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Biomedical subjects

F Rance

Publications and source records attributed to F Rance.

15 recordsLinked to original sources
PubMed2004

A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?

BACKGROUND: While the ingestion of small amounts of an offending food can elicit adverse reactions in individuals with IgE-mediated food allergies, little information is known regarding these threshold doses for specific allergenic foods. While low-dose challenge trials have been conducted on an appreciable number of allergic individuals, a variety of different clinical protocols were used making the estimation of the threshold dose very difficult. OBJECTIVE: A roundtable conference was convened to develop a consensus clinical protocol for low-dose challenge trials for the estimation of threshold doses for specific allergenic foods. METHODS: In May 2002, 20 clinical allergists and other interested parties were invited to participate in a roundtable conference to develop consensus of the key elements of a clinical protocol for low-dose challenge trials. RESULTS: A consensus protocol was developed. Patients with convincing histories of food allergies and supporting diagnostic evidence including past challenge trials or high CAP-RAST scores can be enrolled in low-dose challenge trials. Care must be taken with younger patients to assure that they have not outgrown their food allergy. An approach was developed for the medication status of patients entering such trials. Challenge materials must be standardized, for example, partially defatted peanut flour composed of equal amounts of the three major varieties of peanuts (Florunner, Virginia, Spanish). Challenge materials must be appropriately blinded with sensory evaluation used to confirm the adequacy of blinding. A double-blind, placebo-controlled design should be used for low-dose challenge trials. Low-dose challenge trials would begin at doses of 10 microg of the allergenic food and would continue with doses of 100 microg and 1 mg followed by specific higher doses up to 100 mg depending upon the expert judgement of the physician; even higher doses might be applied to assure that the patient is indeed reactive to the particular food. A 30-min time interval would be used between doses, and reactive doses would be expressed as both discrete and cumulative doses. The goal of each challenge would be to develop objective symptoms; trials should not be discontinued on the basis of subjective symptoms only. Statistically, a minimum of 29 patients would be enrolled in low-dose challenge trials for each allergenic food because 0 reactors out of 29 patients at a particular dose allow the conclusion that there is 95% certainty that 90% of allergic individuals will not react to that dose. CONCLUSION: A consensus protocol was developed. Using this protocol, it will be possible to estimate threshold doses for allergenic foods, the lowest amount that elicits mild, objective symptoms in highly sensitive individuals.

Allergens↗
PubMed2004

Sesame seed allergy in children.

BACKGROUND: Sesame seed allergy is becoming more common in childhood. The aim of this study is to define the clinical signs and the results of allergological work-up of this food allergy as well as the demographical data in children. Sesame seed allergy outcome is unknown. MATERIALS AND METHODS: 14 children were recruited from 3 allergy centers in France. The diagnosis of food allergy was based on a convincing clinical history and positive skin prick tests and/or an elevated sesame specific IgE. Food challenge test was done when results of history and allergological work-up were conflicting. A reintroduction test was done when a child seemed to outgrow his (or her) food allergy. RESULTS: The median age at the beginning of sesame seed allergy was 5 years (range from 5 months to 16 years old). All patients reacted immediately after sesame seed consumption and presented as a first manifestation: edema (9 cases, 48%), urticaria (5, 27%), and one of each of the following symptoms (vomiting, rhinitis, conjunctivitis, asthma and anaphylactic shock). One patient had recurrent anaphylactic shocks and another an anaphylactic shock after subsequent sesame seed exposure; these 2 patients were asthmatic. The median of the wheal size was 5 mm (range 3 to 15 mm). The commercial sesame seed extract was less sensitive than the native seed. The median of sesame seed IgE was 5.58 kUA/L (range 0.35 to 100 kUA/L). The follow up lasted from a few months to 6 years. Three patients outgrew their food allergy. All of these patients showed a previous drop of sesame seed IgE and skin prick-tests became negative. CONCLUSION: Sesame seed allergy is not very different than other food allergy. We reported the spontaneous outgrowing of sesame seed allergy without being able to define the predictive criteria for a good outcome.

Adolescent↗
PubMed2000

[Allergologic diagnosis].

There are two phases in allergologic diagnosis of respiratory diseases related to immediate hypersensitivity reactions: establishment of the allergic origin of the symptoms and identification of the causal allergen or allergens. In addition to the basic information obtained from history taking and physical examination, prick tests provide an easy, rapid, and low cost means of correctly identifying specific allergens. Laboratory tests such as serum assay of specific IgE can be useful when history and prick tests provide conflicting information, in exceptional cases when prick tests cannot be performed, or when specific desensitization is indicated. IgE assay is however of little use if prick tests are negative or clinical history poorly suggestive. The role of screening for atopy using multiple-allergen prick tests which give a global positive or negative result is poorly defined. Screening tests would be interesting if symptoms suggest, among other hypotheses, an allergic disease, especially if prick tests cannot be performed rapidly. Other atopy tests, such as total serum IgE, have little use. Finally, specific provocation tests are rarely needed for routine allergologic diagnosis. They may be useful in complex clinical situations or in particular conditions such as occupational allergy.

Bronchial Provocation Tests↗
PubMed1998

Food allergy to peanuts in France--evaluation of 142 observations.

BACKGROUND: The increase in frequency of peanut allergy and fatal cases have been reported. OBJECTIVES: The objective of this study is to document the severity of food allergy to peanuts by evaluating the reactive dose of peanuts and to search for the role of peanut oil. METHODS: This study is carried out on the basis of 142 observations collected according to the same diagnostic methodology in two allergy centres in France. Skin-prick-tests were performed with peanut powder, peanut oil and peanut oil proteinic extract. Labial provocation tests were performed on 121 patients. The reactive dose of peanuts and the role of peanut oil were determined by standardized oral provocation tests in 50 and 62 patients respectively. The data are computerized and the data bank includes 509 food allergic patients. RESULTS: Allergy to peanuts represents 28% of food allergies and occurs under 1 year of age in 46% of cases, under 15 years of age in 93%. The clinical features were atopic dermatitis (40%), angioedema (37%), asthma (14%), anaphylactic shock (6%) and digestive symptoms (1.4%). The specific IgE were class 3 or higher in 80% of cases. The total reactive dose was less than 100 mg in 25% of cases, from 100 mg to 1 g in 62.5%. All patients reacted to a dose of less than 7.1 g. The threshold of peanut reactivity was lower than the threshold of egg reactivity. An allergy to peanut oil was demonstrated in 14 patients. CONCLUSION: The severity of peanut allergy and the early onset of the occurrence of this allergy is documented. The role of residual allergenic proteins in peanut oil is established by positive skin-prick tests to proteic extracts from peanut oil and by double-blind placebo-controlled challenges to peanut oil. The increased consumption of allergens in the form of peanut oil and fats can contribute to the occurrence or persistence of symptoms and may be suspected to increase the risk of sensitisation.

Adolescent↗
PubMed1997

Labial food challenge in children with food allergy.

The current increase in the prevalence of food allergies appears to have several causes including better screening, improved diagnosis and changes in both the techniques used by food manufacturers and eating habits. Labial food challenge (LFC)is simple, rapid to perform and is associated with only low risks of systemic reaction. It is thus an appealing alternative to the oral food challenge (OFC) for pediatric use. We report a series of 202 LFC performed over two years in 142 children with food allergy suspected from the case history, positive skin prick tests and specific serum IgE assays: 156 LFC were positive; and 46 negative, followed by positive single-blind, placebo-controlled food challenges (SBPCFC). The foods provoking reactions were egg white (75 cases), peanut (60 cases), mustard (23 cases), cow's milk (13 cases), cod (8 cases), kiwi fruit, shrimp (4 cases each), chicken, peanut oil (3 cases each), hazel nuts (2 cases), and snails, apple, fennel, garlic, chilli peppers, pepper, and duck (1 case each). LFC positivity was mostly (89.7% of cases) manifested as a labial edema with contiguous urticaria. There were systemic reactions in 4.5% of cases: generalized urticaria, hoarseness and rapid-onset and generalized eczema. The 46 infants with negative LFC results had positive SBPCFC. The reactions were in 34 cases generalized urticaria, 10 cases asthma attacks, 2 cases early and generalized eczema, and in one case general anaphylactic shock. The sensitivity of the LFC was 77%. The LFC was easy to perform with children. Positive results indicate the presence of food allergy, but negative results require further investigations preferably double-blind, placebo-controlled food challenge (DBPCFC).

Administration, Oral↗
PubMed1991

[Early neurotoxicity of high-dose of methotrexate and tetrahydrobiopterin deficiency].

Transient neurologic dysfunction associated with high-dose methotrexate and citrovorum factor rescue (MTX-CF) has been previously reported. At the biochemical level, there are at least two important pathways in central nervous system metabolism which might be disturbed by MTX: MTX may deplete the cell of the de novo synthesis of purine nucleotides and thymidylate through its action on dihydrofolate reductase (DHFR), and also inhibit dihydropteridine reductase (DHPR), an enzyme maintaining the cofactor of phenylalanine-hydroxylase in its active tetrahydrogenated form (tetrahydrobiopterin), and hence interfere with the supply of the neurotransmitters derived from tyrosine and tryptophan. We describe such a neurologic disease in a patient with acute lymphoblastic leukemia (ALL) receiving chemotherapy. Significant increase in cerebrospinal fluid biopterins supports the hypothesis of an inhibition of dihydropteridine reductase by MTX, and provides additional suggestions in terms of etiology, diagnosis and treatment.

Biopterins↗
PubMed1990

[Iatrogenic Cushing syndrome in infants. Report of a case with dwarfism].

We report a case of iatrogenic Cushing syndrome with dwarfism (-6 SD) in an eight-month-old infant. The respective role of exposure to corticosteroids in utero (the mother took 30 mg prednisolone per day throughout pregnancy) and postnatally (oral prednisolone, prednisolone in breast milk, and betamethasone cream) is discussed. Two other features are pointed out, i.e. presence of a food allergy and favorable outcome under hydrocortisone therapy.

Adrenal Cortex Hormones↗
PubMed1990

[Cervical spondylodiscitis caused by Kingella kingae. Apropos of a case].

We report a new case of spondylodiscitis due to Kingella kingae in a 19-month-old infant who had torticollis as the first manifestation. The main characteristics of Kingella kingae infections are reviewed: frequency of ENT and joint localizations, slow course, difficult clinical and bacteriological diagnosis, and satisfactory susceptibility to antimicrobial agents.

Bacterial Infections↗
PubMed1990

[Delayed severe decompensation of leucinosis. Significance of emergency blood exchange transfusion. Apropos of 2 cases].

The observations of two gypsy cousins born to consanguineous parents and exhibiting classical leucinemia are reminders that severe, life-threatening ketotic decompensations may occur at any time. Emergency exchange-transfusions in these two children aged 3 and 5 years reversed the course of extremely severe attacks. Medium term evaluations showed very satisfactory neuropsychologic development in both children. Pathogenesis and prevention of such episodes are discussed.

Amino Acid Metabolism, Inborn Errors↗
PubMed1986

Fatal intravenous drug abuse secondary to streptomycin overdose.

A fatal case of chronic intravenous drug abuse involving the injection of a nonpsychoactive veterinary combination of penicillin G and streptomycin is reported. The circumstances surrounding the death indicate that the decedent died as a result of streptomycin induced paralytic neuromuscular blockade.

Adult↗
PubMed1986

Dicyclomine in the sudden infant death syndrome (SIDS)--a cause of death or an incidental finding?

We report a case of a small infant apparently dying of the Sudden Infant Death Syndrome (SIDS) with a postmortem blood dicyclomine level of 200 ng/mL. Review of the literature and the comparison with blood dicyclomine values from four rabbits given equivalent doses suggests that a blood dicyclomine value of 200 ng/mL probably is in the therapeutic range for infants. Although safely used for years for infantile colic, recently, the administration of dicyclomine has been related to acute episodes of apnea, seizures, and coma. In the absence of those acute reactions, we feel that a 200-ng/mL blood dicyclomine level in a child dying of apparent SIDS should not prevent categorization of the death as SIDS.

Animals↗
PubMed1985

Gaucher's disease: a case history with extensive lipid storage in the brain.

Patients with acute infantile or type II neuropathic Gaucher's disease demonstrate neurologic deficits that are seemingly greater than the extent of the central nervous system involvement found at autopsy. Examination of the brain of an affected child shows widespread deposition of lipid in a pattern not recognized heretofore. Based on these observations, the authors hypothesize that widespread deposition of the Gaucher glucocerebroside elicits a mild tissue response, which functionally becomes highly significant.

Brain↗