[Pollution and asthma].
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Biomedical subjects
Publications and source records attributed to F De Blay.
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As the number of proteins recognized as causing allergic respiratory diseases increases, new aero allergens have appeared in the animal and vegetable realms, both in home and professional environments. Lepidoglyphus destructor and Blomia tropicalis, two mites found in storage areas, are particularly important in agricultural areas and in homes. Over the last ten years, the frequency of reactions to cockroaches has also increased in several countries. The allergenicity of non-biting insects is a frequent cause of allergy in certain countries including Japan. Chironomides cause respiratory diseases in professional and outdoor environments. The important role of Alternaria, a mold, in producing severe asthma has also been demonstrated. The pathophysiology of pollen-induced asthma has been shown to result from pollen allergens carried by particles less than 5 microns in diameter. Cyprus and ash tree pollen also cause an increasing number of pollinoses and flowers can cause rhinitis and asthma. Respiratory allergy to Ficus benjamina inaugurated a new type of allergies caused airborne allergens from non-pollinating plants. Allergy to latex raises a particular problem for health care workers. The immunochemical structures of the major and minor airborne allergens are now better known and the homologous structures of different allergens largely explains certain cross-reactions. In the future, recombinant allergens will probably be used to better understand the role of allergens in inducing and maintaining the allergic reaction and should help in our approach to diagnosis and therapy.
We report a case of eosinophilic pneumonia secondary to taking Tetracycline whose severity required the use of mechanical ventilation and steroid therapy. On the basis of this case, we review the characteristics of drug-induced pneumonia as well as the differential diagnosis which are evoked.
The relationship between exposure to aeroallergens and the acquisition of allergy and asthma has been shown over the past ten years. Thanks to new developments for detecting major allergens amongst the principle aeroallergens, in future it will be possible to measure their airborne concentration and to determine the particle size of particles carrying them. We report the results obtained from three studies in which we have shown that airborne mites Group I and II and cockroaches Bla g 1 and Bla g 2 allergens have a broadly similar airborne behaviour. That is to say that they are not measurable unless the atmosphere is artificially disturbed and they are carried principally on particles of > 10 microns. On the other hand, 30-40% of cat allergens are carried on particles < 5 microns and measurable in the air without any artificial disturbance. According to our data and those of the literature, we propose a different classification for aeroallergens according to characteristic aerodynamics. Although some progress in the standardisation of techniques for sampling airborne allergens may have been accomplished, other studies are required to improve their reliability in order that airborne measurements can become a marker of allergic exposure in both domestic and occupational environment.
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The spontaneous evolution of 60 patients suffering from recently diagnosed sarcoidosis was compared with their initial biological profile of "activity". 47% of this unselected group of patients belonged to an inactive group (ACE less than 35 nmol/ml/mn and the percentage of alveolar lymphocytes less than 30%). After a mean period of two years of follow up it turned out that the initial bioprofile of activity had no predicted value, even in the absence of any initial elevation of the markers (3 cases out of 28 grew worse). The repeated controls of criteria of activity did not objectively show any concordant change with the outcome in such cases. It is necessary to point out the unfavourable character of very raised ACE activity greater than 50 nmol/ml/mn (7 deteriorations out of 8 cases). It would appear that a systematic search for these criteria should be deferred principally in type 1 lymph node involvement or pulmonary and mediastinal type IIA, all the more so as in practice they have little influence on therapeutic decisions.
The practice of therapeutic trials is indispensable in the management of bronchial carcinoma if one hopes to improve the results. We have questioned 134 doctors in the Alsace region who are involved in the diagnosis and treatment of bronchial cancer. We asked how they would wish to be treated if they had a small cell cancer, and if they would agree to participate in a therapeutic trial should the occasion arise. Four different clinical situations of small cell carcinoma localised to the hemithorax were presented, illustrating current controversy on the best treatment or treatments to apply. The 4 proposed protocols were refused by 50% to 84% of the doctors questioned in different cases. The greater the level of consensus on a therapeutic treatment in a given clinical situation the greater the level of refusal to participate in a randomised protocol was. The fact that at least half of the specialist doctors questioned would refuse to be included in a current therapeutic protocol which is underway for patients in Europe leads to the suggestion that before the application for new protocols experts surrogates should give their opinion in association with ethical committee.
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