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Biomedical subjects

D A Moneret-Vautrin

Publications and source records attributed to D A Moneret-Vautrin.

At least 19 recordsLinked to original sources
PubMed1992

Life-threatening anaphylactoid reactions to propofol (Diprivan)

Fourteen patients who had had a life-threatening reaction within a few minutes after receiving propofol (Diprivan) were investigated for anaphylaxis 4-6 weeks after the incident. Three kinds of immunologic tests were carried out: skin tests (prick tests and intradermal tests with the drugs used and Intralipid, the solvent for propofol), a leukocyte histamine release test, and a radioimmunoassay (RIA) of immunoglobulin E (IgE) against propofol and muscle relaxants, when they had been given with propofol. It had been previously shown that these were always negative in patients anesthetized with propofol without any complications. Thirteen of the 14 patients had at least one positive test supporting hypersensitivity to propofol; 2 patients had three tests positive; 4 had two tests positive; and 7 had one test positive. The skin tests with Intralipid were negative in 4 patients whose tests with propofol were positive. Two patients who had been given muscle relaxants at the same time as the propofol had positive IgE-RIA to both drugs. In one patient, results of all the tests remained negative, and the mechanism involved in the reaction remained unidentified. It is note-worthy that 9 patients of 14 had allergic histories that were known before the anesthetic (atopy; allergy to antibiotics, muscle relaxants, lidocaine, colloids) and that none of the patients had ever received propofol or Intralipid before. It is possible that the IgE that linked abnormally with the propofol had specific binding sites for the phenyl nucleus and the isopropyl groups, which are present in propofol and many other drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Clinical evaluation of in vitro leukocyte histamine release in allergy to muscle relaxant drugs.

We have evaluated the in vitro leukocyte histamine release tests for the diagnosis of allergy to muscle relaxant drugs in 40 patients (Group A) and a control group of 44 subjects with negative leukocyte histamine release (Group B). Non-IgE dependent histamine release, expressed as a percentage of the total blood histamine, was 3.94% +/- 0.49 in Group B. The upper limit of positivity was estimated to be 5% (mean + 2 SD). Leukocyte histamine release tests were positive in 65% of the patients from Group A. The concordance between LHR and QAS-RIA was 64%. The maximal histamine release was observed at dilutions of 10(-2)-10(-4) in 20 of the 26 positive cases. The maximal histamine release was 43.8% +/- 23.3. The spontaneous histamine release was as low as 1.7% +/- 1.1. Cross-reactivity among the 5 different muscle relaxant drugs has been investigated and compared by intradermal testing. The muscle relaxant drugs which gave the lower skin reaction (M2) and the drug responsible for shock (M1) were selected for the study of in vitro leukocyte histamine release. Of 20 M2. All of the 10 cases had negative ID tests with M2. Three of these patients subsequently underwent general anesthesia with the muscle relaxant chosen as harmless (M2) without any clinical reaction.

Adult↗
PubMed1992

[Allergic asthma to latex, proven by a bronchial provocation test].

The authors report the case of a female cook who develops contact urticaria associated with rhinitis and asthma-type dyspnea when using rubber gloves in the course of her work. Allergy to latex was confirmed by a PRICK-test with latex, the presence of specific IgE in the serum, and the onset of contact urticaria after putting on gloves. A latex glove was rinsed with 10 cc of distilled water and the resulting solution, used as a spray, brought on a bronchospasm in the first two minutes. This bronchial provocation test proves that latex can cause asthma-type dyspnea when work involves contact with the substance. The speed of onset and intensity of the respiratory symptoms observed show that such a provocation test must be carried out with extreme care in patients with a marked sensitivity to latex. The future lies in the possibility of easily standardizing the latex protein concentration in order to be able to administer progressive doses without any systemic risk. This case draws attention to the probably underestimated possibility of latex-induced asthma in all subjects who are brought into repeated contact with latex, whatever their profession.

Adult↗
PubMed1992

[Anaphylaxis caused by carboxymethylcellulose: report of 2 cases of shock from injectable corticoids].

Two cases of anaphylactic shock are reported, occurring after intra-articular injections of corticosteroids, containing carboxymethylcellulose (CMC), benzylic acid, polysorbate 80, and merthiolate. Skin tests and leukocyte histamine release are positive to CMC and negative to the other substances including the corticosteroids: prednisolone acetate and cortivazol . No cross-reactivity with hydroxypropylcellulose was demonstrated. These tests lead to incriminate CMC in these patients. Anaphylaxis to CMC seems exceptional, though CMC is widely used in agro-alimentary and pharmaceutical industries, as well as hydroxypropylcellulose. In one case, the possibility of a sensitization by CMC as a food additive is discussed, insofar as the patient has a fixed eruption which has been suspected to be owed to intolerance to food additives.

Anaphylaxis↗
PubMed1992

[Local immunologic system of the nose and paranasal sinuses].

The mucus membranes of the nasal chambers may be compared to a local immune system which has been called the NALT. The submucosa contains a lymphoid infiltration of T-helpers, T-suppressors and a set of plasma cells capable of synthetizing four IgG subgroups, IgM, IgA and IgD. The IgA plasma cells are most numerous. There is no local synthesis of IgE. Macrophages and langerhans' giant cells are present. The epithelium is an immunological entity which is composed, in addition to secretory cells, of uliated cells, lymphocytes, and M cells. The epithelium is able to synthesize secretory component and allows the transport of IgA and IgM into the secretions. The NALT has multiple immunological functions: antigenic information, humoral immune response, and expression of local cellular immunity. Modifications in T lymphocyte subpopulations are observed in allergic rhinitis. Secreted interleukins modify the local efflux and affluence of effector cells (mastocytes and eosinophils). Abnormalities of the NALT are characteristic of deficiency in humoral IgA and IgG subgroups. The possible presence of alterations of cellular immunity in chronic rhinosinusitis has been suggested.

Humans↗
PubMed1992

NARES: a model of inflammation caused by activated eosinophils?

Twenty patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 20% of total leucocytes in nasal secretions (NARES). Nasal endoscopy with biopsies from the middle turbinate and sinus CT were performed. Biopsies were processed for histological examination and for immunofluorescence. The clinical progress during treatment was scrutinized. An acute congestive aspect of the nasal mucosa was noted in 4 cases, and micropolyposis in 9 cases. Sinus CT showed opacity of the ethmoidal cells in 87% of cases (maxillary sinuses: 75%; frontal sinus: 46%; sphenoidal sinus: 31%). An eosinophilic infiltrate of the nasal mucosa was constituted in 9 cases: In 6 cases, the cells expressed the Fc epsilon RII receptor, recognized by the monoclonal antibody Bb10. Anti-H1 drugs usually failed to result in a clinical improvement and local eosinophilia was not changed. Local corticoids were more effective but not sufficient in some cases, so that oral corticotherapy was needed. Ethmoidectomy was performed in three cases. NARES seems to evolve in three stages: (1) migration of eosinophils from the vessels to the secretions; (2) retention of eosinophils in the mucosa which might be linked to activation of unknown origin; (3) nasal polyposis. Numerous interactions between irritation of the epithelium, release of substance P, and eosinophils, lead to the hypothesis of a neurogenic origin of NARES.

Adult↗
PubMed1992

Incidence of medico-surgical treatment for nasal polyps on the development of associated asthma.

The surgical treatment of nasal polyps (in asthmatic patients) is still controversial today because of the contradictory, inconsistent, and unforeseen results reported in the literature. The 50 patients included in this study (mean age 49 years, range 25-67 years) came for a check-up on an average of 18 months (lower limit 12 months, upper limit 40 months) after a radical endoscopic intranasal ethmoidectomy. Thirty patients suffered from polyps and bronchial hyperreactivity; 12 patients in this group also suffered from aspirin intolerance. Twenty patients suffered from nasal polyps alone, and served as a control series. The following parameters were methodically noted relative to the date of ethmoidectomy: 1) the frequency of attacks and possible intervals of respiratory difficulty, pre- and postoperatively; 2) the basic treatment for the asthma, and the difference in size of the therapeutic doses necessary and/or the elimination of one or more therapeutic classes; 3) bronchospasticity, evaluated pre- and postoperatively by auscultation for wheezing and peak flow measurements. A bronchial challenge with carbamyl choline and a four-doses aspirin challenge over two days (10 mg, 50 mg, 100 mg, 400 mg) were carried out pre-and postoperatively in the absence of contra-indications. Ninety-one per cent of the patients have improved and now live in less discomfort. The factors studied show a lower frequency of attacks, a distinct decrease of respiratory difficulty, less need for anti-asthmatic medication and especially less oral corticoids, and a marked improvement in functional respiratory test. The carbamyl choline test confirms these data and even shows the totally reversible nature of nonspecific bronchial hyperreactivity in 30% of these patients. This series is too limited for us to say that intolerance to aspirin is reversible; perhaps only the reactivity threshold changes. In the 20 subjects with nasal polyps alone, no case of asthma have been recorded since the operation. Improvement of the asthmatic condition may be partly dependent upon a global diagnosis and treatment of the patient by the pneumo-immunoallergologist and the ENT-specialist. However, the nature of the surgical act seems to be of prime importance, and we must insist on the need for a radical marsupialization of the paranasal sinuses.

Aspirin↗
PubMed1992

[Hypersensitivity accidents to thrombin following the use of biological glues].

Biological adhesives are made of human plasma and bovine heterologous proteins. These entail a poorly documented risk of sensitization. We report about two allergic accidents caused by the injection of Tissucol in the pituitary mucosa of patients suffering from the Rendu-Osler-Weber disease. The clinical picture of the first case was that of a serum sickness, and leukocytoclastic vasculitis was demonstrated. The second case was a delayed hypersensitivity accident, which was confirmed by the subsequent allergological investigation. Although the responsibility of thrombin seems to be evidenced in these two cases, it nevertheless remains exceptional. However, the risk of sensitization following repeated injections of heterologous proteins in a mucosa with a particularly high immunological responsiveness must be well-known. The increasing use of these biological products will probably result in a growing number of accidents, and we must now contemplate the possibility of screening this sensitization before using biological adhesive. Finally, the possibility of latent sensitization by the ingestion of beef must also be considered.

Aged↗
PubMed1992

[Cytometry of nasal secretory eosinophilia].

Nasal secretory eosinophilia was evaluated in inflammatory chronic rhinitis by a cytometric method. Thirteen control subjects and 97 patients (nasal polyps = 44; chronic sinusitis = 26; chronic rhinitis = 27) took part in this study. Secretory eosinophilia was low in the control group (0.3 +/- 0.2 to 1.3 + 0.8%), compared to: 13.8 +/- 8.2 to 15 +/- 7.6% in idiopathic chronic rhinitis, 16.3 +/- 7.3 to 22.7 +/- 10.2% in perennial allergic rhinitis, 18.5 +/- 6 to 25.3 +/- 6.1% in nasal polyps, 23.1 +/- 1.1 to 25.9 +/- 8.6% in nasal polyps with asthma, 27.3 +/- 7.1 to 30.3 +/- 7.8% in aspirin triad. The NARES syndrome was clearly individualized with a secretory eosinophilia between 48 +/- 16.9 and 58.8 +/- 10.7%. Nasal cytometry is a new method that confirms the role of secretory eosinophilia as an interesting marker in the study of inflammatory chronic rhinitis. Nevertheless reference values would be established only after a better knowledge of cell kinetics in nasal secretion under normal and pathological conditions.

Chronic Disease↗
PubMed1991

[Food allergy].

Ubiquitous and relatively frequent, the food allergy corresponds to the clinical features related to an IgE dependent immunological response, directed against food allergens. Food allergens are mostly glycoproteins contained into eggs, fishes, seafood and some vegetables. Often associated with other atopic diseases, food allergies can be diagnosed by the identification of specific IgE and especially by oral provocative tests. Treatment of these allergies includes dietetic measures, pharmacological therapies and desensitization.

Allergens↗
PubMed1991

Evaluation of a new reactive solid phase for radioimmunoassay of serum specific IgE against muscle relaxant drugs.

Until now, immunoassays for detection of anti-muscle relaxant IgE in serum have been performed with the drug coupled to epoxy-activated Sepharose or to RAST papers dics. In the present work we have used a quaternary ammonium-Sepharose in which the quaternary ammonium reactive group (choline chloride) was directly coupled to Sepharose via an ether linkage. 50 microliters of the quaternary ammonium solid phase (QAS) was incubated with 50 microliters of serum for 3 h, washed, incubated 18 h with 125I-anti-IgE and washed again. The results were expressed as the percentage of 125I-anti-IgE absorbed onto the solid phase. The results were at 1.3 +/- 0.5% for 20 control sera, with an upper normal limit estimated to 2.3%. The within-run reproducibility ranged from 3.2% to 10.0%. The results were significantly correlated with those obtained with either alcuronium-epoxy-Sepharose, choline-epoxy-Sepharose, the RAST-alcuronium or with the RAST-succinyl choline (respectively, r = 0.66, r = 0.80, r = 0.81, r = 0.40 and r = 0.85). The values obtained with the sera of 83 patients ranged from 0.3 to 38.5%. The sensitivity was estimated at 87.9%, 66.7% and 40.7% with the QAS-RIA, the RAST-succinyl choline and the RAST-alcuronium, respectively. The inhibition of adsorption of specific IgE onto the gel ranged from 13.0 to 90.6% in presence of 130 nmol of soluble muscle relaxants. In 83.3% of 30 cases, the highest inhibition was obtained with the muscle relaxant which was clinically incriminated.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcuronium↗
PubMed1991

Basophil histamine release in atopic patients after in vitro provocation with thiopental, Diprivan and chlormethiazole.

The degree of histamine release induced by three different anesthetic drugs was studied in vitro using basophil leukocytes from atopic patients (n = 11) and controls (n = 14). In all, eight dilutions (1/2 to 10(-5)) of Diprivan and its solvent Intralipid, thiopental and chlormethiazole in aqueous solution, were used. Histamine was released in four controls with weak dilutions (1/2 to 10(-5)) of Diprivan (n = 2) and thiopental (n = 2). The reaction with thiopental was greater than that with Diprivan. Five of the atopic subjects released histamine with one or more drug: thiopental and Diprivan four times each, Intralipid twice, and chlormethiazole once. Histamine release was greater in these patients than in controls, and occurred with dilutions ranging from 1/2 to 10(-2), except for one case. It is concluded that atopic patients release histamine with hypnotic anesthetic drugs more easily than normal subjects. In the clinical setting, where blood concentration of the drugs studied is equivalent to a dilution of less than 10(-3), they do not release much histamine. They may be used in atopic patients if the drugs are injected slowly.

Basophils↗