is 2.3% for all personnel. 2.7% for nurses, 4.4% for care assistants or ancillary staff of the hospital service. In this population, 73% of subjects have shown previous atopy. The positive predictive value of the allergy tests was 51.3%, 2.32% of ASH-ASI, 1.75% of AS, 1.47% of IDE were allergic to latex, about 1.06% of the total personnel. 80% had atopy and 36.66% had a crossed allergy (banana, kiwi, avocat, pollen). Prevalence was zero amongst the administrative officers, but not systematic enquiry was made in the professional category. The orthoergical dermatoses were more frequent amongst the ASH-ASI, though the positive predictive value of tests was less. The considerable exposure to a number of caustic substances, as well as absence of precautions such as rinsing and drying of hands may explain this. All employees with allergy to latex have been declared to have a professional illness a card that mentions this allergy has been given to them.

[Importance of epicutaneous tests in drug allergy]. / Intérêt des tests épicutanés dans l'allergie médicamenteuse.

Epicutaneous tests do not permit resolution of all the problems set by drug allergy, but they are an important asset. Their value is sure when the pathology does not correspond precisely with a Gell and Coombes hypersensitisation classification, and especially when there is an interaction between several mechanisms. This presentation of five cases shows the value of these tests.

A double-blind, placebo-controlled trial by the sublingual route of immunotherapy with a standardized grass pollen extract.

Fifty-eight patients with well-documented history of seasonal rhinoconjunctivitis caused by grass pollens were allocated randomly on a double-blind basis to receive either sublingual therapy with a solution of purified, standardized allergen preparation (Stallergènes) or a matched placebo for 17 weeks. The assessment of the effect of oral immunotherapy, done with drops of five-grass allergen extract, was on the clinical symptoms and on the medication score of the authorized rescue treatments. The actively treated patients had significantly (P < 0.05 to P < 0.01) fewer symptoms of rhinitis (sneezing and rhinorrhea) and of conjunctivitis (redness and tears) during the pollen season than the placebo group. Consumption of nasal solution of sodium cromoglycate and of betamethasone and dexchlorpheniramine was significantly less in the desensitized group (P < 0.01). Side-effects were negligible. This study concludes that perlingual immunotherapy with grass pollen extract in grass-pollen-sensitive seasonal hay fever and conjunctivitis patients is effective, easy to perform, inexpensive, and safe.

[The pork-cat syndrome or crossed allergy between pork meat and cat epithelia (1)]. / Le syndrome porc-chat ou l'allergie croisée entre viande de porc et épithélia de chat (1re partie).

This work is a study of the frequency of the association between sensitivity to pork meat and cat epithelia. Comparison with a reference population that was not sensitized to pork meat, shows that this association is highly significant. This suggests therefore the possibility of a crossed allergenicity. If there is a real crossed allergenicity between pork meat and cat epithelia, we suggest that this crossed allergenicity is without doubt much greater and concerns more the meats and epithelia of mammals.