Introduction: Isolated histaminergic angioedema is an uncommon reason for medical consultation. The aim of this study was to investigate the epidemiological and clinical characteristics of isolated histaminergic angioedema in Casablanca. Methods: We collected cases of isolated histaminergic angioedema managed in the Department of Dermatology at the University Hospital Center of Casablanca between March 2021 and September 2024. Results: Seven patients presenting with isolated histaminergic angioedema were identified. The mean age was 32.8 years (range: 18-47 years), with a male-to-female ratio of 2:5. Five patients reported no history of atopy. All patients had previously engaged in chronic self-medication with corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) prior to medical management. None of the cases were associated with superficial urticaria, laryngeal or respiratory involvement, or abdominal pain. The mean duration of symptom progression was two years, with angioedema episodes lasting less than 72 hours. Treatment with antihistamines resulted in a favorable outcome in all patients. Additionally, five patients received adjunctive anti-leukotriene therapy, which contributed to rapid and effective control of the episodes. Conclusions: The isolated presentation of histaminergic angioedema in our patients primarily raises the issue of differential diagnosis with bradykinin-mediated angioedema, highlighting the importance of a thorough clinical history and the measurement of C1 esterase inhibitor levels.
Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, including palbociclib, have transformed the management of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer. While their adverse effects such as neutropenia, diarrhea, and fatigue are well documented, cutaneous toxicities remain less well recognized and are likely underestimated. We report the case of a 34-year-old woman treated with palbociclib for metastatic invasive breast carcinoma who developed an eczematous eruption with a pseudo-metameric distribution mimicking herpes zoster, five months after treatment initiation. This case highlights the importance of early recognition of cutaneous manifestations to avoid diagnostic errors or unwarranted treatment discontinuation and underscores the need for close collaboration between oncologists and dermatologists.
Introduction Exposure to household tobacco smoke among children with asthma remains a relevant public health concern. However, the direct impact of secondhand smoke exposure on asthma control is still debated, and causal relationships cannot be clearly established based on current evidence. This study aimed to describe the prevalence and reporting patterns of household smoking exposure among children with asthma and to explore its associations with sociodemographic factors and asthma care characteristics. Methods In this cross-sectional study, the SHS exposure of 188 children with asthma was compared to that of a healthy control group without any chronic disease. “Childhood Asthma Control Test” and “Asthma Control Test” were administered to children diagnosed with asthma, and the effects of SHS on disease control were examined. Results It was found that 45.7% of asthmatic children and 63.2% of the healthy control group were exposed to SHS in their home environment (P<0.01). Asthmatic children with a larger household size and living in extended families were exposed to passive smoke at a higher rate. The rate of well-controlled asthma was higher in asthmatic children who were not exposed to passive smoking (97.1 vs. 60.5%, P<0.01). In asthmatic children, the rate of uncontrolled asthma was higher when the mother was a smoker (P<0.01), whereas no difference was found between the two groups when asthma control levels were evaluated according to the father's smoking status (P>0.05). Conclusion Household tobacco smoke exposure is commonly reported among children with asthma. These reports reflect not only environmental exposure but also broader sociodemographic conditions and characteristics of asthma care. Within the limitations of this observational design, no causal inferences regarding the relationship between household smoking exposure and asthma control can be made. Nevertheless, the high prevalence of reported exposure underscores the importance of systematically addressing household smoking within the comprehensive clinical assessment of pediatric asthma.
Study objective Drug hypersensitivity reactions are often perceived as medically threatening events, yet death anxiety remains poorly characterized. We compared anxiety, depressive symptoms, and death anxiety in adults with a history consistent with immediate-type drug hypersensitivity reactions versus allergic rhinitis controls without drug allergy. Patients and methods Clinic-based case-control study (January 23-August 30, 2024). Ninety-six adults with a physician-recorded history consistent with drug hypersensitivity reactions and 96 allergic rhinitis controls without drug allergy were enrolled. Drug hypersensitivity reactions were classified based on structured clinical history supported by medical and emergency department records, considering prior allergy testing when available. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale, and death anxiety with the Templer Death Anxiety Scale. Group comparisons were performed using the Mann-Whitney U test. Adjusted analyses used general linear models controlling for age, sex, education, marital status, employment status, chronic/additional disease, and smoking/alcohol use. Results Compared with controls, the drug hypersensitivity group had higher anxiety and higher death anxiety (both P < 0.05), whereas depressive symptoms did not differ (P = 0.455). Adjusted differences remained significant for anxiety (adjusted mean difference 1.35; P = 0.009) and death anxiety (1.04; P = 0.028) but not for depression (P = 0.962). Conclusion Adults with a history consistent with drug hypersensitivity reactions had higher anxiety and death anxiety than controls, independent of key covariates. Incorporating brief psychological screening and targeted counseling into drug allergy evaluation may help address persistent fear and avoidance.
Oral immunotherapy (OIT) represents a major advance in the management of IgE-mediated food allergies. The principle of food scales is based on the gradual and controlled introduction of modified forms of the allergen. However, their use is not standardized and requires significant support from parents. We propose a Moroccan food ladder for milk and eggs, with each ladder comprising four stages. Food ladders are a less restrictive and less anxiety-inducing alternative to oral immunotherapy for children and their families.
Peanut allergy (PA) is one of the main food allergies in children in France, with significant clinical, psychosocial, and organizational impact. It is predominantly mediated by IgE mechanisms, except for rare cases of food protein-induced enterocolitis syndrome (FPIES). Diagnosis relies on a comprehensive approach combining a detailed medical history, skin tests (prick tests), measurement of specific IgE levels, molecular diagnostics (Ara h 1, 2, 3, 6, 8, 9), and sometimes cellular tests (basophil activation tests) and oral food challenges (OFC). Each tool has specific diagnostic performance characteristics and limitations, which must be interpreted within the overall clinical context. An integrated diagnostic approach, combining clinical, biological, and functional tests, optimizes diagnostic accuracy for peanut allergy, limits the indication for oral food challenges, and improves individualized patient management, while reducing the burden of the disease.
Lenalidomide is an immunomodulatory agent used in onco-hematology for the treatment of certain neoplastic disorders. Hypersensitivity reactions to this molecule have been reported. A 76-year-old patient developed a maculopapular exanthema on day 18 of treatment with lenalidomide and rituximab for non-Hodgkin lymphoma. A lenalidomide patch test, prepared under optimal safety conditions, was performed four weeks after the eruption and confirmed delayed hypersensitivity at 72 hours through reactivation of previous toxidermic lesions; intradermal testing with rituximab was not performed. The investigation of hypersensitivity to lenalidomide has been rarely addressed in the literature, as this drug is prescribed in the setting of neoplastic disease where priority is given to disease control, and because of the known toxicity risks associated with its handling. Consequently, greater emphasis has been placed on lenalidomide desensitization or on the search for alternative therapies by substitution. Several desensitization protocols have been tested with encouraging results. Delayed hypersensitivity to lenalidomide can be demonstrated by patch testing, and desensitization represents an appropriate therapeutic option in the absence of an effective alternative.
The continuous rise of allergic diseases in contemporary societies confronts clinicians with a paradox: although the immunological mechanisms of hypersensitivity are now largely elucidated, the prevalence of asthma, allergic rhinitis, atopic eczema, and food allergies continues to increase. Current biomedical models centred on the epithelial barrier, type 2 immunity, the microbiota, and environmental exposures provide essential explanations, yet they do not fully account for the conditions under which these diseases emerge and are expressed. This article proposes to broaden the perspective by bringing allergology into dialogue with contemporary social philosophy, drawing on Hartmut Rosa's work on acceleration, resonance, and the unavailability of the world. We hypothesize that allergic hypersensitivities can be understood as the bodily expression of a mismatch between the biological rhythms of living systems and the acceleration of contemporary lifestyles. Allergic diseases, which primarily affect the interfaces between the body and the environment, seem to emerge when the organism is subjected to repeated demands without having sufficient conditions for recovery. This approach sheds new light on frequent clinical observations: lowered tolerance thresholds, symptom fluctuations associated with stress or fatigue, and exacerbations during periods of disrupted life rhythms. Without calling current treatments into question, it invites clinicians to integrate more explicitly temporality, recovery conditions, and patients' lived experience into allergological practice. It thus opens the perspective of a medicine more attentive to rhythms and to the relationships patients maintain with their environment.
Walks or stays in forests are credited with beneficial immunological and psychological effects in certain chronic diseases, but the role of wooded areas in allergic diseases is poorly studied. While trees constitute a large part of the living mass of the forest, the pollinosis associated with them do not fully encompass the interactions between this complex ecosystem and the development, maintenance, or prevention of allergies. Other plants, moulds, and insects are all potential allergens for patients who go there, but the impact of forests on allergic patients living far from them is also being studied. (c) 2026 Societe franc & cedil;aise d'allergologie. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Eco-anxiety refers to psychological distress related to the perception of a global environmental threat that is real and scientifically established. It manifests through anxiety, depressive, cognitive, and somatic symptoms, which may impair quality of life and exacerbate preexisting psychiatric disorders. Although it is not a formal diagnosis, it is clinically relevant when it becomes persistent and pervasive. Young people, environmental professionals, and healthcare workers are particularly vulnerable. For allergists, as sentinels of environmental change, eco-anxiety should be integrated into the patient's overall assessment. Its management relies on evidence-based psychotherapeutic approaches, as well as on strengthening social support and collective action. (c) 2026 Societe franc & cedil;aise d'allergologie. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Management of chronic urticaria, including chronic spontaneous and inducible forms, relies on symptomatic treatments aimed at disease control and quality-of-life improvement. Second-generation H1-antihistamines are the first-line therapy, with up-dosing up to four times the licensed dose in chronic spontaneous urticaria. In antihistamine-refractory disease, omalizumab is the reference treatment, achieving complete remission in approximately 70% of patients with an excellent safety profile. Cyclosporine is considered a third-line option requiring close monitoring. Long-term systemic corticosteroids are not recommended. International treatment algorithms are largely concordant, with specific adaptations for special populations. Several innovative therapies, including Bruton tyrosine kinase inhibitors, dupilumab, and KIT inhibitors, are emerging or recently approved. Updated international guidelines are currently being published.
The widespread availability of the internet and the rise of social media raise questions about the dual role these tools play in the hands of our patients. On the one hand, they allow rapid access to medical information, facilitate exchanges between patients, and empower them. On the other hand, they can spread misinformation, generate anxiety, or even encourage self-diagnosis, self-medication, or even treatment refusal based on negative reviews. This issue prompts us to reflect on the reliability of online content and the crucial role of healthcare professionals in supporting patients as they navigate these new modes of information and communication. Digital technology should not be considered simply as a context, because today it is an actor that is changing medical consultation and the relationship to care.
The nasal allergen challenge (NAC) is considered the functional gold standard for assessing allergenspecific nasal responsiveness in allergic rhinitis (AR). It combines validated symptom scores such as Total Nasal Symptom Score (TNSS) and Visual Analog Scale (VAS) with objective parameters, including Peak Nasal Inspiratory Flow (PNIF), Anterior Active Rhinomanometry (AAR), and Acoustic Rhinometry (AcRh), to quantify nasal response following allergen exposure. Standardized NAC protocols ensure reproducibility and are widely used in clinical practice and therapeutic research, particularly for early assessment of allergen immunotherapy and anti-inflammatory treatments. (c) 2026 Societe franc & cedil; aise d'allergologie. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Study objective: This study evaluates anxiety and depression levels in mothers of children with food allergies in relation to provocation tests. Food allergies impose a psychological burden on families, and provocation tests may contribute to increased emotional distress. Patients and methods: The study included mothers of 0-3-year-old children diagnosed with food allergies who attended a pediatric allergy clinic. The control group consisted of mothers of healthy children. Participants completed the Hospital Anxiety and Depression Scale (HADS), and data were analyzed using IBM SPSS version 30, with statistical significance set at P < 0.05. Results: A total of 171 mothers participated (86 case, 85 control). No significant difference was found in overall anxiety and depression scores between groups (P > 0.05). However, mothers in the case group reported higher distress in specific areas, such as losing interest in appearance (P = 0.042) and feeling constantly occupied (P < 0.001). Earlier symptom onset and longer dietary restrictions were associated with higher anxiety levels. Conclusion: While provocation tests did not significantly increase overall anxiety or depression, they triggered specific emotional stressors in mothers. These findings highlight the need for psychosocial support during food allergy management. Future longitudinal studies should explore the long-term psychological effects of food allergies on caregivers.
Study objective Food allergy is a growing public health concern, and legumes represent an important group of allergens, particularly in regions where they are consumed early and frequently in childhood. Data on the clinical characteristics of legume allergy in children from Turkey remain limited. To evaluate the clinical features, co-sensitization patterns, and tolerance development in children with legume allergy in a tertiary pediatric allergy clinic. Patients and methods This retrospective study included children who presented with suspected legume allergy (excluding peanut-only allergy) between 2021 and June 2023. Demographic data, type of allergic reaction, coexisting atopic diseases, laboratory findings, and outcomes of skin prick tests and oral provocation tests (OPT) were reviewed. Statistical analyses were performed using SPSS 24.0, with P < 0.05 considered significant. Results Twenty-three children (median age: 3 years, 56.3% female) were included. Lentil was the most frequent allergen (82.6%), followed by green lentil (39.1%), chickpea and peanut (34.8% each), bean (17.4%), and pea (4.3%). Urticaria was the most common manifestation (78.3%), and anaphylaxis occurred in 4 patients (17.4%), most often due to lentils. Multiple legume allergies were present in 52.2% of cases. Coexisting food allergy was observed in 47.8%, most commonly egg allergy. After a median 24-month follow-up, tolerance was achieved in 21.7% of patients who underwent OPT. Conclusion Lentil is the most common cause of legume allergy among Turkish children, often presenting at an early age and occasionally leading to anaphylaxis. Multiple legume allergies and coexisting food allergy, particularly to egg, are frequent. Tolerance development occurs in about one fifth of cases. Larger prospective studies are needed to better define the natural history of legume allergy in this population.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the second most frequently reported cause of drug hypersensitivity reactions in children, following beta-lactams. Although tolerance development over time has been described in NSAID hypersensitivity, the optimal timing and frequency of reassessment in pediatric patients remain unclear. Current guidelines recommend periodic reevaluation but do not propose specific intervals, creating uncertainty in daily clinical practice. We report a pediatric case highlighting early identification of tolerance following drug provocation test (DPT) - confirmed NSAID hypersensitivity. Given the limited antipyretic and analgesic options available in pediatric practice, early recognition of tolerance has important clinical implications. This case underscores the need for pediatric-specific reassessment strategies and prospective studies to define evidence-based intervals for reevaluation in NSAID hypersensitivity.
Introduction. - Le propofol est un agent hypnotique intraveineux, couramment utilis & eacute; comme anesth & eacute;sique dans l'induction et l'entretien des anesth & eacute;sies g & eacute;n & eacute;rales. Les anaphylaxies p & eacute;riop & eacute;ratoires impliquent de nombreuses mol & eacute;cules mais l'imputabilit & eacute; du propofol reste rare surtout d & egrave;s la premi & egrave;re exposition. Observation. - Un patient de 25 ans est op & eacute;r & eacute; pour la premi & egrave;re fois en septembre 2024 d'une septoturbinoplastie sous anesth & eacute;sie g & eacute;n & eacute;rale. L'induction est r & eacute;alis & eacute;e par sufentanil, k & eacute;tamine, propofol, et les traitements associ & eacute;s sont m & eacute;thylprednisolone et lidoca & iuml;ne. En perop & eacute;ratoire, le patient pr & eacute;sente une anaphylaxie de grade 3. Les taux des tryptases percritiques & eacute;taient de 9,73 & micro;g/L & agrave; 30 min et 12,3 & micro;g/L & agrave; 1 h 30 pour une tryptase basale & agrave; 2,94 & micro;g/L. Les tests cutan & eacute;s r & eacute;alis & eacute;s 6 semaines plus tard & eacute;taient n & eacute;gatifs pour k & eacute;tamine, propofol, sufentanil, lidoca & iuml;ne, m & eacute;thylprednisolone. Un test de provocation au propofol est r & eacute;alis & eacute;, revenant positif au seuil de 1 mg. Discussion. - Notre cas d & eacute;montre une anaphylaxie IgE-m & eacute;di & eacute;e au propofol par le seul test de provocation et ceci lors d'une premi & egrave;re exposition perop & eacute;ratoire. Les m & eacute;canismes de sensibilisation crois & eacute;e restent rares mais possibles, notamment via les cosm & eacute;tiques, ce que nous avons recherch & eacute; chez notre patient, notamment par l'interm & eacute;diaire d'une cr & egrave;me visage dermatologique & agrave; laquelle il a r & eacute;agi il y a plusieurs ann & eacute;es. Conclusion. - Les anaphylaxies au propofol d & egrave;s la premi & egrave;re exposition perop & eacute;ratoire sont possibles. Ce cas souligne l'importanced'explorations exhaustives des anaphylaxies perop & eacute;ratoires, incluant, si n & eacute;cessaire, la r & eacute;alisation s & eacute;curis & eacute;e de tests de provocation au propofol. (c) 2025 Les Auteurs. Publie par Elsevier Masson SAS au nom de Societe franc & cedil;aise d'allergologie. Cet article est publie en Open Access sous licence CC BY (http://creativecommons.org/licenses/by/4.0/).
