Bibliographic updates


The Monthly choice - December 2014

Claude MOLINA* & Jacques GAYRAUD**


1.    Early-onset Atopic Dermatitis and sensitization to inhaled allergens
2.    Anti – infective proteins of breast milk and asthma associated phenotypes
3.    Hypersensitivity reaction to antineoplastic agent
4.    Antibiotics in fetal and early life and subsequent childhood asthma: nationwide population based study with sibling analysis
5.    Immunologic feature in patients with Down syndrome.

1) Early-onset Atopic Dermatitis (AD) and sensitization to inhaled  allergens.   
(J. Just et al .Ped .All .Immun (PAI) 2014 October early view)

Item: Atopy – Allergy in childhood
Key word: Early onset atopic dermatitis – Multiple sensitization – Inhaled Allergens – Food Allergens.
This often severe phenotype of AD conveys the risk of developing multiple sensitizations to allergens but little is known about the pathway of this sensitization. In following a cohort of 229 infants, in Paris (France) every year during 6 years, in order to identify the most predictive, clinical or biological  marker to inhaled allergens, the authors demonstrates that a multiple sensitization to food allergens (which decreased over time ) conveys a significant higher risk of sensitization to inhaled allergens that single sensitization.

2)  Anti-infective proteins of breast-milk and asthma associated phenotypes 
(G.Zhang et al Ped.All. Immun. Octob 2014 25 6 544-551)    

Item: Asthma – Allergy in childhood
Key word: Anti-infective proteins – Breast milk - Asthma  
As part of a prospective cohort study on the role of respiratory infections in asthma development in high risk children, the authors measured the concentration  of a panel of proteins in maternal milk samples (s IgA, lactoferrin, Lysoszyme , total proteins) and analyzed associations between these subsequent atopy-infections and asthma related outcomes to age 10 years.
They observed significant but transient inverse association between these concentrations and susceptibility to upper respiratory infections in year 1 only and parallel but positive transient associations with early lower infections and atopy.
No association were seen with asthma-related outcomes.                      
The role of breast milk feeding in the prevention of these diseases is discussed. However, in the UK financial incentives for breastfeeding, regarded  as intervention of great importance to public health, are now planned  (The Lancet 19 Nov 2014 384 Suppl 2).

3)    Hypersensitivity reactions(HR) to antineoplastic agents (ANA)   
(A.Urena-Tavera et al : JACI 2014 Nov in press) 

Item: Atopy – Drug allergy
Key word: Colorectal cancer - Leucovorine – FOLFOX protocol – FOLFIRI protocol

This is an increasingly important problem for some patients doomed to therapy discontinuation by fear of inducing severe reactions. HR to Oxaliplatin (O) have been reported with the incidence of 12% to 17% whereas there are very few cases of HR to Folinic Acid (FA). Colorectal cancer treatments use 2 types of protocol  FOLFOX including Folinic acid (AF) - 5 Fluorouracile (5 FU)  O. or FOLFIRI : Folinic acid, 5 FU and Irinotecan (IRI).                                     
The authors report 5 cases of HR among 44 patients, 52 to 73 years of age, hospitalized between 2013 and 2014 for colon adenocarcinoma. The diagnosis of HR due to Leucovorine (L) (Calcium racemic Folinate) may be more frequent than it seems.  If Skin-tests  were all negative, Provocation tests performed with L-isomer calcium folinate were positive in the 3 cases tested  (negative with O and IRI);  on therapeutic point of view, 4 patients decided with their oncologist to avoid  L. For the 5th patient, a protocol of rapid Desensitization (D) was programmed and performed with success : It is the first intravenous rapid D to L in a reactive patient.    
4)    Antibiotics in fetal and early life and subsequent childhood asthma: nationwide population based study with sibling analysis
(Anne. K Örtqvistet al BMJ 201428/11)

Item: Atopy - Asthma
Key word: Antibiotics – Fetal life – Early life - Asthma

A cohort study of 493 785 children born 2006-2010, including sibling control design, and180 894 eligible, was investigated with Cox proportional hazard regression model adjusted for shared factors within families and confounding by respiratory infections and specific groups of antibiotics. Antibiotic exposure in fetal life was associated with an increase risk of asthma in cohort analyses but not in the sibling analyses where this association disappeared indicating that this association is affected by factors shared by siblings.
The risk for asthma was stronger after exposure to antibiotics used for respiratory infections than those used for urinary tract or skin infections implying cofounding by indication or reverse causation.
In conclusion the association between antibiotics use in fetal and early life and subsequent childhood asthma is questioned,  if all confounding factors are taken into account.

5)    Immunologic features in patients with Down syndrome

Item: Clinical Immunology
Key word: B cells – Down syndrome

Patients with Down syndrome carry immunologic defects as evidenced by risks for autoimmune diseases, hematologic malignancies, and respiratory tract infections. Moreover, the low number of circulating B cells suggest impaired humoral immunity. The study of 17 children has shown that these patients seem capable of normal germinal centers and plasma cell formation. Blood memory B cells were reduced and showed impaired molecular maturation of IgA and IgM important for mucosal immunity. These defects contribute to increased susceptibility of these children to respiratory tract infections.

Comments and questions welcome :

Pr. Claude Molina                         and/or         Dr Jacques Gayraud
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Last updated 28 January 2015