Bibliographic updates


The Monthly choice - November 2014

Claude MOLINA* & Jacques GAYRAUD

1.    Chronic Asthma associated with shorter Leucocyte Telomere
2.    Respiratory virus and Asthma   
3.    Eosinophilic esophagitis
4.    Occupational contact Dermatitis
5.    Common variable Immunodeficiency

1) Chronic Asthma associated with shorter Leucocyte Telomere

D.W.Belsky et al Amer.J.of  Resp. Crit.Care Med 2014 1902 4 384-391

Theme: Asthma – Respiratory allergy
Key words: Telomere – Asthma.

Asthma is increasingly recognized as a disease of aging.  In the Dunedin New-Zealand cohort of 1037 asthmatics, at nine in-person assessments spanning 9-38 years, Leucocyte Telomere Length (LTL) was measured at ages 26 and 38 years. This epidemiologic study reveals that only Childhood Asthma that persists through midlife, is related to shorter LTL, possibly via systemic eosinophilic inflammation. So LTL is proposed as biomarker of  persistent Asthma and accelerated aging.

2) Respiratory virus and Asthma

N.Voraphani et al AJRCCM 2014 190 4 392-398                                                  

Theme:  Asthma – Respiratory allergy
Key words: Asthme – Virus - Wheezing

It is well known that Lower Respiratory Illnesses (LRI), especially when induced by Respiratory Syncitial Virus (RSV) can be followed by asthma-like symptoms and later on by a physician diagnosis of Asthma. Wheezing episodes after RSV- LRI have been shown to reduce by adolescence, suggesting that this is a childhood risk, during the lung development, in the first decade of life. The authors showed, in children of the Tucson birth cohort, that this is the case and not at all an asthma risk. However when young adults had RSV-LRI in early life and are smokers, the risk of having asthma is significantly increased. Treatments of RSV or other rhinovirus (Palivizumab, Inhalation of IFNβ) have been tested more or less successfully.

3) Eosinophilic esophagitis  (EeO)                                          

J.Molina-Infante et al  JACI2014  134 Novembre 1093-1099                    

Theme:  Food allergy
Key words: Eosinophilic esophagitis – 4 Food elimination diet
This Esophageal disorder is predominantly induced by food antigens. EeO was treated in a multicenter (4 hospitals) Spanish  prospective study by an empirical  strategy  eliminating 4 food group in diet of adult patients (dairy products, wheat, egg, legumes). Remission was defined by clinical and histological features (15 eosino/hpf). Four-Food elimination diet accomplished complete remission in 54% of patients and almost a third of non responders could be rescued by six food elimination coming to an overall effectiveness of 72%. Therefore this Four Food elimination diet benefit from less restrictive intervention and fewer endoscopies all the more that food reintroduction allows to identify just one or two food triggers. So this strategy is simple, practical transferable to pediatric population and represents advantages for patients and health care system.

4) Occupational contact Dermatitis (OCD)                     

(JF.Nicolas in press Bull.Acad.Nat Med 2014), (UF Fries et al Contact Dermatitis 2014 6 364-70)    

Theme:  Skin allergy – Occupational allergy
Key words: Occupational contact dermatitis – Eczema – Irritant contact dermatitis

Occupational Contact dermatitis, is a common inflammatory skin disease that occurs at the site of contact with non-protein chemical molecules (xenobiotics). There are two major types of OCD: irritant (ICD) and allergic (ACD) which are very similar in terms of clinical, histological and molecular features. However, it is necessary to differentiate these 2 types, according to the higher severity of ACD and its serious professional consequences: Mechanisms underlying the skin inflammation are also different.
-    The ICD are non-specific inflammatory lesions mainly due to chemicals toxicity on skin cells that induce inflammation by activating innate immunity.
-    The ACD, are an adaptive, delayed type hypersensitivity response due to activation of specific T Lymphocytes (TL) .
Psychological stress, frequently present in the occupational world, worsens contact dermatitis. Experimental models of ACD  showed that stress acts as an adjuvant to cutaneous inflammatory responses through noradrenaline released in the skin by fibers of the sympathetic nervous system. Dendritic cells migrate quickly and in greater numbers at the lymph nodes where they activate numerous effector T cells inducing a greater and prolonged ACD response. These studies identify a number of immunological and environmental factors at the origin of contact dermatitis that can be targets for preventive action and tools facilitating the diagnosis of ACD.

5) Common variable Immunodeficiency (ID)                

(B.Guthman et al JACI 2014134 1 116-126).                                                         

Theme:  Clinical Immunology
Key words: Common variable Immunodeficiency – Immunoglobulins – Bacterial infections.

This is the most frequent primary ID. In a retrospective data 2212 European patients coming from 28 Centers, one third presented with the first symptoms very early ( before 10 years of age) Male subjects are prone to pneumonia, less to other complications such enteropathy autoimmunity and lympho-proliferative disorders. The delay between onset and diagnosis, usually more than 5 years is high in early onset patients whose prognosis is poor. Patients with high dosing levels of immunoglobulins show reduced frequency of bacterial infections whereas low levels less than 4g/L are associated with poor clinical outcomes. There were different strategies in European countries with a great difference in Immunoglobulin dosing, ranging from 130 up to 750mg /kg/month.

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           Prof. Claude Molina                              Dr Jacques Gayraud

Last updated 28 January 2015