[Diagnosis of drug allergies].
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Diagnosis, Differential↗
Biomedical subjects
D Vervloet
Publications and source records attributed to D Vervloet.
Indoor allergens and asthma: report of the Third International Workshop.
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Air Pollution, Indoor↗
Association between latex sensitization and repeated latex exposure in children.
BACKGROUND: Children with spina bifida are at greater risk for latex and ethylene oxide sensitization. The authors' aim in this study was to evaluate the role of previous surgical procedures in the development of sensitization to latex and ethylene oxide. METHODS: The authors investigated 80 children 1-16 yr old, separated into 3 groups. Two groups had a history of 3 or more general anesthetics: 29 children had spina bifida (spina bifida group) and 31 had undergone multiple surgeries for another disease (multiple surgeries group). A control group of 20 children had undergone less than 1 anesthetic. Clinical manifestations with latex, perioperative anaphylactic reactions, and number of previous anesthetics were recorded. Skin prick tests with a commercial extract of latex, four common inhalant allergens, and radioallergosorbent test to latex and ethylene oxide were performed. RESULTS: The three groups did not differ significantly with respect to age, sex, and atopic status. Mean number of anesthetics was comparable in the spina bifida and the multiple surgeries group. Latex sensitization was common in the spina bifida group (59%) and in the multiple surgeries group (55%) but not in the control group (0%, P < 0.05). Ethylene oxide sensitization was significantly more frequent in the spina bifida group than in the multiple surgeries group (44% vs. 19%; P = 0.052) and strongly associated with latex sensitization. Mean number of previous anesthetics was greater in children sensitized to latex (8.4 vs. 3.9; P < 0.05). CONCLUSION: Results suggest that it is the number of surgical procedures rather than spina bifida per se that is related to sensitization to latex.
Adolescent↗
Sex difference in asthma prevalence.
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Adolescent↗
Epidemiological study of the genetics and environment of asthma, bronchial hyperresponsiveness, and atopy: phenotype issues.
The Epidemiological Study of the Genetics and Environment of Asthma (EGEA) combined a case-control study and a family study. The total sample of 1,854 consisted of 348 patients with asthma selected through chest clinics and 416 control subjects and nuclear families ascertained through the cases. The protocol included standardized questionnaires, bronchial responsiveness, allergen skin-prick tests according to international protocols, total serum immunoglobulin E (IgE) level measurements, and blood eosinophilia. Criteria used to select subjects with asthma and determine asthma status of relatives for affected sibling pair linkage analysis are described. Based on figures from the 348 asthma cases of the EGEA study, issues relative to the definition of severe asthma and intermediate phenotypes such as bronchial responsiveness and allergic markers are discussed. Given the phenotypic heterogeneity involved, relevant phenotypes that may lead to the detection of genetic factors will depend on the hypothesis tested. Standardization of primary data and subphenotypes is a prerequisite for pooling data, which will be needed in the future to better understand the genetics and environmental factors of asthma.
Adolescent↗
Drugs that may injure the respiratory system.
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Drug-Related Side Effects and Adverse Reactions↗
Altered compartmentalization of transforming growth factor-beta in asthmatic airways.
BACKGROUND: Asthma is characterized by alterations of the bronchial epithelium associated with inflammatory cell infiltrates and sub-epithelial fibrosis. Transforming Growth Factor-beta (TGF-beta) is an anti-inflammatory and fibrosing cytokine normally present in bronchial epithelial cells and also potentially produced by inflammatory cells. Thus, TGF-beta could play a role in the asthmatic process, and its expression could be modified in asthmatic airways. OBJECTIVE: To test this latter hypothesis, we studied the bronchial distribution of TGF-beta in asthmatic patients. METHODS: TGF-beta 1, 2, 3 distribution was studied by immunohistochemistry in bronchial biopsies from 12 asthmatic patients and 10 non-asthmatic subjects. RESULTS: Bronchial epithelial cells from asthmatics were negative or faintly positive while a bright staining was detected in these from non-asthmatics (P < 0.01). In both groups, when inflammatory cells were present beneath the basement membrane, they were stained by the anti-TGF-beta antibody. CONCLUSION: This study shows an altered compartimentalization of TGF-beta in asthma. (a) TGF-beta is scarse in asthmatic bronchial epithelial cells, which could favour the perennization of the bronchial inflammation, and (b) TGF-beta is present in inflammatory cells beneath the basement membrane, where it could be involved in the frequent sub-epithelial fibrosis.
Adult↗
Prevalence of latex sensitization in subjects attending health screening: implications for a perioperative screening.
BACKGROUND: Because latex is a common allergen, the rate of latex sensitization may be high in the general population. A major issue would then be to determine whether a systematic preoperative screening in the general population should be recommended. OBJECTIVE: The purpose of the study was to evaluate the prevalence of latex sensitization in a sample of the general population and to assess the role of possible risk factors. METHODS: The subjects were 258 people, aged from 20 to 40 yr, visiting a health care centre for a check-up. The protocol included: a questionnaire (occupation, symptoms of atopy, use of latex goods and possible reactions, history of previous surgery), a skin-prick test, and a CAP RAST to latex. Atopy was evaluated by a skin-prick test to common allergens and a Phadiatop test. RESULTS: Some 6.6% of the study group had either a positive skin test or a positive RAST to latex. These subjects had a four-fold higher prevalence of symptoms when wearing gloves. The rate of latex sensitization was higher by fivefold in subjects with a history of reactions to latex goods and by fourfold in atopic subjects. CONCLUSIONS: Because the rate of latex sensitization is much higher than the anticipated rate of perioperative reactions due to latex allergy, a systematic preoperative screening for latex allergy should not be recommended for adults.
Adult↗
[Severe bronchial stenosis with upstream bronchiectasis in an arc welder: causal relation or epiphenomenon?].
This case concerns an arc welder who presented suppurative bronchiectasis and episodes of purulent left side pleurisy in relation to cystic bronchiectasis of the left lower lobe and a very severe stenosis at the origin of the main left bronchus. The medicolegal problem was to assess the causal relationship between these lesions and occupational exposure. They do not come under the heading of table 44 of the General List and we made this the aim of discretionary award in front of a regional committee of compensation for occupational disease.
Bronchial Diseases↗
[Allergies: determinants of T2 lymphocyte polarization and desensitization mechanisms].
Distinguishing two populations amongst T lymphocytes, namely Th1 and Th2, has enabled a better understanding of the pathophysiology of inflammatory diseases most notably immunoallergic disorders. These two populations, initially described in mice, are defined by the profile of cytokines which they produce. Th1 lymphocytes secrete amongst others IL-2 and IFN-gamma and the action exercised by these cytokines are involved in cellular reactions. Th2 lymphocytes are involved in humoral responses and immediate hypersensitivity secreting IL-4 and IL-5. In man the distinction between the two populations is more subtle than in the mouse, in particular for the same cell there is a possibility to pass from one type of cytokine to another. Thus the importance of factors which influence the orientation towards Th1 or Th2 type amongst the T lymphocytes. What are these factors? Can one use these to change the response to achieve a therapeutic goal? These are the questions that we propose to touch on in this analysis broaching the induction of the Th2 response. Certain responses are linked to the individual and concern their heredity. Others are the cells themselves which are involved in antigen presentation, the presenting cell and the HLA molecules, peptide antigen and T cell receptor. Again there are others which influence the presentation without being directly involved: these are the cytokines already present in the biological milieu and engaged co-receptors. All these factors act in concert, perhaps with others which are not yet known and account for the complexity of the response. Desensitisation is a treatment whose efficacy is recognised in certain precise indications. During the course of treatment, there is a diminution of IgE to the benefit of IgG and a diminution of the eosinophil count induced by specific provocation. These effects may be related to a decrease in the production of IL-4 and IL-5 respectively, which has been found in several recent studies. Desensitisation also shows that in spite of its complexity, one can reorientate towards a Th1 response based on spontaneous Th2 response. In this respect desensitisation constitutes a human model for the study of orientation of the Th2 immune response. In the future better understanding of the mechanisms of the allergic reaction will enable new treatments to be developed based on the use of antigenic peptides or using cytokines and inhibitors of cytokines.
Animals↗
[New aero-allergens. Interaction between allergens and the environment].
There is a qualitative as well as a quantitative change in allergen exposure. From a qualitative viewpoint, the relevance of some allergens (domestic allergens i.e. cockroaches, outdoor allergens i.e. plane tree, chestnut and ash tree pollens) has been established. The role of some other allergens has been, strictly speaking, discovered: latex from Hevea and ficus, trichophyton mold, some occupational allergens and very recently transgenic allergens. From a quantitative viewpoint, the concentration and/or distribution of some allergens has increased. Plantation of numerous trees or fortuitous introduction of weeds has led to an increased specific sensitization. In like manner, introduction of new foods or food processing procedures has created new food allergens and allergy. Besides, the distribution of some well-known aero-allergens is better known since discovery of ELISA--technology allowing measurements of minute amounts of these allergens. A burning issue today is to know whether irritant factors could modify allergens. Few data, sometimes contradictory, are available in the field of interaction between air pollutants and allergens.
Air Pollutants↗
[Specific treatments of allergic manifestations].
Because we now know more about the relationship between environment and allergy, we should aim: at preventing allergic diseases in at-risk populations; at alleviating symptoms in sensitized patient using avoidance methods; and at modifying immunological responses through specific immunotherapy. Recent studies provide a better knowledge of the allergenic levels which induce sensitization and trigger symptoms in allergic patients. This knowledge allows a strategy for avoidance measures. A better understanding of cross allergenicity of several allergens has been drawn from a better knowledge of the epitopes. Specific immunotherapy has proven its efficacy in selected patients suffering from asthma and/or rhinitis and patients with hymenoptera sensitivity.
Desensitization, Immunologic↗
Sex difference in Fel d 1 allergen production.
BACKGROUND: Previous experiments have shown that in vivo Fel d 1 production is under hormonal control. It strongly decreased 1 month after castration of male cats and increased after testosterone injection. OBJECTIVE: These results led us to put forward the hypothesis that Fel d 1 production could be more important in male that in female cats. Five adult male and five adult female cats were studied. METHODS: On day 0 three separate sites of each cat's trunk were shaved, and a 5.72 cm2 area in each site was washed twice (D0a and D0b) with 5 ml of distilled water. Then a collar was attached to the neck to prevent contamination from saliva. Twenty-four hours later on day 1, all areas were washed again once (D1a). Skin washes and fur extracts from the shaved areas were evaluated for Fel d 1 content. The same procedures (apart from collection of fur) were repeated 5 months later. RESULTS: The Fel d 1 level was higher in the first skin wash of male cats compared with that of female cats on each separate site of the trunk in both experiments, initially and 5 months later. Results were significant in the first experiment (median Fel d 1 per milliliter: 69.4 and 28.9 mU, respectively, for the combined three sites; p < 0.05). Fel d 1 production over a 24-hour period was higher in male cats, but the difference did not reach statistical significance. Furthermore, correlation between Fel d 1 levels in washes D0a and in fur was highly significant (p < 0.01). CONCLUSION: These results confirm that Fel d 1 originates from skin. Furthermore, they suggest that Fel d 1 production is higher in male than in female cats.
Allergens↗
Fel d I levels in cat anal glands.
BACKGROUND: Major cat allergen Fel d I is produced consistently by skin and by sebaceous glands before being spread on the fur. OBJECTIVE: Since cats have tubular anal glands secreting sebum, proteins and lipids, we looked at the possible presence of Fel d I in these secretions and compared the levels found to those already reported in other cat tissues or secretions. METHODS: Thirty-seven cats were studied. Fel d I dosage in the anal sacs' secretions was performed using an enzyme linked immunosorbent assay (ELISA) method and total protein evaluation by the Bradford's method. RESULTS: The geometric mean Fel d I concentration was 41 U/g secretion which represents 3.4% of the total protein levels. This amount is the highest ever reported in cat tissues or secretions. CONCLUSION: The close association of Fel d I protein with skin sebaceous glands and anal sacs both with holocrine function and lipids' secretions in one hand, and the homology of chain I of Fel d I with some steroid-binding proteins in other hand, suggest a possible physiological role for Fel d I in the regulation of lipids on skin and cat fur.
Allergens↗
Balance between alveolar macrophage IL-6 and TGF-beta in lung-transplant recipients. Marseille and Montréal Lung Transplantation Group.
Acute inflammation in the lung is characterized by a phase of tissue injury followed by a phase of tissue repair. When the latter is excessive, fibrosis occurs. Alveolar macrophages (AM) can produce cytokines involved in both phases of acute lung inflammation, notably interleukin-6 (IL-6), involved in injury and transforming growth factor-beta (TGF-beta), mediating repair. We hypothesized that AM were activated in both phases, and studied IL-6 and TGF-beta production by AM during complications of lung transplantation, acute rejection (AR), and cytomegalovirus pneumonitis (CMVP). In addition, we analyzed these cytokines in bronchiolitis obliterans (BO), a fibrotic complication of lung transplantation linked to previous AR and CMVP. At the onset of AR and CMVP, IL-6 secretion increased, whereas AM TGF-beta content was increased, but not its secretion. In contrast, with time, IL-6 reached control value whereas TGF-beta secretion rose significantly. In BO, IL-6 was not oversecreted, but TGF-beta increased, notably before functional abnormalities occurred. These results show that during acute complications of lung transplantation, AM display an early activation with oversecretion of IL-6, which is involved in tissue injury, counterbalanced by a late activation in which TGF-beta predominates, mediating tissue repair. The results provide new insights into the pathogenesis of BO, which is linked to acute complications of lung transplantation through this biphasic AM activation.
Adolescent↗
Single, high dose intramuscular triamcinolone acetonide versus weekly oral methotrexate in life-threatening asthma: a double blind study.
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Administration, Oral↗
[Role of atmospheric pollutants in asthma].
Air pollution can be divided into two basic types, industrial acid pollution (black smoke-dust particles sulfur oxide) and photochemical pollution (nitrogen oxides-ozone from automobile exhausts). In western countries, industrial pollution has greatly decreased while photochemical pollution has remained stable or increased depending on the area. In animal models, all types of air pollution, at high concentration, have an effect on the airways: irritation, facilitation of allergic sensitization, reduced resistance to infections. In humans, is the prevalence of asthma higher in polluted areas? Most surveys have found that the prevalence of respiratory, ear-nose-throat, and bronchial symptoms is higher but not symptoms of asthma. The surveys comparing East and West Germany suggest that irritation (repeated rhinobronchitis) is related to acid-particle pollution. The higher prevalence of allergic diseases in ex-West Germany does not appear to be related to photochemical pollution but rather to western lifestyle in general. In addition, changes in air pollution have an effect on the clinical and functional score in asthma patients, affecting the demand for medication and health care. Of particular importance for health care is the fact that these effects occur at concentrations below "standard" levels of pollution.
Air Pollutants↗
Latex allergy: allergen identification in Hevea braziliensis fractions by immunoblotting.
BACKGROUND: Latex is the cause of several clinical symptoms of allergy, but the identification of allergens is not completely known. OBJECTIVE: The aim of this report was to study the immunoreactivity of purified stable latex fractions from Hevea braziliensis. METHODS: We purified the cytoplasm of Hevea braziliensis and obtained three fractions: latex particles (LP), lutoids (L) and cytosolic serum (CS). Using Western blot, specific IgE directed to latex allergens was found in 80 patients with latex allergy. RESULTS: Five major groups of allergens migrating as 14, 25, 29, 37-45 and 50 kDa were recognized. They were unequally distributed with the latex fractions: 37-45 kDa proteins were essentially recognized in CS and LP, whereas 14 and 29 kDa proteins were mainly labelled in the L fraction. As a control, aqueous glove extracts exhibited a more restricted pattern of reactivity, because only 14 and 29 kDa proteins were recognized by patient sera. The pattern of reactivity was not correlated specifically with IgE levels, but sera from patients suffering from spina bifida reacted specifically with the minor protein of 25 kDa located in LP. CONCLUSIONS: The present results show that latex allergic patients recognize several allergens which are differently distributed in subcellular fractions extracted from H. braziliensis and aqueous GE. The L fraction and GE were enriched in low molecular weight proteins and apparently contained the same allergens.
Adolescent↗