Work-related respiratory symptoms in Champagne vineyard workers.

BACKGROUND: Vineyard workers (VW) are exposed to various respiratory allergens. The aims of the study were to determine the prevalence of work related respiratory symptoms (WRS) in Champagne VW in France and to analyze the relationships between symptoms, occupational exposure and sensitization profile. METHODS: VW of Reims area were prospectively recruited between 2007 and 2010. Demographic and occupational characteristics were recorded. Respiratory symptoms were scored for each month of the past year. Results of respiratory functional tests and skin prick tests for common respiratory allergens, grape moulds and vine pollen were recorded. RESULTS: 307 subjects were included. The prevalence of WRS was 11%. Compared to subjects with symptoms unrelated to work, subjects with WRS were more frequently sensitized to gramineae (34% vs 18%, p = 0.05), described ocular itching (74% vs 37%, p < 0.001) and seasonal symptoms (88% vs 69%, p = 0.03) mainly during lifting and trellising (57% vs 17%, p < 0.001). CONCLUSION: WRS are frequent in Champagne WV and are associated with a sensitization to gramineae and with activities performed close to vine in late spring.

[Birch pollen allergy]. / Allergie au pollen de bouleau.

In the North-East of France, birch is the main tree responsible of spring pollen allergy. However, the epidemiology of sensitization to birch pollen remains unclear. Monosensitization to birch pollen seems rare because of the frequency of cross-reactions with other pollens of the same botanical family via the major allergen Bet v 1. Around one third of patients with allergic rhinoconjunctivitis due to birch pollen are also asthmatics and a half suffer from a food allergy, essentially an oral syndrome due to rosaceae fruits eaten raw. The molecular allergens of birch pollen are well-known and have been cloned. They are available for use in in vitro diagnostic tests and also in clinical trials of specific immunotherapy.

Exercise-induced bronchospasm related to different phenotypes of rhinitis without asthma in primary schoolchildren: the French Six Cities Study.

BACKGROUND: Exercise-induced bronchospasm (EIB) is frequent among asthmatic children. However, opinions differ on the relation between EIB and rhinitis in the absence of asthma. OBJECTIVES: We assessed the relationship between EIB and various phenotypes of rhinitis according to asthmatic status at the general population level in the Six Cities Study. METHODS: Of 7781 schoolchildren with a mean age of 10 years underwent an EIB test and skin prick test to assess allergic sensitization. Their parents completed a standardized questionnaire recording asthma-like symptoms and past-year rhinoconjunctivitis, ever hay fever (EHF), and a score for allergic rhinitis (SFAR) ≥7 as a marker of 'past-year allergic rhinitis'. Exercise-induced bronchospasm was defined as a fall in peak expiratory flow rate ≥15% after exercise. RESULTS: Of the 6813 schoolchildren retained for analysis, 227 (3.33%) experienced EIB after exercise. Odds ratios [95% confidence intervals] between EIB and allergic rhinitis phenotypes in the absence of asthma were 1.56 [0.92-2.63] for EHF, 1.97 [1.16-3.35] for past-year rhinoconjunctivitis, and 1.84 [1.16-2.91] for a SFAR ≥7. Results were unchanged after adjustment for confounders. Multiple correspondence analysis showed that EIB, although related to asthma, constitutes a separate entity. Exercise-induced bronchospasm was not significantly related to familial history of asthma. CONCLUSION: In our large population-based sample of children, different phenotypes of atopic rhinitis were associated with EIB, independently of asthma. Exercise-induced bronchospasm, although related to asthma, seems to constitute a separate entity. CLINICAL RELEVANCE: In this large (6813) sample of 10-year children drawn from the general population, EIB is associated with rhinitis phenotypes in the absence of asthma. Furthermore, it constitutes an entity independent from asthma and is not related to a familial history of asthma. Thus, investigating these symptoms could be important in this disease, as a specific nasal treatment might improve EIB in these children.

Externalizing and internalizing behavioural problems related to asthma in school children.

We investigated the relationships of behavioural problems as assessed using the standardized Strengths and Difficulties Questionnaire (SDQ) to asthma in view of improving asthma management. Six thousand eight hundred and eighty children (mean age 10.4 years, male: 49%) were recruited in the French 6 Cities Study. Children with abnormal or borderline emotional symptoms (internalizing problems) or conduct problems (externalizing problems) were more asthmatic than others (P < 0.01). Compared to being normal, abnormal emotional symptoms or conduct problems were found to be related to mild-to-moderate persistent asthma (logistic model adjusted odds ratio = 1.55 (95% CI = 1.26-1.90) and 1.42 (95% CI = 1.17-1.71), respectively) and to early-onset asthma (Cox's model Adjusted Hazard Risk = 1.60 (95% CI = 1.27-2.01) and 1.34 (95% CI = 1.05-1.70). Borderline conduct problems were found to be negatively related to parents' knowledge on how to prevent asthma attacks, compared to normal conduct problems [adjusted OR = 0.51 (95% CI = 0.31-0.85)]. Further data are needed to better understand the involvement of behavioural problems in childhood asthma according to phenotypes.

Usefulness of omalizumab in ten patients with severe occupational asthma.

BACKGROUND: The management of severe occupational asthma (OA) remains problematic and new alternative treatments providing better disease control are required, ideally enabling affected individuals to remain in their job. METHODS: Ten patients with severe uncontrolled OA were treated with the monoclonal anti-IgE antibody omalizumab. In six cases the causative agent was a high molecular weight (HMW) compound and in four cases it was a low molecular weight (LMW) chemical. All of the patients had well documented OA despite workplace adjustments. RESULTS: During treatment, nine patients exhibited a lower rate of asthma exacerbations and used less oral or inhaled corticosteroids. Seven patients were able to continue working at the same workplace as before treatment. CONCLUSION: We have demonstrated that omalizumab is a potential treatment for severe uncontrolled OA and enabled seven of the ten patients in the study to remain in their job.

Long-term exposure to close-proximity air pollution and asthma and allergies in urban children.

The aim of this study was to evaluate the impact of urban air pollution, assessed through reliable indicators of exposure, on asthma and allergies in schoolchildren. A validated dispersion model combining data on traffic conditions, topography, meteorology and background pollution was used to relate 3-yrs averaged concentrations of major urban pollutants at the sites of schools to skin prick tests, exercise-induced asthma and reported asthma and allergies in 6,683 children (9-11 yrs) attending 108 schools randomly selected in six French communities. For the 4,907 children who had resided at their current address for the past 3 yrs, asthma (exercise induced, past year and lifetime) was significantly positively associated with benzene, SO(2), particles with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)), nitrogen oxides (NO(x)) and CO. In the same children, eczema (lifetime and past year) was significantly positively associated with benzene, PM(10), NO(2), NO(x) and CO, lifetime allergic rhinitis with PM(10) and sensitisation to pollens with benzene and PM(10). Among the 2,213 children residing at their current address since birth, the associations persisted for lifetime asthma with benzene (adjusted OR per interquartile range (95% CI) 1.3 (1.0-1.9)) and PM(10 )(1.4 (1.0-2.0)), and for sensitisation to pollens with volatile organic compounds (1.3 (1.0-1.9)) and PM(10) (1.2 (1.0-1.9)). Accurately modelled urban air pollution was associated with some measures of childhood asthma and allergies.

Alternaria sensitization and allergic rhinitis with or without asthma in the French Six Cities study.

BACKGROUND: Allergic sensitization to Alternaria has been related to asthma in various studies, but its association with allergic rhinitis is still controversial. OBJECTIVES: The aim of this study was to assess at the population level the relationships in childhood between Alternaria sensitization and 'past-year rhinoconjunctivitis' (PYRC), 'ever hay fever' (EHF) and 'ever allergic rhinitis caused by allergens other than pollens' (EAR) according to the presence or the absence of asthma. METHODS: This study is part of the Six Cities Study, the French contribution to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II. Children underwent skin prick test (SPT) to Alternaria and parents filled a standardized medical questionnaire. RESULTS: Some 6726 children with a mean age of 10 years were examined. The overall prevalence of Alternaria sensitization was 2.8%, 0.8% for monosensitization. Prevalences of symptoms in sensitized children were 27.7% for PYRC, 27.0% for EHF and 30.4% for EAR. Adjusted Odds Ratios (OR) between Alternaria sensitization and allergic rhinitis phenotypes were 2.34 (95% confidence interval: 1.51-3.63) for PYRC, 2.40 (1.65-3.50) for EHF and 2.95 (2.05-4.23) for EAR. The relationship still remained in the case of monosensitization to Alternaria for both PYRC and EAR when excluding the asthmatic children [OR = 3.87 (1.54-9.78) and 2.88 (1.10-7.55) respectively]. CONCLUSION: In our population-based sample of children, we found a link between Alternaria sensitization and allergic rhinitis, independently of asthma, which is compatible with the mechanisms of deposition of Alternaria in the upper airways.

Anaphylactic reaction to hydroxyzine in an anesthetized patient.

A case of anaphylaxis occurring during a general anesthesia is presented. The reaction was severe with bronchospasm and hypotension (grade 2 in the severity of per-operative anaphylactic shock). The responsibility of hydroxyzine, administered for premedication was suspected by intradermal testing with the molecule, which was twice positive at a 10(-2) dilution of the commercial solution. The same test remained negative in 5 control subjects. All the other drugs received during anesthesia gave negative results. Using the same protocol excepted for the use of hydroxyzine a new general anesthesia could be performed under a premedication with dexchlorpheniramine without any allergic reaction. Anaphylactic reactions are very rare with hydroxyzine used in premedication for anesthesia in regard to the large prescription of the drug. Only two previous cases were reported but attention of the allergist must be also pointed towards the medications received in the perioperative period as for the anesthetic drugs.

[Exposure to fine air particles and occurrence of allergic diseases: results of ISAAC-France phase 2]. / Exposition aux particules atmosphériques fines et développement des maladies allergiques de l'enfant. Résultats épidémiologiques issus de l'étude des six villes (ISAAC-2 France).

To evaluate whether fine air particles could be involved in the occurrence of atopy and allergic diseases, we performed a cross-sectional epidemiological survey involving primary schoolchildren living in six French towns with contrasted air pollution levels. Air pollution was measured during a week in the school yards and by standard air monitoring networks. Children get an examination in school looking for atopic dermatitis and bronchial hyperresponsiveness assessed by a standardized run test. Besides, parents or guardians provided past medical history and environmental data, especially on passive smoking. Overall, 5,338 children, aged 10.4 (+/-0.7) years, coming from 108 different schools and 401 different classes were included in the survey. Taking into account potential confounders, high exposure to proximity PM(2.5) was linked to a higher point prevalence of atopic dermatitis and hyperresponsiveness, to a higher cumulative prevalence of allergic asthma and a higher sensitization rate to common indoor allergens. Thus, these data suggest that chronic exposure to urban fine particles could be a risk factor for atopy, hyperresponsiveness and asthma.

Coincidence measurement of residues and light particles in the reaction 56Fe+p at 1 GeV per nucleon with the spallation reactions setup SPALADIN.

The spallation of 56Fe in collisions with hydrogen at 1A GeV has been studied in inverse kinematics with the large-aperture setup SPALADIN at GSI. Coincidences of residues with low-center-of-mass kinetic energy light particles and fragments have been measured allowing the decomposition of the total reaction cross section into the different possible deexcitation channels. Detailed information on the evolution of these deexcitation channels with excitation energy has also been obtained. The comparison of the data with predictions of several deexcitation models coupled to the INCL4 intranuclear cascade model shows that only GEMINI can reasonably account for the bulk of collected results, indicating that in a light system with no compression and little angular momentum, multifragmentation might not be necessary to explain the data.

[Mosquito bites allergy, which prevention?]. / Réactions allergiques aux piqûres de moustiques, quelle prévention?

Mosquito bites may induce allergic reactions in children. Usually underestimated, these reactions are often cutaneous and difficult to distinguish from non-specific histaminic phenomena. Recently, the identification of major allergens in mosquito saliva has allowed the achievement of recombinant allergens, which should facilitate the diagnosis and treatment of allergic reactions. Preventive cares must be performed in all children with large reactions, allergic or even non-allergic. Prevention consists in cutaneous protection, the use of repellents (with special attention to their toxicity), and antihistamines. A practical sheet for patient is provided.

Long-term exposure to background air pollution related to respiratory and allergic health in schoolchildren.

BACKGROUND: The impact of air pollution on asthma and allergies still remains a debate. OBJECTIVE: Our cross-sectional study was intended to analyse the associations between long-term exposure to background air pollution and atopic and respiratory outcomes in a large population-based sample of schoolchildren. METHODS: Six thousand six hundred and seventy-two children aged 9-11 years recruited from 108 randomly schools in six French cities underwent a clinical examination including a skin prick test (SPT) to common allergens, exercise-induced bronchial reactivity (EIB) and skin examination for flexural dermatitis. The prevalence of asthma, allergic rhinitis (AR) and atopic dermatitis was assessed by a standardized health questionnaire completed by the parents. Three-year-averaged concentrations of air pollutants (NO2, SO2, PM10 and O3) were calculated at children' schools using measurements of background monitoring stations. RESULTS: After adjusting for confounders, EIB, lifetime asthma and lifetime AR were found to be positively related to an increase in the exposure to SO2, PM10 and O3. The adjusted odds ratios (aOR) per increase of 5 microg/m3 of SO2 was 1.39 (95% confidence interval (CI)=1.15-1.66) for EIB and 1.19 (1.00-1.41) for lifetime asthma. The aOR for lifetime AR per increase of 10 microg/m3 of PM10 was 1.32 (CI=1.04-1.68). Moreover, SPT positivity was associated with O3 (aOR=1.34; CI=1.24-1.46). Associations with past year symptoms were consistent, even if not always statistically significant. Results persisted in long-term resident (current address for at least 8 years) children. However, no consistent positive association was found with NO2. CONCLUSIONS: A moderate increase in long-term exposure to background ambient air pollution was associated with an increased prevalence of respiratory and atopic indicators in children.