F. Hacard

Anakinra delayed skin allergy expressing as both injection site reactions and generalized exanthema.

Anakinra is a human interleukin-1 receptor antagonist (r-metHul-1ra), produced by recombinant DNA technology using an E. coli bacterial expression system. It is indicated for the treatment of adult rheumatoid arthritis (RA) in association with methotrexate [1]. Only a few cases of immediate allergic hypersensitivity to anakinra have been so far reported. We report a case of allergic delayed hypersensitivity to anakinra in a patient with RA.A 48-year-old male patient with RA had, over a period of [...]

Plus il y a de bactéries différentes, moins il y a d’inflammation : la révolution microbiotique

Resume Notre microbiote est l’ensemble des micro-organismes, saprophytes et pathogenes, qui colonisent notre corps. Les recents progres des techniques d’analyse metagenomiques ont elargi notre connaissance du microbiote et transforme en profondeur notre vision des relations qu’il entretient avec le systeme immunitaire. La flore saprophyte apparait comme essentielle au developpement harmonieux du systeme immunitaire, et la diversite du microbiote est correlee avec le bon niveau de sante des individus. Ces decouvertes ouvrent de nouvelles voies conceptuelles et therapeutiques dans les maladies inflammatoires chroniques.Human microbiota includes all microorganisms, saprophytes and pathogens that colonize our bodies. Recent advances in metagenomic analysis techniques have expanded our knowledge of the microbiota and fundamentally changed our view of its relationships with the immune system. The commensal flora appears to be essential to the development of the immune system, and the diversity of the microbiota is correlated with good health status of individuals. These findings open up new conceptual and therapeutic approaches in chronic inflammatory diseases.

Skin tests may induce DRESS relapse

DRESS is a rare but life threatening drug allergic disease. The value of skin tests, especially patch-tests (PT) for defining the culprit drug were recently reported. Nevertheless DRESS has been associated with high risk of disease flare linked to drug rechallenge (culprit drug or not) or viral reactivation . In this study we analyzed the frequency of patch test-induced DRESS flares. Method Between 01/2009 and August 2013, patients with DRESS syndrome (diagnosis score KARDAUN >5 : definite case) were hospitalized for drug allergic evaluation and received skin patch tests (Patch tests and/or IDT) with 72h reading. In case of DRESS flare blood viral load (HHV6, EBV, CMV), white blood cells count , liver enzymes and kidney function were performed. Results 68 DRESS were included. Among them, 39 patients showed positive PT (57%) and 29 were negative at the 72h reading. From the 39 PT positive patients, 8 patients (20%) experienced a DRESS flare in the form of a mild skin rash developing in the 48h following the realization of skin tests. The rash started before the 72h reading in all cases. In two cases, general signs were noted and in one case eosinophilia was found (760/mm3 N 5. Liver and kidney assays were normal. Viral blood PCR for herpes viruses were negative at the onset of the relapse and during the two following days. The culprit drugs were dominated by betalactam antibiotics (4/8 : 50%). Skin biopsies of the skin rash were compatible with a delayed hypersensitivity reaction in all cases. Interestingly 4 patients (50%) were able to induce non specific rash after introducing drugs unrelated to the culprit one with negative blood herpes viral load. Conclusion Our study demonstrates that positive skin tests may induce a mild reactivation of DRESS in a noticeable proportion of patients. The delay between skin tests and flare (in all cases <48h) confirms that DRESS is a drug specific delayed hypersensitivity reaction. The negativity of viral load does not confirm the relation of DRESS flare with viral reactivation. Many hypotheses could explain the occurrence of skin test-induced DRESS rash in these patients : T reg dysfunction after DRESS syndrome , very strong T cell sensitization in these patients, long term persistence of drug in skin, T cell chronic pre-activation state, as suggested by the frequency of non specific DRESS flare following alternative drug administration. Clinicians should be aware of the risk of skin test-induced DRESS flares in order to optimize the management of these patients during the allergological work up.

Tolerance of methotrexate in a daily practice cohort of adults with atopic dermatitis

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Efficacy and Safety of Infliximab Tolerance Induction in Patients with Inflammatory Bowel Diseases who Experienced Acute Infusion Reactions

Background and Aims: One of the reasons for the failure of infliximab (IFX) is immediate hypersensitivity reactions (IHR). We aimed to report the efficacy and safety of a tolerance induction protocol in inflammatory bowel diseases (IBD) patients who had previously experienced IHR during IFX infusions. Patients and Methods: We reported all cases of IBD patients who had previously experienced IHR due to IFX and who were submitted to a standardized protocol of tolerance induction to IFX from 2010 to 2015. Results: IHR occurred in a majority of patients (69%) during the first 3 infusions and for half of them after a period of IFX withdrawn. Skin prick tests were negative and only 2 intradermal tests were positive. Basophil activation tests and antidrug antibody measurements were performed in 8 out of 16 patients and were positive in 3 and 4 patients respectively. Induction of tolerance was successful in 69% of patients and IFX was pursued with clinical efficacy > 1 year in 7 patients (44%). Allergologic investigations were not predictive of tolerance induction success. Conclusion: A majority of IHR to IFX infusions occurred during the beginning or restarting of treatment and was related to a nonallergic hypersensitivity. Induction of tolerance to IFX is feasible and effective and may safely allow retreatment of IFX in almost 70% of IBD patients.