Francisque Leynadier

Sublingual-swallow immunotherapy with standardized 3-grass pollen extract: a double-blind, placebo-controlled study

BACKGROUNDnSublingual immunotherapy (SLIT) is accepted as a safe and effective route for the treatment of grass pollen allergy, but clarification of its clinical and biological efficacy requires more study.nnnOBJECTIVEnTo evaluate the efficacy, safety, and compliance of SLIT with a standardized 3-grass pollen extract in patients with grass pollen seasonal allergic rhinoconjunctivitis, with or without mild asthma.nnnMETHODSnThis multicenter, randomized, double-blind study included 127 patients (aged 12-41 years; mean age, 24.9 years) with grass pollen seasonal allergic rhinoconjunctivitis, with or without mild asthma. They received either SLIT with a high-dose, standardized, 3-grass pollen extract or placebo for 10 months before and during the grass pollen season. The efficacy evaluation compared weekly clinical scores (defined as the sum of the symptom score and rescue medication score) to measure rhinoconjunctivitis and asthma for the first 8 weeks of the pollen season. We also evaluated safety and compliance and measured changes in anti-Dactylis specific IgG4 antibody levels.nnnRESULTSnThere was a trend in favor of the study group in the mean adjusted clinical score. The groups were not comparable on inclusion (P = .02): the SLIT group included more subjects with asthma and had a higher mean IgG4 serum level. Additional exploration according to subgroups with and without asthma found that among the patients without asthma, the SLIT group had a significantly better clinical score (P = .045). Anti-Dactylis specific IgG4 levels increased significantly in the SLIT group.nnnCONCLUSIONnSLIT with a standardized, high-dose, 3-grass pollen extract is safe and significantly improves the clinical score in patients with hay fever and without asthma during the pollen season.

Is the application of cosmetics containingprotein-derived products safe?

Plant, mainly wheat, proteins hydrolyzed or not, are common substitutes for animal proteins in cosmetics for safety reasons. Contact urticaria induced by cosmetics is not common. The conjunction of contact urticaria and oral allergy to the same plant proteins is even less frequent. Gluten is the major group of proteins in wheat and other cereal grains. We describe here a case of urticaria to hydrolyzed wheat proteins in cosmetics associated with generalized urticaria induced by preserved foods containing wheat proteins.

Anaphylactic shock after application of chlorhexidine to unbroken skin.

likely to have occurred during the collection of used dye containers. He was restricted from contact with azo dyes at work. Follow up at 4 months showed resolution of his hand dermatitis. Carbonless copy paper manufacturing is a complicated process which requires the addition of many chemicals to paper pulp (1, 2). These chemicals can broadly be divided into preservatives, sizing agents and dyes. Allergic contact dermatitis has been described during paper production from chromate (3, 4), cobalt (3), and 1,2-benzisothiazolinone (5). Azo dyes have not previously been previously reported as allergens in the production of paper.

Emerging principles for the design of promiscuous HLA-DR-restricted peptides: an example from the major bee venom allergen

Mechanisms underlying successful immunotherapy of allergic patients operate at the level of CD4+ helper T cells. T cell epitopes from allergens may thus constitute interesting molecules for immunotherapy, provided they are efficient for all patients and are not recognized by IgE. In an attempt to define such peptides for allergy to bee venom, we have investigated the capacity ofpeptides encompassing the sequence of the major bee venom allergen to stimulate PBMC from allergic patients and to react specifically with their IgE. The region 77–110 emerged as the most frequently T cell stimulating. We then analyzed the binding modes of the sequence 81–97 for ten different HLA‐DR molecules and introduced punctual mutations to enhance the peptide affinity for these molecules. Six different modes have been identified on the sequence 81–97, one mode being common to eight HLA‐DR molecules. Four HLA‐DR molecules can bind the P85–97 peptide by two different modes with an equivalent affinity. The peptide N89L has a higher affinity for DRB1*0301 and DRB3*0101 and remains as active as the native peptide towards the other HLA‐DR molecules.

Chronic generalized eczema caused by multiple dye sensitization.

Textile dye sensitization is rare; its low incidence (1.4% to 5.8%) is most likely because dye contact allergy is not suspected and therefore not tested. The greatest number of positive test results are obtained for disperse dyes. We report an uncommon observation of severe and chronic textile dye dermatitis with positive patch test results to Disperse Blue 106, Disperse Blue 124, Disperse Brown 1, Disperse Yellow 3, and p-aminophenol.p-aminophenol, Disperse Blue 124, and Disperse Blue 106 are derived from p-phenylenediamine, but this allergen seems to be unreliable as a detector of textile dye allergy. The admittedly allergic capacity of disperse dyes and the increasing fabrication of synthetic fibers (acrylics and polyesters) usually colored with this group of dyes could induce more frequent textile sensitization.

Airborne contact dermatitis from propacetamol

eczema at the application area (forearm), with extension to the neck and face. Patch tests to components of this varnish were undertaken in May 1996. They showed contact sensitivity to nitrocellulose when tested in the solvent at the same concentration as used in the varnish, as well as when diluted 2X (50%) or !OX (10%) in the same solvent. 2 different solvents were used. Solvent A: mixture of ethyl/butyl acetate (88.7%) and isopropyl alcohol (11.3%). Solvent B: mixture of ethyl/butyl acetate (49.45%), toluene (41.35°/<,), isopropyl alcohol (8.1%) and diacetone alcohol ( 1.1 %). The concentration of nitrocellulose in these different products varied from 1.1% to 13.3%. Patch tests to nitrocellulose at the concentration used in varnish or at 50% were positive in· every case, only 112 being positive when diluted to 10%. Solvents, as well as their components, were tested on our patient and showed no reaction. In the same solvents and at the same 3 concentrations, the nitrocellulose component was then tested on more than I 00 control subjects and did not elicit any reactions.