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Biomedical subjects

F Rancé

Publications and source records attributed to F Rancé.

49 records · Page 3Linked to original sources
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↗
PubMed1997

Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges.

The skin prick test is the most widely used test for detecting IgE-mediated food hypersensitivity. Our study aimed to define firstly the correlations between results obtained with prick tests using commercial extracts and fresh foods, and secondly the correlations between these results and those obtained with labial and/or oral challenge. We compared the wheal diameters read at 15 min with commercial extracts and fresh foods, for four foods, in 430 children with suspected food allergy. For cow's milk, wheal diameters were larger with commercial extracts, but the difference was not significant. Conversely, wheal diameters were significantly larger with fresh foods for the other food allergens. Skin prick tests were positive in 40% of cases with commercial extracts and in 81.3% with fresh foods. The overall concordance between a positive prick test and positive challenge was 58.8% with commercial extracts and 91.7% with fresh foods. These results indicate that fresh foods may be more effective for detecting the sensitivity to food allergens. Fresh foods should be used for primary testing for egg, peanut, and cow's milk sensitivity.

Adolescent↗
PubMed1996

[Clinical course and treatment of pleural empyema in children].

BACKGROUND: Purulent pleurisy has become rare. It is often masked by previous antibiotic treatment so that functional prognosis may be poor. PATIENTS AND METHODS: Twenty children with purulent pleurisy of the large cavity admitted from 1987 to 1993 were included in the study: there were nine infants (age 5 to 18 months) with pleuro-pulmonary staphylococcal infection (group I) and 11 children (4-13 years) (group II). Clinical, biological, bacteriological and radiologic findings were analysed retrospectively as was the outcome. RESULTS: Patients of group I were admitted in poor general condition. X-ray showed moderate effusion and characteristic signs of staphylococcal infection. The bacteria identified in seven patients (77%) was S aureus. Recovery was rapid with antibiotics and simple local treatment. X-rays were normal two months after hospital discharge in seven patients (77%). One infant presented cicatricial bullous emphysema which required segmental resection. Patients of group II were admitted for moderate respiratory signs after a relatively long delay (14 days) since the onset of symptoms. X-rays showed considerable effusion in all and mediastinal shift in five patients (45%). Streptococcus pneumoniae was identified in one patient only. Local treatment of empyema was difficult; the effusion, already fibrinous, required repeated use of chest tubes in eight cases and surgical decortication in three. X-rays, performed 2 months after hospital discharge, were normal in only three patients. Long-term course was nevertheless favorable since chest X-rays at 5 months were normal in all children of both groups. CONCLUSIONS: Early recognition of purulent pleurisy is important in children aged over 3 years to ensure effective drainage before the effusion becomes fibrinous. All patients in whom the first tube was inserted after more than 10 days had a difficult follow-up requiring repeated chest drainages or surgery. Ultrasonography was a useful aid for diagnosis and local treatment. Computed tomography was useful for adapting treatment after several days of course.

Adolescent↗
PubMed1995

[Treatment of asthma crisis in children].

The occurrence of an acute exacerbation of asthma frequently reflects failure of a first line treatment that has to be reconsidered. Severe episodes of acute asthma are often related to non-recognition of signs of gravity, inadequate treatment and/or delayed access to an emergency department. Several consensus conferences have established guidelines for management of asthma attacks in the patient's home, and have defined the symptoms which should lead the physician to refer the patient to an emergency department and the criteria of hospitalization when the patient does not respond properly to the treatment. Guidelines for management of acute asthma based on the currently recommended therapeutic schedules are presented.

Aftercare↗