But de l’étude Évaluation de l’intérêt diagnostique du test d’activation des basophiles (TAB) par cytométrie en flux dans l’allergie aux curares. Patients et méthodes Cent vingt et un patients de plus de 18 ans ayant présenté un choc de grade II à IV ont été inclus dans 9 CHU français. La conclusion de l’allergo-anesthésiste est basée sur la clinique, les tests cutanés (TC) et la biologie. Les allergènes testés sont les sept curares disponibles au moment de l’étude et le mélange des sept curares, les plus fréquemment utilisés étant le suxaméthonium, le rocuronium et l’atracurium. Le TAB a été effectué selon le protocole du laboratoire Bühlmann et ses résultats sont exprimés en pourcentage de basophiles exprimant le CD63 (%CD63) et en index d’activation (IA) calculé selon un algorithme dédié. Résultats Sur 100 dossiers retenus, les valeurs prédictives positives (VPP) et négatives (VPN) des TC sont respectivement de 100 % et de 75 %. Pour le TAB, sur 64 dossiers exploitables, la VPP est de 100 % et la VPN de 41 % pour les résultats exprimés en %CD63 et la VPN de 51 % pour l’index d’activation. La dépendance calculée sur l’ensemble des dossiers entre les TC et le TAB est significative (khi2 ; p<0,001) pour le suxaméthonium et le rocuronium. La tryptase est élevée dans 98 % des cas d’hypersensibilités immédiates (HSI) confirmées aux curares. Une spécificité de 100 % est observée pour les IgE spécifiques pour des valeurs≥2 kUA/L. Pour ce seuil, la VPP est de 100 % et la VPN de 27 %. Conclusion Les caractéristiques des TC observées dans cette étude sont conformes aux données de la littérature, la VPN du TAB étant plus faible que celle des TC. Toutefois, la VPP élevée du TAB (100 %) est en faveur de son utilisation pour le diagnostic d’une HSI aux curares et pour la recherche d’un curare négatif dans le cas d’une intervention ultérieure nécessitant l’utilisation d’un curare chez un sujet ayant présenté préalablement une HSI aux curares. La sensibilité plus faible du TAB par rapport à celle des TC peut être améliorée par l’analyse simultanée de l’immunomodulation d’un deuxième marqueur d’activation plus précoce que le CD63, tel que l’IgE membranaire.

Aim of the study. - Evaluation of the diagnostic value of the basophil activation test (BAT) by flow cytometry in allergy to neuromuscular blocking agents (NMBA). Patients and methods. - One hundred and twenty-one patients older than 18 having experienced a grade II to IV peranesthetic shock were included in nine French hospitals. The final conclusion of the allegro-anesthesiologist was based on clinical and biological data and on skin tests, representing the "gold standard" of muscle relaxant agent's allergy diagnosis. The most frequently used NMBAs were suxamethonium, rocuronium and atracurium. Skin tests were performed according to EAACI recommendations and BAT according to B & uuml;hmann's laboratory protocol. BAT results were expressed in percentage of basophils expressing CD63 (%CD63) and in an activation index (AI) calculated according to a specific algorithm. Results. - Out of the 100 cases included, the positive (PPV) and negative (NPV) predictive values for ST were respectively 100% and 75%. For BAT, out of 64 cases, the PPV and NPV were respectively 100% and 41% (%CD63) and 100% and 51% (AI). The khi2 test calculated between ST and BAT was statistically significant (P < 0.001) for suxamethonium and rocuronium. Using a threshold of 2 kUA/L (threshold corresponding to 100% specificity), the PPV and NPV of morphine specific IgEs were respectively 100% and 27%. Cross- reactions observed by TC and TAB for benzylisoquinolinium and aminosteroid compound groups were not significantly different. Conclusion. - The ST characteristics observed in this study are consistent with literature data with a lower NPV but a high PPV for BAT authorizing its use for diagnosis and selection of a negative NMBA with a view to subsequent intervention concerning a patient allergic to an NMBA. Its sensitivity is, however, lower than for TC but may be improved by the simultaneous use of an early activation marker as the membrane IgE. (c) 2024 Societe franc,aise d'allergologie. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

To simulate the effects of forest tent caterpillar (FTC) defoliation on trembling aspen growth and mortality, an artificial defoliation experiment was performed over three years in young aspen stands of northwestern Quebec. Defoliation plots of 15 × 15 m were established on three sites, together with associated control stands of pure trembling aspen. In 2007, root collar diameters were measured and positions of all trees were mapped prior defoliation. Severe FTC defoliation was simulated for three successive years (2007–2009) by manually removing all leaves from all but 7–10% of the trees present in the defoliation plots. Yearly surveys of growth and mortality were conducted until 2010 to evaluate defoliation effects on defoliated as well as surrounding undefoliated trees. In absence of other factors, growth and mortality of trembling aspen decreased and increased, respectively, after defoliation. Our study further revealed that small diameter trees died after one year of artificial defoliation, while larger-diameter trees died after repeated defoliations. Distributions of tree mortality tended to be aggregated at small scales (<5 m), corroborating gap patterns observed in mature stands following FTC outbreaks. This experiment revealed that trembling aspen mortality can be directly attributed solely to defoliation. Repeated defoliations during FTC outbreaks have the potential to profoundly modify stand productivity and structure by reducing tree growth and increasing tree mortality in the absence of predisposing factors.

Wheezing and stridor are symptoms induced by airflow obstruction. While wheezing evokes a sub-glottic origin, stridor, which consists of an inspiratory noise, can be related to an obstacle in the upper airways, larynx, or trachea. Asthma is one of the most frequent causes of wheezing. However differential diagnoses must be considered, including chronic obstructive pulmonary disease (COPD), laryngeal dysfunction, and other causes of bronchial hyperreactivity. Different aetiologies resulting in airway mechanical obstruc-tions, such as extrinsic compressions or endobronchial obstacles, for example, foreign bodies, tumors, or mucosal injuries, can induce wheezing. The research on the cause of stridor must differentiate supra-glottic and sub-glottic obstructions, and take into account the onset and the rhythm of the stridor, whether acute, intermittent, or chronic. The diagnosis relies on a detailed clinical history, rigorous clinical exa-minations of the ENT and the respiratory systems, Chest X-Ray and/or CT-scan, analysis of respiratory functional tests and endoscopy.(c) 2023 Societe franc,aise d'allergologie. Published by Elsevier Masson SAS. All rights reserved.

Les sifflements respiratoires témoignent d’un obstacle à l’écoulement de l’air. On individualise le wheezing qui traduit une obstruction à l’étage sous glottique et le stridor, sifflement inspiratoire en rapport avec une obstruction haute intéressant le larynx ou la trachée. Si l’asthme est la principale cause de wheezing, d’autres pathologies peuvent être en cause et constituent son diagnostic différentiel. Il faut surtout insister sur la bronchopneumopathie chronique obstructive (BPCO) et la dysfonction laryngée mais de nombreuses causes d’hyperréactivité bronchique doivent être évoquées de même que toute obstruction mécanique des voies respiratoires, compressions extrinsèques ou formations endobronchiques, corps étrangers, tumeurs, anomalies pariétales. Les étiologies du stridor sont multiples et il faut schématiquement isoler les obstructions sus-glottiques et les obstructions sous-glottiques. En outre, il faut tenir compte de la fréquence du stridor, aigu, intermittent ou chronique. L’examen clinique méthodique, ORL et respiratoire associé au contexte anamnestique est une étape essentielle au diagnostic différentiel, aidée par les techniques d’imagerie, d’endoscopie et par l’étude de la fonction respiratoire.

Las reacciones alérgicas mediadas por IgE (inmunoglobulinas E) después de las picaduras de himenópteros son frecuentes, pero siguen estimándose de forma incompleta en los datos epidemiológicos. Según los estudios, la prevalencia de las reacciones sistémicas es del 0,3-7,5% en la población general y es mucho menor en los niños, del orden del 0,34%. En los casos más graves, la anafilaxia puede causar la muerte. En Francia, la incidencia de la mortalidad por picadura de himenópteros se estima en 0,48 por millón de habitantes por año. Los himenópteros responsables en Francia y en Europa son la abeja, las avispas Vespula y Polistes, los avispones y ocasionalmente los abejorros. La composición de los venenos se conoce cada vez mejor y se han identificado los alérgenos principales. Para desarrollar una reacción alérgica, hay que haberse sensibilizado previamente y haber desarrollado IgE específicas frente a los alérgenos del veneno. Los factores de riesgo que aumentan el riesgo de picaduras y/o que agravan los síntomas alérgicos son los factores ambientales, profesionales (apicultores) o de ocio, así como el tipo de insecto. También se han identificado factores de riesgo relacionados con el contexto (edad avanzada, patología cardiovascular, trastornos mastocíticos francos, elevación de la triptasa sérica basal). La actitud terapéutica ante las reacciones alérgica se basa en una conversación exhaustiva con el paciente y/o la familia para analizar los datos de la anamnesis y ambientales, descartar un diagnóstico diferencial, evaluar los factores de riesgo y las repercusiones sobre la calidad de vida y definir el lugar de la evaluación alergológica que asocia pruebas cutáneas y determinación de la concentración de IgE sérica específica para los extractos de venenos sospechosos. Las medidas terapéuticas de los accidentes alérgicos son las de cualquier manifestación anafiláctica (administración de adrenalina). La prevención se basa en los consejos para limitar los riesgos de nueva picadura y en la prescripción de dispositivos autoinyectores de adrenalina para los niños y adultos que hayan presentado una reacción sistémica moderada a grave que sobrepase los simples signos cutáneos o con alto riesgo de nueva picadura o de reacciones graves (en particular, trastornos mastocíticos). La instauración de una inmunoterapia alergénica (ITA) para el veneno o venenos responsables se basa en unas indicaciones y un protocolo médico bien definidos. Sus resultados son buenos, con una protección frente al riesgo de reacción grave durante una nueva picadura mayor del 75% para la abeja y del 90% para la avispa.

The purpose of this retrospective study was to determine the prevalence of artifacts on whole-body (WB) magnetic resonance imaging (MRI) examination in pediatric patients and identify their causes.A total of 107 pediatric patients who underwent a total of 107 WB-MRI examinations, including short-tau inversion recovery (STIR) and T1-weighted sequences, were included. There were 62 girls and 45 boys with a mean age of 11 ± 3 (SD) years (age range: 2–16 years). WB-MRI examinations were analyzed for the presence of artifacts on STIR and T1-weighted sequences. Artifacts were further assigned to one of eight categories (motion, partial volume, cross-talk, phase sampling, susceptibility, equipment, noise, and “other”) and 19 anatomical sites by a 4-year resident. Prevalence of artifacts were analyzed especially according to hands position during the examination for the upper limbs and patients’ age. Age was expressed as a binary variable using median age (10 years) as the cut-off value. All qualitative variables were compared using chi-square test.A total of 3436 artifacts were found. The STIR sequences showed more “noise” artifacts (93/1038; 8.96%) and more “cross-talk” (102/1038; 9.83%) artifacts than T1-weighted sequences (12/1038 [1.16%] and 7/1038 [0.67%], respectively) (P < 0.001 for both). T1-weighted sequences showed more “equipment” (84/1038; 8.09%) and “stair-step” (a subset of “other”) (41/1038; 3.95%) artifacts than the STIR sequences (39/1038 [3.76%] and 21/1038 [2.02%], respectively) (P < 0.001 and P = 0.01, respectively). T1-weighted sequences showed fewer artifacts on the wrists when the hands were under the bottom (P = 0.001). T1-weighted sequences showed less “equipment” artifacts when the hands were alongside the body (22/296; 7%) than on the abdomen (48/432; 11%) or under the bottom (14/128; 11%) (P < 0.001). STIR sequences showed more “motion” artifacts when the hands were on the abdomen (54/432; 13%) than alongside the body (30/296; 10%) or under the bottom (15/128; 12%) (P < 0.001). WB-MRI examinations had more “susceptibility” artifacts (38/960; 4%) and more “equipment” artifacts (81/960; 8.4%) in patients older than 10 years than in those under 10 years (23/752 [3.1%] and 42/752 [5.6%]) (P = 0.01 and P < 0.001, respectively).Artifacts on WB-MRI do not affect coronal STIR and T1-weighted sequences equally, so the use of both sequence types appears useful. Hands position should be considered with respect to both diagnostic benefit and safety.

La graine de tournesol est un aliment avec un fort potentiel sensibilisant mais finalement peu d’allergies confirmées. Les modes de sensibilisation sont multiples, respiratoires, digestifs et cutanés. De nombreuses manifestations cliniques ont été décrites, les profils des patients sont également très variés. Des réactions à l’huile de tournesol sont possibles mais exceptionnelles. Des prick-tests avec l’aliment natif et la recherche d’IgE spécifiques confirmeront le diagnostic. La recherche d’allergènes moléculaires a permis d’identifier notamment une LTP et des albumines 2S. Nous rapportons une série de cas déclarés au Réseau d’Allergo-Vigilance® et faisons une revue de la littérature sur le sujet.Sunflower seed is a food with a high sensitising potential but few allergies have been confirmed. Sensitization modes are multiple, respiratory, digestive and cutaneous. Numerous clinical manifestations have been described, and patient profiles are also very various. Reactions to sunflower oil are possible but very rare. Prick tests with the native food and the search for specific IgE antibodies will confirm the diagnosis. The search for molecular allergens has allowed the identification of LTP and 2S albumin. We report a series of cases declared to the Allergy-Vigilance Network®, and review the literature on the subject.

Background: The pathophysiology and the role of allergies(A) and AT in paediatric(ped) OSA-ast are not clear. Objectives: To explore the role of A and AT to AHI/RE in ped OSA-ast. Methods: Cohort study, SPSS analysis on Respiratory Polygraphy(PG) and A profile in children 2-16years old with sleep disorders/OSA. Results: Conclusions: RA+NIgE both correlate to the increase RE>22 and AHI>6,8 implicating that they both contribute to the ped OSA-ast through a common pathophysiological mechanism. Evaluation of RA/ NIGE in separate groups decreases statistical significance, as if comparing similar groups, indicating that they may co-operate in ped OSA-ast. AHI & RE are both correlated to BMI. Increased RE could indicate obesity. AT correlates to decrease AHI<6,8 significantly. As AT & AT+ED seems to decrease AHI, identification of children allergic to RA+NIgE could be a way to help differentiate the group of children with OSA who could mostly benefit from rigorous A and AT to get rid of OSA.

Local and regional reactions to bites from bloodsucking insects are common, often painful and sometimes disabling. With no effective immunotherapy currently available, treatment options are limited to preventing infestations and bites and using symptomatic medications. Simple daily life advice can reduce the risk of bites. This includes installing mosquito screens, modifying work and travel habits to avoid infested areas and treating clothes with an insecticide such as permethrin. Topical repellents are a key protection method, and advice should be sought from a doctor or pharmacist to ensure the most suitable product is used according to the patient's age and level of exposure. They are effective but should be used carefully and with caution. Special care should be taken when used in children and pregnant women due to their potentially toxic effects (they should not be sprayed directly onto the face, for example). Better knowledge of the biology of these insects combined with reasoned use of preventive measures could reduce the impact of these stings and bites. (C) 2021 Elsevier Masson SAS. All rights reserved.

Une nouvelle entité clinique présente chez certains patients atteints d’œsophagite à éosinophiles a été décrite récemment : « Food-induced Immediate Response of the Esophagus syndrome » (FIRE syndrome). Nous rapportons l’observation d’un patient chez qui le diagnostic de syndrome oral, puis de crise aiguë d’asthme a été posé initialement, alors qu’il s’agissait d’un FIRE syndrome faisant retarder le diagnostic d’œsophagite à éosinophiles. Nous détaillons les caractéristiques de ce nouveau syndrome.A new clinical entity, named Food-induced Immediate Response of the Esophagus syndrome (FIRE syndrome), has been recently described in a subgroup of patients suffering from eosinophilic oesophagitis. We report the observation of a patient in whom the diagnosis of oral syndrome and then asthma attack were initially made when it was a FIRE syndrome delaying the diagnosis of eosinophilic esophagitis. We detail the characteristics of this new syndrome.