Epidemiological Data on Anaphylaxis in French Emergency Departments.

BACKGROUND: Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis. METHODS: Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxisrelated codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis. RESULTS: Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine. CONCLUSION: Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions.

Occupational asthma caused by powder paint in the automotive industry

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Epidemiological data on anaphylaxis in French emergency departments

BACKGROUND: Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis. METHODS: Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxis-related codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis. RESULTS: Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine. CONCLUSION: Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions

ANTECEDENTES: La anafilaxia es un problema prioritario de salud pública en la comunidad mundial alergológica. Sin embargo, los datos epidemiológicos disponibles de morbilidad y mortalidad son mejorables. Presentamos el primer estudio epidemiológico multicéntrico, realizado en siete departamentos de urgencias franceses durante un año, que tuvo como objetivo identificar las cuestiones relevantes para lograr cambios en futuras estrategias, nacionales e internacionales, que deriven en un mejor diagnóstico, tratamiento y prevención de la anafilaxia. MÉTODOS: Se trata de un estudio descriptivo que utilizó la información proveniente de las bases de datos de siete instituciones francesas de salud pública, de la región de Lorena, desde enero hasta diciembre de 2015. Se buscaron nomenclatura y códigos relacionados con la anafilaxia, de la Clasificación Internacional de Enfermedades (CIE-10), y los pacientes fueron validados clínicamente como casos de anafilaxia. RESULTADOS: De los 202.079 ingresos en urgencias, 4.817 tenían códigos relacionados con la anafilaxia CIE-10, 323 de los cuales se validaron clínicamente con el diagnóstico de anafilaxia. Aunque el 45,8% presentó criterios de gravedad, la adrenalina se prescribió solo en el 32,4% de estos casos. En total, 323 casos, el 57,9%, se remitieron posteriormente para un estudio o evaluación alergológica (después o durante la hospitalización) y el 17,3% recibió una receta de adrenalina autoinyectable . CONCLUSIÓN: Según los resultados de este estudio, existe una necesidad urgente e imperiosa de mejorar los planes de salud pública respecto al reconocimiento y tratamiento de la anafilaxia. Los problemas clave detectados en este trabajo, señalan el camino de la toma de decisiones e implementación de acciones de mejora, nacionales e internacionales, para una mejor atención de los pacientes con anafilaxia

FeNO levels increase with degree of sensitisation in apprentices at risk of occupational asthma.

BACKGROUND: Atopy has emerged as a major determinant of airway inflammation. OBJECTIVE: To examine whether early markers of occupational asthma increase with degree of sensitisation. METHOD: This study was a prospective follow-up study of apprentices in baking, pastry-cooking and hairdressing during their 2-year apprenticeship. Four visits were conducted to administer a standardised questionnaire, a methacholine challenge test to assess bronchial hyperresponsiveness (BHR) and to measure fractional exhaled nitric oxide (FeNO). Degree of sensitisation was estimated based on the number of positive skin prick tests (SPTs) for 12 common allergens. Mixed-effect models were applied to examine the association between the degree of sensitisation and FeNO levels, BHR and eosinophilic status (more than 3% of cells in nasal lavage fluid). RESULTS: Of the 441 apprentices who agreed to take part in the study, 417 had at least one SPT session providing usable results. Degree of sensitization was related to BHR and FeNO levels. Compared to non-sensitised subjects, FeNO levels were 83% higher (P < 0.01) in highly sensitised subjects and 30% higher (P < 0.01) in weakly sensitised subjects. However, the degree of sensitisation was not predictive of the evolution of these markers. CONCLUSION: Degree of sensitisation is related to early markers of airway inflammation.

Occupational asthma to detergent protease associated with a late-phase neutrophilic cutaneous response

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First evidence of occupational asthma to argan powder in a cosmetic factory.

BACKGROUND: Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder. METHODS: Patients were investigated in the occupational disease department and, according to their symptoms, underwent pulmonary function testing, methacholine challenge, specific inhalation challenge to argan powder, skin prick tests, and immunoblotting analysis. RESULTS: We report three cases of occupational asthma to argan powder and a probable case of rhinitis. Fifteen argan proteins were recognized by the patients' IgE. Identification of proteins, cross-reactions to nuts, and ELISA inhibition tests suggested that some argan allergens can cross-react in vitro with hazelnut allergens, including 11S globulin and vicilin. CONCLUSION: High-level exposure to argan powder should be considered to be a potential cause of IgE-mediated allergy, and workers handling argan powder should be carefully investigated.

Occupational Asthma to dried tobacco leaves: a very delayed diagnosis

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Exhaled nitric oxide and screening for occupational asthma in two at-risk sectors: bakery and hairdressing.

BACKGROUND: Fractional exhaled nitric oxide (FENO) levels are increasingly being used in the diagnosis and management of asthma. However, this indicator has rarely been used to detect occupational asthma. OBJECTIVE: To examine non-invasive methods to estimate airway inflammation. METHODS: A nested case-control study was conducted among a retrospective cohort of young workers in the bakery, pastry-making and hairdressing industries. Subjects underwent a clinical examination during a medical visit. Blood samples were collected and FENO levels measured. Cases were subjects diagnosed as suffering from 'confirmed' or 'probable' occupational asthma. RESULTS: Of the 178 workers included in the study, 19 were cases. In univariate analysis, FENO was associated with case/control status, and height and smoking status. In a multiple linear regression model, case/control status (P < 0.001), height (P = 0.006) and smoking status (P < 0.001) remained independent risk factors for variations in FENO levels. Good or fair sensitivity of respectively around 80% and 70% can be achieved using low FENO thresholds (8.5 and 10.5 ppb, respectively). FENO >8.5 ppb and a positive clinical examination increases specificity without loss of sensitivity (to 80.5% and 79.0%, respectively). CONCLUSION: This study suggests that FENO measurements alone cannot be considered a useful screening test for occupational asthma. Further investigations are needed to investigate the use of combined FENO and questionnaire or repeated measures.