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Biomedical subjects

F Rancé

Publications and source records attributed to F Rancé.

At least 19 recordsLinked to original sources
PubMed2000

[Relationship between respiratory syncytial virus bronchiolitis and asthma].

Data of the literature over the last 20 years indicate that infantile asthma, although heterogeneous, often appears following RSV bronchiotitis, especially when sufficiently severe to justify hospitalisation. The risk of developing episodes of wheezing (bronchial obstruction syndrome) over the following 2 to 3 years is higher than 50%, but estimations vary according to the authors. Functional disturbances (pulmonary distension, nonspecific bronchial hypperreactivity, hypoxia), with or without associated clinical symptoms, may be observed several months to several years after hospitalisation for bronchiolitis. On the other hand, mild bronchiolitis, and most of the recurrent expiratory obstructive syndromes with asymptomatic free intervals between episodes do not appear to carry a risk of functional sequelae. Children suffering from severe bronchiolitis usually develop a severe bronchial obstruction syndrome. In asthma, the percentage of IgE-dependent sensitization is less than 20% before the age of 4 years. The presence of positive skin tests and/or specific serum IgE directed against the usual allergens are associated with the persistence of asthma during the childhood. Similarly, the appearance of wheezing after the age of 3 years (or recurrence after this age) is associated with the persistence of asthma. Prospective studies of cohorts followed since birth show that pre-existing functional abnormalities can promote the appearance of bronchiolitis and bronchial obstruction syndrome. Asthma in infants comprises several phenotypes with very different prognoses.

Asthma↗
PubMed2000

Mustard allergy in children.

BACKGROUND: Mustard allergy is not well known. This study aimed to assess its clinical features and other associated allergies, and to define skin prick tests (SPT), specific IgE, and dose response by oral food challenge. METHODS: Our study investigated 36 children with positive mustard SPT. The diagnosis of mustard allergy was based on open or single-blind, placebo-controlled food challenge (SBPCFC). We compared the subjects to 22 controls. RESULTS: The initial clinical features were atopic dermatitis (51.8%), and urticaria and/or angioedema (37%). Fifteen children were allergic (positive SBPCFC) and 21 children were nonallergic (negative SBPCFC). Symptoms after mustard ingestion started under 3 years of age in 53.3% of the subjects. There was no significant difference in the food allergies and associated inhalant allergen sensitizations between the two groups. In the allergic group, the mean wheal diameter for mustard SPT was 8.8 mm and the median concentration of mustard serum (s) IgE 14.8 kU/l. The mean cumulative reactive dose were 153 mg. CONCLUSIONS: Allergic reactions to mustard started early in life. Clinical symptoms were not severe in children. Mustard should be included in screening tests of food allergy in children.

Adolescent↗
PubMed2000

[Current childhood food allergies].

Changes of dietary habits, new food technology, international meals and increasing consumption of exotic food has changed the repartition of food allergens. Some food allergens are worrisome and symptoms severe (peanut and nut butters). Others are new and increase strongly: exotic fruits, sesame, mustard and lupin. Primary prevention include avoidance of such food in high risk infants. Product labeling must be improved.

Adolescent↗
PubMed2000

[Prognosis of asthmatic adolescents in adulthood].

Little is known about the long-term outcome of asthmatic adolescents. According to the literature, 20 to 50% of asthmatic adolescents become symptom-free when they become adults. We report 50 cases of asthmatic adolescents, 25 girls and 25 boys, with a mean follow of 4.4 years (range 1-12 years). Only 4 patients (8%) became symptom-free, all 4 were stage I and II patients. One death occurred subsequent to penicillin allergy, but was not related to status asthmaticus. Nor remission was observed in stage III and IV patients, whereas 5.8% and 12% of stage II and II patients respectively grew out of their asthma. The factors predictive of persistent asthma in adulthood were severe asthma at the age of 13 years, female gender, onset of asthma before the age of 7 years, no periodic rhinitis, and exercise induced asthma.

Adolescent↗
PubMed1999

[New food allergies].

RISING INCIDENCE OF FOOD ALLERGIES: Food allergies are becoming more and more common, concerning 3 to 4% of the general population. One out of four persons allergic to nuts, the most frequent food allergen, have severe signs and symptoms. A CLASSICAL DIAGNOSIS: Certain diagnosis of food allergy is established on the basis of labial and oral tests. The dose required to induce a reaction is established by the oral test, giving information about the severity of the allergy and its progression. OTHER ALLERGENS: "Emerging" food allergens include spices and condiments, exotic fruits (kiwi, avocado, cashew and pecan nuts, Brazil nuts), sesame seeds, psyllium, sunflower seeds. Endurance exercise following ingestion of a food allergen can lead to severe anaphylactic reactions. Allergen associations "food-pollen", "latex-food", "mitessnails" have been described. INDISPENSABLE PREVENTION: Avoiding contact is essential. Many allergens are "masked" within prepared foods. Precise labeling, with particular attention to nut content, must be reinforced. Individualized counseling on food allergies should be available for school children. Persons with severe allergies should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids and adrenalin (1 mg/ml).

Arachis↗
PubMed1999

[Allergy to hymenoptera venoms in children].

Incidence of hymenoptera venom allergy in children is about 0.4 to 0.8%. Clinical features usually range from urticaria to anaphylaxis. Fatal reactions can occur but with less frequency than in adults. Allergologic investigations must be performed in children with systemic or generalized reactions after hymenoptera stings, which may lead to venom immunotherapy. Venom immunotherapy is well reported, but protocols differ according to the authors: ultra-rush in 3 h, accelerated in 3 to 5 days and semi-rush in 2 to 8 weeks. Results are always excellent (90 to 100%). We report our experience with 91 children receiving venom immunotherapy. Clinical history and positivity of skin tests indicated immunotherapy. Clinical symptoms were anaphylaxis (15.3%), serious reaction (37.3%) strong reaction (34%), and mild reaction (7.6%). Changes in immunological parameters revealed wide individual variations, not differing from data in the literature, with no correlation with evolution of immunotherapy. Venom immunotherapy appeared with good tolerability in children, whatever the protocol used.

Adolescent↗
PubMed1999

[Food allergens in children].

Food hypersensitivity is increasing, with clinical indications and allergens multiplying and evolving. We report our experience with clinical indications and distribution of allergens in children with food hypersensitivity. Data were established in a prospective study at medical centres in Nancy and Toulouse (France). We studied 378 children with food hypersensitivity indicated by food challenge, which account for 74.2% of food hypersensitivity. Clinical features were: atopic dermatitis (46.5%), urticaria (17.9%), oedema (14.2%), asthma (8.4%), anaphylaxis (5.2%), gastro-intestinal symptoms (2.1%), oral syndrome (1.8%) and rhino-conjunctivitis (0.5%). Five allergens accounted for 82% of confirmed food hypersensitivity: egg (51.8%), peanut (34.3%), milk (11.6%), mustard (8.9%) and codfish (7.1%). Allergens according to the symptoms showed that peanut allergies were more serious than other food allergy. Allergens according to age showed that peanut allergy is the first food allergy occurring after the age of three. There exists a modification in children's allergen distribution. Peanut allergy is increasing seriously, and diagnosis with food challenge is a necessity.

Adolescent↗
PubMed1999

[Allergic bronchopulmonary aspergillosis in children].

Allergic bronchopulmonary aspergillosis (ABPA) associates the development of aspergillus in bronchus and a predominant immediate hypersensitivity for aspergillus antigens. It complicates an old and severe allergic asthma or cystic fibrosis. Its prevalence is not well known. In children, ABPA prevalence is rare, except in cystic fibrosis where 0.6% to 11% of patients can be affected by the disease. Acute exacerbation of the disease favours the development of bronchiectasis and fibrosis. The diagnosis is suggested by an unexplained aggravation of asthma or, in cystic fibrosis, by wheezing, an unsuccessful antibiotherapy, and a recent modification of the chest X-ray. The diagnosis is based upon the presence of seven major criteria or six major criteria and one minor. The follow-up of biological parameters is important for early diagnosis of exacerbations. Some parameters are very sensitive, ie, precipitins and total serum IgE. Systemic corticotherapy is the usual treatment of exacerbation. The association with inhaled corticotherapy could reduce the duration of systemic treatment. The use of Itraconazole is logical, mainly in cystic fibrosis.

Adrenal Cortex Hormones↗
PubMed1999

Food hypersensitivity in children: clinical aspects and distribution of allergens.

The aims of this work were to investigate, in children and adolescents, the clinical aspects of food hypersensitivity and the distribution of allergens, in a prospective and descriptive study. Five hundred and forty-four pediatric cases from a series of 703 patients with food allergies, confirmed by food challenge, were studied. Their clinical characteristics and the distribution according to allergen were investigated. There was a family history of atopic disease in 70.5% of patients. Atopic dermatitis was the main symptom (275/544; 50.5% of patients), followed by urticaria and angio-edema (165/544; 30%). There was asthma in 8.6% of patients (47 children) and anaphylaxis in 4.5% (27 patients). The rarest signs were rhinitis (n=2; 0.3%), oral allergy syndrome (n=8; 1.4%), and gastrointestinal signs (n=11; 2%). Five allergens accounted for 78% of food hypersensitivity. These allergens were: eggs (36%), peanuts (24%), cow's milk (8%), mustard (6%), and cod (4%). Peanut was the most common allergen for children over the age of 3 yr. In this selected population, sensitivity of individuals to more than three foods was unusual (5%). Atopic dermatitis was the main symptom of food allergy in children. The symptoms changed over time, with respiratory disorders, oral allergy syndrome and ocular problems occuring later. Anaphylaxis also occured mostly in older children. Five allergens were responsible for more than three-quarters of food allergies in children. However, the number of allergens implicated was higher for the group of children over the age of 6 yr than for younger children.

Adolescent↗
PubMed1999

Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases.

The aim of our study was the evaluation of contact sensitization in pediatric patients with atopic dermatitis (AD). It seems that the frequency of contact allergies in the course of AD, and also the frequency of contact allergies in children, is underestimated in general. Our study has been performed by investigating 137 children with AD. The childrens' history was taken according standardized consultation guidelines and followed by a physical examination. Patch testing was performed systematically, including the European standard series, together with tixocortol pivalate, budesonide and the applied emollient. If necessary, optional patch tests were performed according to the child's history. The results demonstrate contact sensitization in 43% of all children tested. The most frequent contact allergens are: metals (19.3%), fragrance (4.4%), balsam of Peru (2.6%), lanolin (4.4%), neomycin (2.6%) and emollients (2.6%). No contact sensitization to corticosteroids nor any induction of active sensitization were seen. Statistical analysis demonstrates that the risk of developing a contact allergy is significantly elevated in children after the age of 5 years. Female sex is a risk factor only for nickel. Age of onset of AD or its severity is not associated with the development of contact allergy. In conclusion, the results indicate the necessity of performing systematic patch testing in the investigation of allergies in children with AD. Preventive measures from an early age are suggested to avoid exposure to the most frequent contact allergens.

Adolescent↗
PubMed1999

Peanut hypersensitivity in children.

Peanut is the major allergen in the United States. It is increasing in importance in Europe and has become the principal food allergen affecting children over the age of three years, once hypersensitivity to eggs has resolved. We report 132 pediatric cases of peanut hypersensitivity, confirmed by food challenge. The study group included 86 boys and 46 girls aged between 6 months and 15 years. More than half the children with peanut hypersensitivity were diagnosed before the age of three. The most common symptom was atopic dermatitis (43.1% of cases). The other symptoms observed were hoarseness (34.8%), asthma attacks (13.6%), anaphylaxis (6%), gastrointestinal symptoms (1.5%) and oral syndrome (0.7%). All patients had positive skin prick tests, with a mean wheal diameter of 8 mm (range: 2 to 25 mm). Wheal diameter was significantly smaller in the youngest children (mean 4.5 mm for children under the age of 1 year, p < 0.01). Specific IgE concentration was below 0.75 IU/ml in 16 cases (14.3%), the mean for the entire group being 30.9 IU/ml (range: 0.75 to 100 IU/ml). Food challenges were not performed in three of the eight children with a history of anaphylaxis. Labial food challenge (LFC) was positive in 85 cases (64.8%). An oral food challenge (OFC) was carried out for 45 children (34.3%) and the mean reactive dose was 850 mg (range: 1 mg to 7g). LFC with peanut oil was positive in 2 cases of 50 tested (4%) and 17 of 63 children (29.9%) tested by OFC were also found to be sensitized to peanut oil. Half the children were also hypersensitive to other foods, as demonstrated by oral challenge (53.7%) or sensitized to airborne allergens (62.8%). Hypersensitivity in the very youngest children raises questions about how sensitization occurs. Diagnosis was confirmed by food challenge. Peanut products are very difficult to eliminate from the diet because of inadequate labeling of food products. An ELISA test, available in a number of countries, can be used to detect the allergen.

Adolescent↗
PubMed1999

[Climate therapy for children with respiratory allergy].

Climate therapy is often proposed for children with severe allergic asthma which remains uncontrolled in spite of adapted treatment. The beneficial effects of climate therapy are related to the reduced allergenic load and to the fact that mites do not survive at high altitudes. Less exposure to allergens leads to improved respiratory function, decreased bronchial hyperreactivity and lower levels of total and specific IgE as well as markers of inflammation. These different actions combine to produce a lower prevalence of asthma at higher altitudes. Other advantages of climate therapy is related to better management of care by a multidisciplinary team. This in turn enables: a combined medial and paramedical approach to stablize the asthma with minimal effective doses of drug therapy; the development of a specific educational program aimed at improving therapeutic compliance; and an individualized education adapted to the learning problems which are often important in these children. The problems of the child being separated from his/her parents and the risk of recurrence after returning home must also be addressed and can generally be prevented by simple precautions.

Allergens↗
PubMed1999

[Allergologic explorations in children].

Guidelines to the multitude of allergologic tests are defined. But, in practical experience, skin prick test are the first and the best test for allergy diagnosis. Positive skin prick test refer to sensitization in accordance with clinical history.

Adolescent↗
PubMed1998

[Penicillin-resistant pneumococcal pneumonia (serotype p14), and coinfection with respiratory syncytial virus and Mycoplasma].

A 3-year old child was admitted for a pneumococcal pneumonia with pleural effusion, initially treated with amoxicillin and clavulanic acid. Clinical deterioration suggested a resistance to conventional antibiotics which was confirmed by bacteriological investigation. A co-infection with respiratory syncitial virus and Mycoplasma pneumoniae was associated. Under adapted antibiotherapy, the clinical course improved.

Anti-Bacterial Agents↗