Il existe peu de données cliniques sur la diminution de la pression thérapeutique encore appelé step-down. Selon les recommandations, devant un patient ayant un asthme contrôlé, il faut envisager de ...diminuer la pression thérapeutique et trouver ainsi la dose thérapeutique minimale mais efficace sur les symptômes et la fonction respiratoire. Selon les recommandations GINA 2012, le rythme recommandé de diminution du traitement de fond est d’environ trois mois.
There is little clinical data on the reduction of inhalation therapy, now known as step-down therapy. Present guidelines for a patient with well-controlled asthma recommend that inhalation therapy be decreased until the minimal therapeutic dose which effectively provides control of asthma symptoms and lung function is reached. According to GINA 2012, the recommended rhythm of dose reduction should cover about three months.
Background
Conflicting results have been obtained when analyzing the relationship between complementary feeding (CF) practices and allergic diseases in childhood. This study aims to further explore ...the association between allergic diseases in early childhood (10.1016/j.jaci.2012.02.036) and the age at CF introduction (10.1016/S0140‐6736(15)00149‐X), food diversity in the first year of life (10.1016/j.ijporl.2019.109759) and the delayed introduction of major allergenic foods.
Methods
This analysis focused on 6662 children from the French nationwide ELFE cohort. Data on feeding practices were collected monthly from 3 to 10 months old. Their age at CF introduction was calculated alongside a diversity score, and the number of major allergenic foods (out of eggs, fish, wheat, and dairy products) not introduced at 8 and 10 months. Their associations with parent‐reported allergy‐related health events between 1 and 5.5 years were assessed using logistic regressions adjusted for confounding factors. A sensitivity analysis excluding early allergic cases (occurring between 2 months and 1 or 2 years) was conducted.
Results
Late CF (>6 months) was related to a higher risk of food allergy (OR 95% CI = 1.35 1.02; 1.78), a low diversity score at 8 months to a higher risk of asthma (OR 95% CI = 1.22 1.01; 1.48), and two allergenic foods or more not being introduced at 10 months to a higher risk of rhinoconjunctivitis (OR 95% CI = 1.20 1.00; 1.44) and food allergy (OR 95% CI = 2.46 1.77; 3.42). Only this last association remained significant after the exclusion of early cases.
Conclusion
The delayed introduction of major allergenic foods is related to a higher risk of food allergy, which supports the updated guidelines for allergy prevention.
The study aimed to explore the association between complementary feeding practices (age, food diversity and allergenic food) and the risk of food allergy, eczema, asthma, and rhinoconjunctivitis in early childhood. More than 50% children were not introduced with at least one major allergenic food (egg, wheat, fish, dairy products) at 10 months. This delayed introduction (after 10 months) of major allergenic food is associated with a higher risk of food allergy up to the age of 5.5 years.Abbrevations: CI, confidence interval; ELFE, Étude Longitudinale Française depuis l’Enfance; OR, odds ratio
L’asthme de la femme Raherison Semjen, C.
Revue française d'allergologie (2009),
April 2013, Letnik:
53, Številka:
3
Journal Article
Recenzirano
L’asthme est plus fréquent chez les garçons comparativement aux filles. Cette relation s’inverse après la puberté. La littérature donne des pistes suggérant un rôle hormonal et métabolique dans la ...survenue de l’asthme de la femme, et un impact sur la fonction respiratoire, mais la physiopathologie demeure mal connue. L’imprégnation hormonale de la femme varie selon l’âge des premières règles, le cycle menstruel, la grossesse, l’allaitement, la ménopause, et les taux hormonaux peuvent également varier selon d’autres facteurs métaboliques comme l’obésité. L’asthme est plus fréquent et plus sévère chez les femmes après la puberté. Des exacerbations d’asthme ont été rapportées comme associées à des variations du cycle menstruel ; les cycles menstruels irréguliers, la ménopause sont associées à une augmentation du risque d’asthme et une diminution de la fonction respiratoire.
Asthma is more prevalent among boys than girls; this relationship is reversed on reaching puberty. The literature gives several indications that hormonal and metabolic factors play a role in the development of asthma in women and an impact on their lung function, but the pathophysiology remains unclear. Endogenous hormone levels vary according to menarche, menstrual phase, menstrual irregularity, pregnancy, lactation and proximity to menopause; sex hormone levels might also vary according to other metabolic factors, such as obesity. Asthma is more frequent and severe in women after puberty. Asthma exacerbations seem to be associated with menstrual cycle variations; irregular menstruation and menopausal transitions are associated with an increased risk of incident asthma and a decrease in lung function.
Summary
Background
The impact of air pollution on asthma and allergies still remains a debate.
Objective
Our cross‐sectional study was intended to analyse the associations between long‐term exposure ...to background air pollution and atopic and respiratory outcomes in a large population‐based sample of schoolchildren.
Methods
Six thousand six hundred and seventy‐two children aged 9–11 years recruited from 108 randomly schools in six French cities underwent a clinical examination including a skin prick test (SPT) to common allergens, exercise‐induced bronchial reactivity (EIB) and skin examination for flexural dermatitis. The prevalence of asthma, allergic rhinitis (AR) and atopic dermatitis was assessed by a standardized health questionnaire completed by the parents. Three‐year‐averaged concentrations of air pollutants (NO2, SO2, PM10 and O3) were calculated at children' schools using measurements of background monitoring stations.
Results
After adjusting for confounders, EIB, lifetime asthma and lifetime AR were found to be positively related to an increase in the exposure to SO2, PM10 and O3. The adjusted odds ratios (aOR) per increase of 5 μg/m3 of SO2 was 1.39 (95% confidence interval (CI)=1.15–1.66) for EIB and 1.19 (1.00–1.41) for lifetime asthma. The aOR for lifetime AR per increase of 10 μg/m3 of PM10 was 1.32 (CI=1.04–1.68). Moreover, SPT positivity was associated with O3 (aOR=1.34; CI=1.24–1.46). Associations with past year symptoms were consistent, even if not always statistically significant. Results persisted in long‐term resident (current address for at least 8 years) children. However, no consistent positive association was found with NO2.
Conclusions
A moderate increase in long‐term exposure to background ambient air pollution was associated with an increased prevalence of respiratory and atopic indicators in children.
This review is the synthesis of a working group on mild asthma. Mild asthma includes intermittent and persistent mild asthma according to the Global Initiative for Asthma (GINA) classification, and ...affects between 50% and 75% of asthmatic patients. Mild asthma is more frequent, more symptomatic, and less well controlled in children than in adults. Cohort studies from childhood to adulthood show that asthma severity usually remains stable over time. Nevertheless, mild asthma can lead to severe exacerbations, with a frequency ranging from 0.12 to 0.77 per patient-year. Severe exacerbations in mild asthma represent 30-40% of asthma exacerbations requiring emergency consultation. In mild asthma, inflammation and structural remodelling are constant, of varying intensity, but nonspecific. Therapy with inhaled corticosteroids (ICS) decreases bronchial inflammation, but has only a slight effect on structural remodelling, and, when stopped, inflammation immediately recurs. Permanent low-dose ICS therapy is the reference treatment for persistent mild asthma. Effectiveness is to be reassessed at 3 months, and if it is insufficient the patient is no longer considered mildly asthmatic, and treatment has to be stepped up. As mild asthma is the most frequent form of the disease, diagnosis and management require physicians' particular attention.
L’exposition aux contaminants environnementaux en début de vie pourrait être associée au risque ultérieur d’allergies ou de symptômes respiratoires.
L’objectif de ce travail était d’étudier le lien ...entre l’exposition maternelle par voie alimentaire à des mélanges de contaminants chimiques et les allergies ou la santé respiratoire de l’enfant.
Cette étude a porté sur 11 638 couples mère–enfant de la cohorte française ELFE « étude longitudinale française depuis l’enfance ». L’exposition par voie alimentaire des mères pendant la grossesse à plus de 200 contaminants a été déterminée en croisant des données de consommation avec des données de contamination des aliments, puis 8 mélanges de contaminants ont été identifiés. Les allergies et les symptômes respiratoires de l’enfant (eczéma, allergies alimentaires, sifflements et asthme) ont été rapportés par les parents depuis la naissance jusqu’à l’âge de 5,5ans. Les associations ont été estimées à l’aide de modèles de régressions logistiques ajustés sur les principaux facteurs de confusion, tels que le niveau d’études, les antécédents familiaux d’allergies, ou le tabagisme pendant la grossesse. Les résultats sont exprimés en odd-ratio (OR IC95 %) pour l’augmentation d’un écart-type du score d’exposition au mélange.
L’exposition des mères par voie alimentaire à un mélange composé principalement d’éléments trace, furanes et hydrocarbures aromatiques polycycliques (HAPs) était associée positivement au risque d’eczéma (1,10 1,05 ; 1,15) avant 5,5ans. L’exposition alimentaire à un mélange de pesticides était associée positivement au risque d’allergie alimentaire (1,10 1,02 ; 1,18), et l’exposition à un deuxième mélange de pesticides était associée positivement au risque de sifflements (1,05 1,01 ; 1,08). Enfin, l’exposition alimentaire à un mélange de perfluoroalkyl acide, HAPs et éléments traces était associée négativement au risque d’asthme (0.89 0.80 ; 0.99).
Dans la cohorte ELFE, l’exposition alimentaire pendant la grossesse à certains mélanges de contaminants chimiques est associée au risque d’allergies ou d’asthme chez l’enfant. Ces associations nécessitent d’être confirmées dans d’autres études.
Although exposure to indoor microorganisms in early life has already been associated with respiratory illness or allergy protection, only a few studies have performed standardized samplings and ...specific microbial analysis. Moreover, most do not target the different groups of microorganisms involved in respiratory diseases (fungi, bacteria, dust mites).
In our study, ten specific qPCR targets (6 fungal species, 1 family and 2 genera of bacteria, 1 house dust mite) were used to analyze the microorganism composition of electrostatic dust fall collector (EDC) from 3193 dwellings of the Elfe French cohort study.
Multivariate analyses allowed us to show that the microbial composition of dwellings, assessed with simultaneous analysis of 10 microorganisms, can be characterized by four entities: three bacteria, house dust mite Dermatophagoïdes pteronyssinus, fungi Alternaria alternata, and five other molds.
Some dwellings' intrinsic characteristics (occupational ratio, type of dwelling and presence of pets) clearly influence microorganism distribution, and six different profiles of dwellings, characterized by their composition in microorganisms, have been described across France.
The use of these clusters seems promising in the evaluation of allergic risk. Allergic respiratory diseases will develop in the near future in some children of the Elfe cohort and will indicate to what extent our approach can be predictive of respiratory disease.
•Electrostatic dust collector and qPCR analysis in 3193 Elfe children dwellings•qPCR targets were 6 fungal species, 1 family and 2 genera of bacteria, 1 dust mite.•6 dwelling profiles across France have different geographical repartitions.•Occupational ratio, pets, dwelling types influence microorganism concentration.•High microorganism levels in West France in coherence with high wheezing area
Association of asthma with myasthenia gravis presents a twofold peculiarity. First, as dyspnea characterizes both conditions, diagnostic orientation is difficult. Second, from a therapeutic ...standpoint, the initiation of anticholinesterase treatment requires a multidisciplinary approach due to possible contraindication for asthma. We report on the case of a patient monitored for severe asthma and treated with biotherapy, and also monitored for myasthenia gravis, and treated with anticholinesterase.
Summary
Background
Exercise‐induced bronchospasm (EIB) is frequent among asthmatic children. However, opinions differ on the relation between EIB and rhinitis in the absence of asthma.
Objectives
We ...assessed the relationship between EIB and various phenotypes of rhinitis according to asthmatic status at the general population level in the Six Cities Study.
Methods
Of 7781 schoolchildren with a mean age of 10 years underwent an EIB test and skin prick test to assess allergic sensitization. Their parents completed a standardized questionnaire recording asthma‐like symptoms and past‐year rhinoconjunctivitis, ever hay fever (EHF), and a score for allergic rhinitis (SFAR) ≥7 as a marker of ‘past‐year allergic rhinitis’. Exercise‐induced bronchospasm was defined as a fall in peak expiratory flow rate ≥15% after exercise.
Results
Of the 6813 schoolchildren retained for analysis, 227 (3.33%) experienced EIB after exercise. Odds ratios 95% confidence intervals between EIB and allergic rhinitis phenotypes in the absence of asthma were 1.56 0.92–2.63 for EHF, 1.97 1.16–3.35 for past‐year rhinoconjunctivitis, and 1.84 1.16–2.91 for a SFAR ≥7. Results were unchanged after adjustment for confounders. Multiple correspondence analysis showed that EIB, although related to asthma, constitutes a separate entity. Exercise‐induced bronchospasm was not significantly related to familial history of asthma.
Conclusion
In our large population‐based sample of children, different phenotypes of atopic rhinitis were associated with EIB, independently of asthma. Exercise‐induced bronchospasm, although related to asthma, seems to constitute a separate entity.
Clinical relevance
In this large (6813) sample of 10‐year children drawn from the general population, EIB is associated with rhinitis phenotypes in the absence of asthma. Furthermore, it constitutes an entity independent from asthma and is not related to a familial history of asthma. Thus, investigating these symptoms could be important in this disease, as a specific nasal treatment might improve EIB in these children.
Reunion Island is a French overseas department characterized by a tropical climate with 2 distinct seasons. While the prevalence of asthma among adults in Reunion Island is close to that in mainland ...France, mortality and hospitalization rates are twice as high. To date, however, no epidemiological studies have evaluated the influence of environmental factors in asthma exacerbations in Reunion Island.
From January 2010 to June 2013, 1157 residents of Saint-Denis visited the emergency rooms of the Centre hospitalier universitaire site Nord de Saint-Denis for asthma. After exclusion of children under the age of 3, 864 visits were analyzed. These were correlated with the following daily factors: pollens and molds, meteorological parameters (temperature, precipitation levels, humidity and relative humidity levels, wind), pollutants (sulfur dioxide (SO2), nitrogen oxide (NOx), and the fine particles PM10 and PM2.5), and the influenza virus. The correlation between these factors was evaluated using the DLNM and GO-GARCH models.
Of the 864 analyzed visits, 532 were by pediatric patients (aged 3 to 16 years) and 332 by adult patients (aged over 16 years). In adults, pollens positively correlated with asthma exacerbations were Urticaceae, Oleaceae, Moraceae, and Chenopodiaceae. In children, these were Urticaceae, Oleaceae, Poaceae, and Myrtaceae. Molds positively correlated with asthma exacerbations in adults were ascospores and basidiospores. Only basidiospores were positively correlated with exacerbations in children. Temperature was positively correlated with exacerbations in both adults and children. The pollutants PM10 and NOx were positively correlated with exacerbations in children. Influenza epidemics were strongly correlated with exacerbations in both adults and children.
Our analysis shows that in Reunion Island, asthma is exacerbated by pollens (Urticaceae, Oleaceae, Moraceae, Chenopodiaceae in adults; Urticaceae, Oleaceae, Poaceae, Myrtaceae in children), molds (ascospores and basidiospores in adults; basidiospores in children), temperature, influenza, and the pollutants PM10 and NOx (in children).
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