Search PubMed⌕ Search

Biomedical subjects

P Demoly

Publications and source records attributed to P Demoly.

At least 55 records · Page 3Linked to original sources
PubMed2003

[Specific immunotherapy for respiratory allergies. A modern treatment].

UNLABELLED: AN EFFICIENT AETIOLOGICAL TREATMENT: Specific immunotherapy or allergen vaccination currently constitutes the only aetiological treatment for allergic respiratory diseases and is more effective in children than in adults. Since its introduction in 1911, it has been much disparaged in spite of its effectiveness demonstrated in double blind placebo controlled studies, for the treatment of both allergic rhinoconjunctivitis and stable and controlled asthma. MECHANISM OF ACTION: Its mechanism of action varies depending on the type of allergen (venoms or pneumallergenes) and its administration route (subcutaneous or local) and recent studies indicate that the prevalent mechanism proceeds from a modification of the T cell response by an immunological deviation (stimulation of the Th0/Th1 lymphocytes) or T lymphocyte anergy (reduction in Th0/Th2) or both at same time. The IL-10, immunosuppressive cytokine secreted by the third population of T-Tr1 lymphocytes, would have an important role. IN PRACTICE: The indications for specific immunotherapy have been specified in international consensuses, and its practical administration must respect preconditions and a certain number of rules. Improvement in quality of allergenic extracts by standardization, better knowledge of its mechanism of action and the availability of local administration routes reinforce its place in the global therapeutic strategy for the management of respiratory allergies. A greater use of the sublingual route, together with biological and clinical research will allow the widening of its indications.

Allergens↗
PubMed2003

National survey on the management of rhinopathies in asthma patients by French pulmonologists in everyday practice.

BACKGROUND: Epidemiological and pathophysiologic studies have shown that allergic rhinitis and asthma often occur in combination. The internationally developed ARIA position paper (Allergic Rhinitis and its Impact on Asthma) recently offered recommendations on allergic rhinitis. As part of this new report and prior to its diffusion, we investigated the management of rhinopathies in asthma patients by pulmonologists in their everyday practice. METHODS: From March to June 2000, 477 (48%) French pulmonologists in office-based practice participated in the survey. They were asked to include their first five asthmatic adult patients. In addition to descriptive statistics, univariate and multivariate analyzes were performed. RESULTS: We studied 1623 patients with varying severity of asthma (sex ratio 0.9; median age 35 years). The pulmonologists reported rhinopathy in 76.6% of these, with a chronic course in 91%. Among the patients, 67.1% reported rhinopathy. The diagnosis was allergic rhinitis in 66.2% of participants and nasal polyposis in 10.1%. Examination of the nasal cavities was performed by the pulmonologists themselves in 56.2% of patients. Imaging of the sinuses was performed radiographically in 55.3% of enrolled patients and/or by computed tomography in 17.2%. Referral to an ENT specialist occurred for 21.6% of patients, being more common for patients with rhinitis that failed to respond to medical therapy (although some pulmonologists referred their patients routinely). CONCLUSIONS: The high prevalence of rhinopathies in asthma patients requires that these conditions are recognized and managed by pulmonologists. Thus, our findings support one of the central messages contained in the new ARIA guidelines-asthma patients should be investigated routinely for rhinitis and other rhinopathies.

Adult↗
PubMed2003

Links between rhinitis and asthma.

There is compelling evidence of a close relationship between the upper and lower airways in asthma and rhinitis. Rhinitis is present in the majority of patients with asthma, and a significant minority of patients with rhinitis have concomitant asthma. Similarities between the two conditions occur in the nature of the inflammation present in the target tissues. A common initiating step in the inflammatory process of allergic airways disease is the presence of immunoglobulin E providing an adaptor molecule between the offending allergen and inflammatory cell activation and mediator release. Differences in the two conditions arise largely from the structural differences between the nose and the lungs. In an asthmatic, concomitant allergic rhinitis increases healthcare costs and further impairs quality of life. The presence of rhinitis should always be investigated in children and young adults with asthma. Subjects with allergic rhinitis have an increased risk of developing asthma and may form a suitable population for secondary intervention to interrupt the 'allergic march'.

Allergens↗
PubMed2003

Allergen-induced mediator release tests.

The diagnosis of allergic reactions in clinical practice is based on both clinical history and the determination of specific immunoglobulin E (IgE), either in the serum or on skin mast cells. However, for various reasons, identification of the causative factors is not possible in all the cases. Moreover, not all allergies are IgE-dependent. In an attempt to find sensitive, specific and cost-effective methods to investigate hypersensitivity reactions, in vitro tests were developed at a very early stage. Allergen-induced mediator release assays analyze the mediator released from effector cells, mainly peripheral blood cells, when stimulated in vitro with serial dilutions of the putative allergens. Described initially as research tools, they could well become diagnostic tests. However, relatively few high quality reports have been published so far. In this review, we will detail allergen-dependent histamine, tryptase, arachidonic acid metabolite, e.g. cysteinyl leukotrienes and 15-hydroxyeicosatetraenoic mediator release tests.

Allergens↗
PubMed2003

Validation of the classification of ARIA (allergic rhinitis and its impact on asthma).

BACKGROUND: Allergic rhinitis is commonly divided into seasonal and perennial rhinitis. The recent Allergic Rhinitis and its Impact on Asthma (ARIA) workshop proposes to replace these terms by intermittent vs persistent rhinitis. METHODS: In order to test the new ARIA classification against the classical one used in medical practice in France, we designed two cross-sectional surveys: (i) a spring survey, where 1321 general practitioners enrolled 3026 patients consulting for seasonal allergic rhinitis and (ii) an autumn-winter survey, where 1346 doctors enrolled 3507 patients for perennial allergic rhinitis. Both doctors and patients filled out a specific questionnaire on allergic rhinitis. RESULTS: Focusing on the number of days per week and consecutive weeks per year, the patients described the duration of their symptoms (based on an auto-questionnaire). About 43.7% of the patients, classified by their doctor as seasonal, did in fact have persistent rhinitis, whereas 44.6% classified as perennial had intermittent rhinitis. CONCLUSIONS: The proposal of the ARIA expert panel defining the chronology of allergic rhinitis as number of days per week and consecutive weeks per year is likely to change daily physician practice.

Adult↗
PubMed2003

[Respiratory allergic disease genes].

Asthma and atopy are polygenic diseases with an hereditary and an environmental component. Improvement in statistical and molecular tools has enabled the localization of a dozen chromosome regions bearing susceptibility genes: 1p32-34, 3q21, 5q31-33, 6p21-23, 11p15, 11q13, 12q14-24, 13q14-qter, 14q11, 17q11-21, 19q13 and 20p13. There are many candidate genes, particular the cluster of interleukin-4 genes (5q31-33), the major histocompatibility complex genes HLA D and the TNFalpha gene (6p21-23), the gene of the receptor B chain with strong affinity for IgE (11q13), the interferon-gamma gene (12q15-24), the genes of the alpha/gamma chains of the T receptor (14q11), the IL4 receptor gene (16p12), and the metalloprotease gene ADAM33 (20p13). Research will continue to define these genes more precisely or to recognize others and to apply this knowledge to therapeutic and diagnostic applications.

Asthma↗
PubMed2003

Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years).

BACKGROUND: Between 30 and 50% of patients with sinonasal polyposis (SNP) will require surgical treatment. OBJECTIVE: To determine the medium term risks and benefits of endonasal ethmoidectomy in SNP. METHOD: 132 cases of SNP have been retrospectively studied before and after endoscopic nasal surgery with a mean follow-up of 5 years. Functional symptoms and appearances on endoscopic examination were recorded on graded scales. Non-parametric statistical analyses for matched series were used in the assessment of data. RESULTS: Post-operative normalisation of nasal function was obtained in 62% of cases. Each of the four main nasal symptoms (nasal obstruction, rhinorrhoea, facial pain and anosmia) was improved (p = 0.001). Patients with associated asthma or ASA triad had higher scores for nasal obstruction and rhinorrhoea (Fisher's exact test; p < 0.02). The pre-operative clinical stage of SNP correlated neither with recurrence nor with functional outcomes (Fisher's exact test; p > 0.05). The requirement for steroid treatment of concurrent asthma was also reduced post-operatively (p = 0.001). The association with asthma and its level of treatment was not related to the frequency of recurrence of SNP (Chi2; p > 0.6). CONCLUSIONS: Functional outcomes for patients with SNP and asthma were significantly improved by endoscopic surgical treatment, even if the appearance of the nasal mucosa did not always return to normal.

Asthma↗
PubMed2003

[Smoking habits, attitudes and knowledges of medical students of Medicine, Pharmacy and Odonto-Stomatology's Faculty of Dakar, Senegal].

INTRODUCTION: Smoking is a public health problem that does not spare the medical profession. We set out to determine the prevalence of smoking in medical students in Dakar and to assess their attitudes and knowledge in the face of this problem. METHODS: A cross sectional study was conducted by means of an auto-questionnaire among 1547 medical students between 3 and 31 May 2001. There were 1061 males (68.6%) and 486 females (31.4%). RESULTS: The overall prevalence of regular or occasional smoking was 34.6%, with 42.8% in the first cycle, 38% in the second and 19% in the third. It was significantly higher among males at 76.4%. The average age of starting smoking ranged from 10 to 22 years and average duration from 5 to 26 years. The influence of fashion was the most frequent initiating factor at 37.4% and 96.6% smoked commercial cigarettes. Nicotine dependence, assessed by the Fagerstrom score, was average in 59.3%, strong in 14% and very strong in 4.7%. 58.8% smoked in public places and 78.2% thought they could give up smoking within the next 5 years. 8.4% were unaware of the effects of tobacco on health and 20.5% of the relationship between tobacco and the diseases quoted. 37.7% of future doctors would not systematically avoid smoking in the presence of patients but 79% wished to ban advertising and 70.4% to ban the use of tobacco in hospitals. 94.4% of students wanted health care workers to be educated about the effects of smoking. CONCLUSIONS: Tobacco smoking among medical students has increased between 1989 (28.7%) and 2001 (35.6%). This observation should stimulate the establishment of a course on the pathology of tobacco smoking and the integration of education and prevention within the medical curriculum, increase the awareness of smokers and above all help them stop.

Adolescent↗
PubMed2002

Prick tests to aeroallergens: is it possible simply to wipe the device between tests?

BACKGROUND: Improperly performed skin prick tests (SPT) can lead to wrong allergy diagnosis and incorrect treatment. To overcome false-positive results it is recommended to change the puncture device between each test, although very few studies have examined the real drawbacks (false-positives) and advantages (time and cost savings) of using only one device. METHODS: Two groups of 20 patients with rhinitis or asthma, sensitized to either house-dust mites or grass pollens, had successive serial SPT to 9% codeine phosphate and the relevant allergen using the same needle or lancet, wiped between each test. RESULTS: With both the needle and the lancet, there were 12.5-67.5% false-positive results using the house-dust mite or grass pollen allergen extracts, respectively. There were no false-positive results with the 9% codeine phosphate. CONCLUSIONS: Our study shows that this technique is not reliable as it provoked an unacceptable number of false-positive results.

Adolescent↗
PubMed2002

Long-term safety and efficacy of nevirapine tolerance induction.

BACKGROUND: The most frequent side-effects due to nevirapine (Viramune), the first non-nucleoside HIV reverse transcriptase inhibitor introduced for clinical use, are cutaneous hypersensitivity reactions. In non-serious cases, tolerance induction can be proposed. OBJECTIVE: Describe the long-term safety and efficacy of tolerance induction to nevirapine. METHODS: Six HIV-infected patients started a tolerance 1 to 2 months after an episode of nevirapine hypersensitivity. Increasing doses of nevirapine (2.5, 10, 25, 100, 250 and 750 microg and 2.5, 5, 10, 25, 50 and 100 mg) were given orally at half-hour intervals under strict medical surveillance and patients were followed up regularly. RESULTS: All but two of the patients tolerated this induction well. One had a mild and transient reaction on day 1; nevirapine was not stopped. One had a moderate to severe reaction one month later; nevirapine was stopped and he recovered fully. All other patients have been taking nevirapine for more than 3 months without any adverse reaction. CONCLUSION: Therefore, when no alternatives are available in severely ill and hypersensitive HIV-infected patients, tolerance induction is a possible therapeutic option.

Adult↗
PubMed2002

Immunotherapy with keyhole lampet hemocyanin-conjugated decapeptide vaccine in cypress pollen allergy.

BACKGROUND: Cupressaceae pollen allergy is a world-wide pollinosis but immunotherapy has rarely been tested. Immunotherapy is usually allergen-specific but new forms may be targeted towards IgE. OBJECTIVES: A randomized, double-blind, placebo-controlled trial was carried out to assess the efficacy of a vaccine made of keyhole lampet hemocyanin (KLH)-conjugated decapeptide from the Fc(epsilon4) domain of the IgE in cypress pollinosis. METHODS: Sixty patients with cypress pollen allergy were studied. They were included on a suggestive clinical history, positive skin tests and nasal challenge to cypress pollen extract. Three intramuscular injections of the vaccine (250 microg) or placebo were administered monthly with a booster injection 5 to 8 weeks later. The primary end-point criterion was the threshold dose inducing a positive nasal challenge. The secondary end-point was the symptom-medication scores measured when cypress pollen grains were over 50 grains/m3. RESULTS: Nasal challenge before treatment was non-significantly different between the placebo and vaccine groups. After treatment there was no significant difference between the two groups. Pollen counts were over 50 grains/m3 for 8 weeks during the trial. There was no significant difference in total symptom scores between the placebo and vaccine groups. The vaccine was safe. CONCLUSIONS: The KLH-conjugated decapeptide vaccine was not effective in cypress pollen allergy.

Adult↗
PubMed2002

The accuracy of the diagnosis of suspected paracetamol (acetaminophen) hypersensitivity: results of a single-blinded trial.

BACKGROUND: Hypersensitivity to paracetamol (acetaminophen) is rare and very few clinical data are available in the literature. MATERIALS AND METHODS: Eighty-four patients (28 males and 56 females, 5-70 years old) with a suspicion of paracetamol hypersensitivity were referred to our drug allergy clinic between May 1996 and May 2000. The reaction had occurred 1-96 months prior to the consultation. Single-blinded placebo-controlled oral challenges were carried out in 82 patients, under strict hospital surveillance. RESULTS: Most of the patients experienced skin eruptions 82/84 (97.6%), with 10 cases of anaphylactic shock (11.9%). Twenty-six (30.9%) reactions were immediate (occurring within the first hour after drug intake), 53 (63.1%) non-immediate and five could not remember. Oral provocation tests (OPT) demonstrated drug hypersensitivity in 11 patients only. The two patients not tested (due to a history of life-threatening reaction) were included in the positive group. Thus, 13 (15.5%) patients had paracetamol hypersensitivity and 71 (84.5%) had not. All the 13 positive patients had skin eruptions, five with anaphylactic shock. 9/13 had immediate reactions. Using OPT, 10 out of 11 had the same clinical reaction but more delayed. In both groups, whether hypersensitive to paracetamol or not: atopy was similar (7/13-53.8% and 31/71-43.7%), sex ratio was not different (M/F 0.3 and 0.5), 3/13 (23.1%) and 0/71 (0%) had aspirin/ibuprofen hypersensitivity. CONCLUSION: The clinical history of paracetamol (acetaminophen) hypersensitivity is rarely sufficient to set a firm diagnosis and only OPT can confirm this. Careful OPT reproduces the same symptoms (not more severe in our hands) with the same or slightly more delayed chronology. Atopy and sex are not risk factors.

Acetaminophen↗