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Biomedical subjects

G Dutau

Publications and source records attributed to G Dutau.

At least 55 records · Page 3Linked to original sources

Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges.

The skin prick test is the most widely used test for detecting IgE-mediated food hypersensitivity. Our study aimed to define firstly the correlations between results obtained with prick tests using commercial extracts and fresh foods, and secondly the correlations between these results and those obtained with labial and/or oral challenge. We compared the wheal diameters read at 15 min with commercial extracts and fresh foods, for four foods, in 430 children with suspected food allergy. For cow's milk, wheal diameters were larger with commercial extracts, but the difference was not significant. Conversely, wheal diameters were significantly larger with fresh foods for the other food allergens. Skin prick tests were positive in 40% of cases with commercial extracts and in 81.3% with fresh foods. The overall concordance between a positive prick test and positive challenge was 58.8% with commercial extracts and 91.7% with fresh foods. These results indicate that fresh foods may be more effective for detecting the sensitivity to food allergens. Fresh foods should be used for primary testing for egg, peanut, and cow's milk sensitivity.

Adolescent↗

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↗

[Clinical course and treatment of pleural empyema in children].

BACKGROUND: Purulent pleurisy has become rare. It is often masked by previous antibiotic treatment so that functional prognosis may be poor. PATIENTS AND METHODS: Twenty children with purulent pleurisy of the large cavity admitted from 1987 to 1993 were included in the study: there were nine infants (age 5 to 18 months) with pleuro-pulmonary staphylococcal infection (group I) and 11 children (4-13 years) (group II). Clinical, biological, bacteriological and radiologic findings were analysed retrospectively as was the outcome. RESULTS: Patients of group I were admitted in poor general condition. X-ray showed moderate effusion and characteristic signs of staphylococcal infection. The bacteria identified in seven patients (77%) was S aureus. Recovery was rapid with antibiotics and simple local treatment. X-rays were normal two months after hospital discharge in seven patients (77%). One infant presented cicatricial bullous emphysema which required segmental resection. Patients of group II were admitted for moderate respiratory signs after a relatively long delay (14 days) since the onset of symptoms. X-rays showed considerable effusion in all and mediastinal shift in five patients (45%). Streptococcus pneumoniae was identified in one patient only. Local treatment of empyema was difficult; the effusion, already fibrinous, required repeated use of chest tubes in eight cases and surgical decortication in three. X-rays, performed 2 months after hospital discharge, were normal in only three patients. Long-term course was nevertheless favorable since chest X-rays at 5 months were normal in all children of both groups. CONCLUSIONS: Early recognition of purulent pleurisy is important in children aged over 3 years to ensure effective drainage before the effusion becomes fibrinous. All patients in whom the first tube was inserted after more than 10 days had a difficult follow-up requiring repeated chest drainages or surgery. Ultrasonography was a useful aid for diagnosis and local treatment. Computed tomography was useful for adapting treatment after several days of course.

Adolescent↗

[Asthma in children].

Asthma is the most frequent chronic disease in children. Its prevalence has increased over the last 20 years. In the newborn, the diagnosis can be retained after 3 episodes of whistling dyspnea. Asthma often appears following respiratory syncytial virus bronchiolitis. In the child, asthma frequently accompanies allergy to airborne allergies. Adolescence, often a difficult period, carries the highest risk of severe episodes. A minimal asthma workup should be performed in all children with asthma including a search for an allergen and respiratory function tests. Asthma in childhood can be classed in different categories depending upon the nature of the allergen and the degree of bronchial obstruction. Recommended management has been the object of several consensus conferences and should include symptomatic treatment and prevention, adapted to the age of the child and the severity of the episodes. To be effective, preventive treatment must be given daily and for a long period.

Adolescent↗

[The pediatrician and the telephone].

Approximately half of the phone calls received in the pediatrician's office are telephone consultations or advice requests concerning pathologies. In those cases the pediatrician has to know that his responsibility is involved. Among the rules to be applied in this telephone practice, he must always require that the child be examined when parents call for the second time. In some chronic pathologies permanent phone services with the participation of trained practitioners might be useful in order to properly answer parent's advice requests.

Asthma↗

[Treatment of asthma crisis in children].

The occurrence of an acute exacerbation of asthma frequently reflects failure of a first line treatment that has to be reconsidered. Severe episodes of acute asthma are often related to non-recognition of signs of gravity, inadequate treatment and/or delayed access to an emergency department. Several consensus conferences have established guidelines for management of asthma attacks in the patient's home, and have defined the symptoms which should lead the physician to refer the patient to an emergency department and the criteria of hospitalization when the patient does not respond properly to the treatment. Guidelines for management of acute asthma based on the currently recommended therapeutic schedules are presented.

Aftercare↗

[Egg allergy].

Explore the source record for details and available documents.

Child↗

Continuous subcutaneous infusion of beta 2-agonists in infantile asthma.

Eleven infants presenting with an asthmatic syndrome were treated with subcutaneous infusions of a beta 2-agonist (beta 2A) during an acute episode. This treatment was used after difficulties with or failure of beta 2A infusions and IV nebulizations. No local or general adverse reactions were observed. The serum concentrations of salbutamol obtained at a dose of 0.1 micrograms/kg/min were measured in six infants and found to be within the generally accepted therapeutic range. This mode of administration proved extremely useful, both by itself and as part of a therapeutic protocol, combined with an antibiotic, a corticosteroid, and theophylline. It avoids the difficulties of administering beta 2A intravenously or by nebulization, while preserving some degree of freedom and better general care for the child. The preferred indication is in treatment of severe acute asthmatic episodes after failure of nebulizations. The exact place in the therapeutic arsenal of infantile asthma remains to be defined.

Adrenergic beta-Agonists↗

Immunostimulant effects on granulocyte functions during an acute respiratory infection.

Treatment of healthy volunteers by Ribomunyl, whether or not in association with in vitro antibiotics (amoxicillin or josamycin), has been earlier demonstrated to be an efficient stimulant of PMN functions (adhesion and migration). This second double-blind study versus placebo was performed on 17 patients with acute respiratory infections (placebo group: eight subjects; Ribomunyl group: nine subjects). Ribomunyl treatment (four days) associated with antibiotherapy (amoxicillin) induced a significant increase of PMN adhesion (p = 0.014) with no significant effect of the placebo (p = 0.30) and no significant difference between the initial level of PMN adhesion of the two groups (placebo-Ribomunyl).

Adolescent↗

[A unilateral hyperlucent lung...].

The occurrence in a young patient of a chronic cough with dyspnoea and restrictive ventilatory failure as shown by respiratory function tests suggested the possibility of a Mac Leod syndrome. However, other aetiologies could be considered such as vascular malformations, bronchial malformations and also tumours. If the chest X-ray sometimes enables an aetiological slant, bronchoscopy remains a first line investigation.

Adolescent↗