ABSTRACT
BACKGROUND: Dupilumab is the first biotherapy available for the treatment of moderate-to-severe childhood atopic dermatitis (AD). OBJECTIVE: The aim of this study was to evaluate the effectiveness and safety of dupilumab in daily practice. METHODS: Patients aged 6-11, who had received a first dose of dupilumab, were included in this multicentre retrospective cohort study. The primary endpoint was change in SCORAD after 3 months of treatment. Secondary endpoints were change in IGA score at 3 months, proportion of patients with SCORAD50 and SCORAD75, description of adverse events and proportion of children in our cohort who would be excluded from pivotal phase 3 clinical trial. RESULTS: Eighty patients were included. After 3 months of treatment, there was a significant decrease in SCORAD (mean: 21.8 ± 13.8 vs 53.9 ± 18.5; P < 0.0001) and IGA (1.3 ± 0.8 vs 3.5 ± 0.7; P < 0.0001). Conjunctivitis was observed in 11.3% (n = 9/80); three patients experienced dupilumab facial redness (DFR); 17.5% (n = 14/80) reported injection site reactions; 6.3% (n = 5/80) discontinued treatment. 61.2% (n = 49/80) children were ineligible in the phase 3 trial. LIMITATIONS: There is no control group. Because it was a real life study based on information from patient medical records in a French multicentre cohort, we cannot rule out the presence of reporting bias generated by the use of patient reported characteristics and missing information. CONCLUSION: These real-life data confirm the efficacy and safety of dupilumab in children with moderate to severe AD extended to dyshidrosis and atopic prurigo, but it also revealed a lower frequency of DFR and conjunctivitis. However, administration in injectable form may be a barrier in this age group.
Subject(s)
Conjunctivitis , Dermatitis, Atopic , Child , Humans , Dermatitis, Atopic/drug therapy , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Conjunctivitis/chemically induced , Cohort Studies , Immunoglobulin ASubject(s)
Dermatitis, Atopic , Eczema , Pharmaceutical Preparations , Child , Cohort Studies , Cyclosporine , Dermatitis, Atopic/drug therapy , HumansSubject(s)
Dermatitis, Contact/etiology , Foot/pathology , Hydrazines/toxicity , Imines/toxicity , Leg/pathology , Adolescent , Dermatitis, Contact/diagnosis , Humans , Male , Patch TestsSubject(s)
Obesity/complications , Urticaria/complications , Adrenal Cortex Hormones/administration & dosage , Adult , Body Mass Index , Chronic Disease , Female , France , Histamine Antagonists/therapeutic use , Humans , Male , Middle Aged , Severity of Illness Index , Urticaria/drug therapy , Waist CircumferenceSubject(s)
Burns, Chemical/complications , Hair Bleaching Agents/adverse effects , Skin Diseases, Vesiculobullous/etiology , Administration, Topical , Adrenal Cortex Hormones/therapeutic use , Adult , Female , Humans , Skin Diseases, Vesiculobullous/drug therapy , Skin Diseases, Vesiculobullous/pathologyABSTRACT
BACKGROUND: Skin patch-tests in dermatology-allergology practice require good preparation. To this end, the dermatology-allergology group of the French Society of Dermatology introduced an information notice informing patients about patch testing procedures. The aim of this study was to evaluate the utility and understanding of the notice. PATIENTS AND METHODS: The information notice was sent out to patients before testing. On the day of the test, a questionnaire was submitted to patients to evaluate their comprehension of the notice. Another questionnaire was submitted simultaneously to the dermatology-allergology practitioner to evaluate whether the patient had complied with the guidelines given in the information notice. Paired questionnaires were analyzed for this study. RESULTS: Eight dermatology-allergology hospital departments participated in the study and collected 921 paired questionnaires over a period of 18months. Among the vast majority (96.2%) of patients who had read the information notice, most found it useful (98.8%), easy to read (97.4%), and appropriate (91.5%). Ten percent of patients had difficulty understanding. CONCLUSION: This study shows that the information notice was clear and explicit for the immense majority of patients. Thanks to the feedback of a number of patients, the information notice was further improved to enhance patient understanding.
Subject(s)
Patch Tests , Patient Education as Topic , Comprehension , Humans , Patient Compliance , Prospective Studies , Surveys and QuestionnairesSubject(s)
Angioedema/physiopathology , Angioedemas, Hereditary/physiopathology , Bradykinin/physiology , Algorithms , Angioedema/classification , Angioedema/diagnosis , Angioedemas, Hereditary/classification , Angioedemas, Hereditary/diagnosis , Angioedemas, Hereditary/genetics , Complement C1 Inhibitor Protein/metabolism , Cross-Sectional Studies , Diagnosis, Differential , Humans , IncidenceSubject(s)
Cosmetics/adverse effects , Dermatitis, Contact/etiology , Eyelid Diseases/chemically induced , Adult , Female , Humans , Patch TestsSubject(s)
Angioedema/drug therapy , Bradykinin , Tranexamic Acid/administration & dosage , Adolescent , Adult , Aged , Angioedema/etiology , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Retrospective Studies , Tranexamic Acid/therapeutic use , Treatment Outcome , Young AdultABSTRACT
We describe the methods used in patch-testing: various kinds of chamber tests, the standard and additional series of patch-tests, mix of allergens, information about allergens comprising the European Standard Series.
Subject(s)
Allergens , Dermatitis, Allergic Contact/diagnosis , Patch Tests/methods , HumansSubject(s)
Antidepressive Agents, Tricyclic/adverse effects , Mianserin/analogs & derivatives , Stevens-Johnson Syndrome/chemically induced , Adult , Antidepressive Agents, Tricyclic/therapeutic use , Depression/drug therapy , Humans , Male , Mianserin/adverse effects , Mianserin/therapeutic use , Mirtazapine , Patch Tests , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/pathologySubject(s)
Allergens/toxicity , Dermatitis, Contact/etiology , Dermatitis, Occupational/etiology , Disinfectants/toxicity , Occupational Exposure/adverse effects , Operating Room Nursing , Polyethylene Glycols/toxicity , Quaternary Ammonium Compounds/toxicity , Urticaria/chemically induced , Dermatitis, Contact/diagnosis , Dermatitis, Occupational/diagnosis , Humans , Male , Middle Aged , Skin Tests , Urticaria/diagnosisABSTRACT
Allergic contact dermatitis due to mydriatic eyedrops is rare despite extensively used by ophthalmologists. Phenylephrine is responsible for most of the cases in the literature. We reported two other cases due to phenylephrine eyedrops with an unusual evolution characterized by chronic debilitating blepharoconjunctivitis.
Subject(s)
Adrenergic alpha-Agonists/adverse effects , Blepharitis/chemically induced , Conjunctivitis, Allergic/chemically induced , Phenylephrine/adverse effects , Aged , Anesthetics, Local/therapeutic use , Female , Fluorescein/therapeutic use , Fluorescent Dyes/therapeutic use , Humans , Keratitis/chemically induced , Male , Mydriatics/therapeutic use , Ophthalmic Solutions , Retinal Degeneration , Skin Tests , Tetracaine/therapeutic use , Tropicamide/therapeutic useABSTRACT
BACKGROUND: Nickel-elicited systemic contact dermatitis is a rare event seen in previously skin sensitized patients. We report a case of systemic contact dermatitis due to nickel released into the bloodstream from a metal section of a catheter during infusion. CASE REPORT: A 39-year-old woman presented papular and vesicular flexural dermatitis and pompholyx 72h after cervical spine surgery. She received numerous treatments during the perioperative period. A challenge test with one of the suspected treatments, cefazolin, was performed by intravenous infusion over a six-hour period using the same Optiva) peripheral catheter (Johnson & Johnson, USA). Six hours after withdrawal of the catheter, an eruption occurred. A further cefazolin challenge test performed later under identical conditions but using a different type of catheter (nickel-free) was negative. Nickel-elicited systemic contact dermatitis due to nickel release from a catheter was diagnosed. The patient's medical history was notable for contact dermatitis with jewellery. Patch tests confirmed marked nickel sensitization. DISCUSSION: A little-known way of systemic nickel absorption is through insertion of a venous catheter with a metal section containing nickel and a metallic eyelet containing nickel can in fact remain in place after catheter placement. Nickel can thus be released into the circulation during infusion and an eruption may occur during the postoperative period. This diagnosis is noteworthy as such eruptions can easily be mistakenly diagnosed as cutaneous drug eruptions.
Subject(s)
Catheterization, Peripheral/adverse effects , Dermatitis, Contact/etiology , Eczema/chemically induced , Nickel/toxicity , Adult , Catheterization, Peripheral/instrumentation , Cefazolin/administration & dosage , Cervical Vertebrae/pathology , Cervical Vertebrae/surgery , Dermatitis, Contact/pathology , Eczema/pathology , Female , Humans , Jewelry/adverse effects , Medical History Taking , Rickets/surgeryABSTRACT
Two genes of wheat low-molecular-weight glutenin subunits (LMW-GS), B16 and P73, were cloned and expressed in E. coli. They were homologous to proteins encoded respectively at Glu-B3 and Glu-D3 loci. The N-terminal and C-terminal halves of B16 (NB16 and B16C) and the two chimeras combining the halves of the two genes (B16-P73 and P73- B16) were also expressed. All these constructs were compared for their reactivity with IgE from 24 patients suffering from different forms of wheat allergies. The results confirmed that LMW-GSs bound IgE in all adult allergies tested. Strong differences in reactivity between all the constructs were observed. They were disease-dependent. In wheat-dependent exercise-induced anaphylaxis (WDEIA), the reactivity of the constructs depended partly on common epitopes with omega-5 gliadins but also on differences in molecule conformation. The presence of NB16 in the constructs greatly influenced their IgE reactivity.
Subject(s)
Glutens/genetics , Glutens/immunology , Immunoglobulin E/immunology , Wheat Hypersensitivity/immunology , Amino Acid Sequence , Anaphylaxis/immunology , Chimera , Escherichia coli , Exercise , Glutens/chemistry , Humans , Molecular Sequence Data , Molecular Weight , Plant Proteins/chemistry , Plant Proteins/genetics , Plant Proteins/immunology , Recombinant Proteins/chemistry , Recombinant Proteins/genetics , Recombinant Proteins/immunology , Wheat Hypersensitivity/diagnosisABSTRACT
BACKGROUND: Anti-gliadin IgE are expressed in patients with food allergy associated to skin immediate hypersensitivity to hydrolyzed wheat proteins (IHHWP). It is not known if they react with omega5-gliadins, the major allergens in wheat dependant exercise-induced food anaphylaxis (WDEIA), encoded on wheat chromosomes 1B. METHODS: Unmodified gliadins from 14 wheat varieties expressing most of the 1B omega-gliadin alleles, were immunoprobed after SDS-PAGE and blotting, with four sera from patients with IHHWP, and two with WDEIA. Gliadins reacting with IgE were visualized using chemiluminescence and identified according to their mobility and typical SDS-PAGE pattern. The resulting signal was also measured to compare their IgE reactivity. RESULTS: IHHWP and WDEIA sera exhibited distinct patterns of reactivity. IgE of patients with IHHWP reacted mainly with all omega-gliadins alleles and one gamma-gliadin encoded respectively on chromosomes 1D and 1B, but not with any omega5-gliadins alleles as for WDEIA. A few other reactive alleles of omega-gliadins were encoded on chromosomes 1A. Unassigned additional bands of the whole gliadin pattern were also reactive. The four patients with IHHWP exhibited almost the same pattern of reactivity. Main differences concerned band reactivity which modulated the overall reactivity of each wheat variety. CONCLUSIONS: The IgE epitopes involved in IHHWP and WDEIA are different. This suggests that the protein state and the route of exposure to very similar gluten structures, probably orientate the pattern of epitope reactivity and the wheat food allergy manifestations.
Subject(s)
Gliadin/genetics , Gliadin/immunology , Hypersensitivity, Immediate/genetics , Wheat Hypersensitivity/genetics , Alleles , Allergens/adverse effects , Allergens/genetics , Allergens/immunology , Anaphylaxis/genetics , Anaphylaxis/immunology , Dermatitis, Atopic/etiology , Dermatitis, Atopic/genetics , Dermatitis, Atopic/immunology , Electrophoresis, Polyacrylamide Gel/methods , Exercise , Humans , Hypersensitivity, Immediate/blood , Hypersensitivity, Immediate/immunology , Immunodominant Epitopes/genetics , Immunodominant Epitopes/immunology , Immunoglobulin E/blood , Immunoglobulin E/genetics , Immunoglobulin E/immunology , Luminescent Measurements/methods , Triticum/adverse effects , Triticum/genetics , Triticum/immunology , Wheat Hypersensitivity/blood , Wheat Hypersensitivity/immunologyABSTRACT
We reported an anaphylaxis after oral intake and contact urticaria due to polyethylene glycols.