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Toulouse, France

The role of house dust mites in the generation of various allergic symptoms, in particular, those of rhinitis and asthma, is now well known. Nevertheless, the mechanisms by which house dust mites can induce sensitization and allergies are still the theme of numerous studies. While the literature is extremely abundant, with 34,371 articles indexed on the theme of house dust mite allergy in Pub Med since 1871, with more than 1000 articles published annually in recent years, a critical, comprehensive analysis of the publications dealing with the diagnosis and management of allergy to house dust mites would appear to us to be useful, in light of the historical, epidemiologic, taxonomic, allergenic (molecular allergenic diagnostic tools) and therapeutic data available. The rational management of respiratory allergy to house dust mites, of which the two principal causes in France are Dermatophagoides pteronyssinus and Dermatophagoides farinae which co-exist in our homes, depends on consensus-based recommendations and evidence-based medical data. © 2014 Elsevier Masson SAS.

Dutau G.,rue Maurice Alet | Lavaud F.,Reims University Hospital Center
Revue Francaise d'Allergologie | Year: 2013

If one out of two children experience chest wheezing during their earliest years, at least 20% of them will continue to wheeze later, after 6 years of age. Several studies have tried to define the clinical characteristics of the different types of evolution - the phenotypes - in order to optimize as early as possible the treatment and management of these patients. Several new phenotypes have been described, mainly in those children with severe asthma, which turn out to correspond to several different situations: allergic asthma, asthma with virus-induced exacerbations, and mild asthma with a sudden severe expiratory deficit. Is it possible to recognize any one of these asthma phenotypes in babies and young infants? If yes, then what are the benefits and limits of their identification in daily practice? © 2013 Elsevier Masson SAS.

Dormoy C.,Center Hospitalier Of Bigorre | Petrus M.,Center Hospitalier Of Bigorre | Duraffour C.,Center Hospitalier Of Bigorre | Perdrieux P.,Center Hospitalier Of Bigorre | Dutau G.,rue Maurice Alet
Revue Francaise d'Allergologie | Year: 2013

We report a case of food protein-induced enterocolitis syndrome (FPIES) due to fish protein in a 17-month old child. The first signs were observed at 12. months of age, with pallor, asthenia, vomiting, malaise within three hours after eating fish. Prick tests with commercial extracts and crude fish extract, a provocation test on the lip, and specific serum IgE assays were negative. On the other hand, a patch test with cutlass-fish (Trichiurus lepturus) was positive at 24 and 48. hours. An oral provocation test with this fish resulted in the same symptoms after absorption of 9.44. g of fish, which confirmed the diagnosis. The principal characteristics of FPIES due to fish are described as follows: allergy to more than one fish (75%), monosensitivity (78.5%). The treatment of an acute episode includes rehydration and corticotherapy. An oral provocation test is indispensable to confirm the diagnosis. Prevention is based on avoidance of the causative food proteins. Tolerance after 3 to 4. years of avoidance is possible in about 30% of cases. © 2013 Elsevier Masson SAS.

Bidat E.,Service de pediatrie | Chaabane M.,Center hospitalier Sud Essonne | Chevallier B.,Service de pediatrie | Dutau G.,rue Maurice Alet
Revue Francaise d'Allergologie | Year: 2011

We report one case of food protein-induced entererocolitis syndrome (FPIES) with milk whose signs of intolerance to milk began as of the first life days, by minor and nonspecific symptoms. Three foods are in question, cow's milk, soya and corn. The diagnosis of FPIES is suspected at the age of 9 months after three hospitalizations for vomiting out of jet, sometimes associated with lethargy and hypotension, occurring two hours after the cow milk ingestion, This symptomatology is associated with negative results of specific IgE and cutaneous tests. Signs then occurred with soja and wheat. Because of late diagnosis, three anaphylactic shocks occurred. FPIES is an uncommon cell-mediated food allergy reaction. This syndrome is characterized by gastrointestinal symptoms, especially severe vomiting, sometimes associated with anaphylactic shock. Usually, signs occur two hours after ingestion. These reactions begin early in the first months of life and regress at the age of 3 years in 38% to 100% of cases depending on the food. They are usually induced by cow milk and soy proteins. Diagnosis is difficult and delayed because of non-specific symptoms. Oral food challenge is the only examination that confirms the diagnosis. The treatment involves the exclusion of the specific food. Severe reaction requires treatment of the shock and, what is particular in that pathology, the adjunction of corticosteroid. © 2011 Elsevier Masson SAS.

In our consultations, parents often report anaphylactic symptoms that were not optimally managed, despite calling emergency services. Three recent observations allow us to recall the warning signs of the acute phase of anaphylaxis and his management. Our proposals follow recent international recommendations. The safety in children of intramuscular injection of adrenaline should always be remembered. These observations led us to modify our education program of anaphylaxis. © 2011 Elsevier Masson SAS.

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