Related Articles

Honeybee venom immunotherapy: certainties and pitfalls.

Immunotherapy. 2012 Nov;4(11):1153-66

Authors: Bilò MB, Antonicelli L, Bonifazi F

Abstract
The honeybee is an interesting insect because of the fundamental agricultural role it plays, together with the composition of its venom, which presents new diagnostic and immunotherapeutic challenges. This article examines various aspects of honeybee venom allergy from epidemiology to diagnosis and treatment, with special emphasis on venom immunotherapy (VIT). Honeybee venom allergy represents a risk factor for severe systemic reaction in challenged allergic patients, for the diminished effectiveness of VIT, for more frequent side effects during VIT and relapse after cessation of treatment. Some strategies are available for reducing the risk of honeybee VIT-induced side effects; however, there is considerable room for further improvement in these all-important areas. At the same time, sensitized and allergic beekeepers represent unique populations for epidemiological, venom allergy immunopathogenesis and VIT mechanism studies.

PMID: 23194365 [PubMed - in process]

Related Articles

Gene-environment interactions in asthma and allergic diseases: Challenges and perspectives.

J Allergy Clin Immunol. 2012 Dec;130(6):1229-40

Authors: Kauffmann F, Demenais F

Abstract
The concept of gene-environment (GxE) interactions has dramatically evolved in the last century and has now become a central theme in studies that assess the causes of human disease. Despite the numerous efforts to discover genes associated in asthma and allergy through various approaches, including the recent genome-wide association studies, investigation of GxE interactions has been mainly limited to candidate genes, candidate environmental exposures, or both. This review discusses the various strategies from hypothesis-driven strategies to the full agnostic search of GxE interactions with an illustration from recently published articles. Challenges raised by each piece of the puzzle (ie, phenotype, environment, gene, and analysis of GxE interaction) are put forward, and tentative solutions are proposed. New perspectives to integrate various types of data generated by new sequencing technologies and to progress toward a systems biology approach of disease are outlined. The future of a molecular network-based approach of disease to which GxE interactions are related requires space for innovative and multidisciplinary research. Assembling the various parts of a puzzle in a complex system could well occur in a way that might not necessarily follow the rules of logic.

PMID: 23195523 [PubMed - in process]

Publication year: 2012
Source:Revue de Pneumologie Clinique, Volume 68, Issue 2

P.-B. Pagès, H. Abou Hanna, D. Caillot, A. Bernard

La chirurgie fait partie de la stratégie thérapeutique des infections aspergillaires et des mucormycoses. L’aspergillome se définit comme une masse arrondie pseudotumorale de développement intracavitaire due à la prolifération des spores d’Aspergillus. La complication la plus fréquente est l’hémoptysie rapportée dans 50 à 95 % des cas. Les lésions pleuropulmonaires favorisantes sont : les cavernes tuberculeuses, les poches pleurales résiduelles, les bulles d’emphysème et le poumon détruit après radiothérapie ou fibrose ou bronchectasies. Les indications de la chirurgie dépendent des symptômes, de la fonction respiratoire du patient, de l’état du poumon sous-jacent et du type d’aspergillome (simple ou complexe). Chez un patient porteur d’un aspergillome intrapulmonaire, si les fonctions respiratoires le permettent, une résection pulmonaire sera proposée éventuellement précédée d’une embolisation. Pour les aspergillomes intrapleuraux, la thoracoplastie sera préconisée si l’état général du patient le permet. L’aspergillose pulmonaire invasive (API) se caractérise par une invasion des tissus bronchiques et des vaisseaux par les filaments mycéliens chez des patients ayant une immunosuppression profonde et prolongée. Le taux de décès des patients ayant fait une API après traitement pour une leucémie ou lymphome était de 30 à 40 %, après une greffe de moelle de 60 %, après transplantation de 50 à 60 % et après toute autre cause d’immunosuppression de 70 à 85 %. La principale cause de ces décès est l’hémoptysie massive. La chirurgie (une lobectomie) est indiquée pour la prévention des hémoptysies lorsque la masse aspergillaire se situe au contact de l’artère pulmonaire ou l’une de ses branches et si elle augmente de taille avec la disparition du liseré de sécurité entre la masse et la paroi du vaisseau. Le patient sera opéré en urgence avant que les globules blancs n’atteignent le seuil de 1000éléments/mm³. Une masse résiduelle persistante après un traitement antifongique peut justifier d’une résection pulmonaire (wedge ou lobectomie) avant la reprise d’une nouvelle thérapeutique agressive. Les mucormycoses surviennent chez des patients immunodéprimés (maladie hématologique, diabètes, transplantation, brûlures, dénutrition). Le traitement d’une mucormycose pulmonaire associe les antifongiques et la résection pulmonaire. Surgery is part of the therapeutic strategy of aspergillosis and mucormycosis. The aspergilloma is defined as a rounded mass, developing in a cavity by the proliferation of spores of Aspergillus. The most common complication was haemoptysis reported in 50–95% of cases. The pleuropulmonary lesions predisposing are: tuberculosis, residual pleural space, emphysema and lung destroyed by fibrosis or radiotherapy or bronchiectasis. The indications for surgery depend on symptoms, respiratory function, the parenchyma and the type of aspergilloma (simple or complex). In a patient with an intrapulmonary aspergilloma, lung resection preceded by embolization is recommended based on respiratory function. For intrapleural aspergilloma, thoracoplasty is recommended according to the patient's general condition. The invasive pulmonary aspergillosis (IPA) is characterized by an invasion of lung tissue and blood vessels by hyphae in immunocompromised patients. The death rate of patients who have an API after treatment for leukemia or lymphoma was 30 to 40%, after bone marrow transplantation 60%, after solid organ transplantation from 50 to 60% and after any other cause of immunocompromising from 70 to 85%. The main cause of these deaths is massive hemoptysis. Surgery (lobectomy) is indicated for the prevention of hemoptysis when the mass is in contact with the pulmonary artery or one of its branches, and if it increases in size with the disappearance of border security between the mass and the vessel wall. The patient will be operated in an emergency before the white blood cells do not exceed the threshold of 1000cells/μl. A persistent residual mass after antifungal treatment may justify a lung resection (lobectomy or wedge) before a new aggressive therapy. Mucormycosis affects patients following immunocompromising states — haematologic malignancy, diabetes mellitus, transplantation, burns and malnutrition. The treatment of pulmonary mucormycosis combines surgical and medical approach.

Publication year: 2012
Source:Revue de Pneumologie Clinique, Volume 68, Issue 5

F.Z. Hanim, J.E. Bourkadi, F.Z. Cherkaoui, M. Soualhi, R. Zahraoui, K. Marc, J. Benamour, G. Iraqi

Nous rapportons le cas d’une patiente âgée de 71ans, sans antécédent pathologique particulier, admise pour une hémoptysie de moyenne abondance. Après 48heures de son admission, la malade a expulsé spontanément une sangsue par le nez. Le parasite a été examiné au laboratoire de parasitologie qui a confirmé l’hémiptère. L’infestation des voies aériennes par une sangsue n’est pas rare, cependant ce diagnostic est rarement évoqué. La symptomatologie clinique est variable selon la localisation et le diagnostic doit être rapide pour éviter les complications. Quel que soit le site d’implantation, le retrait du parasite est difficile. L’évolution après extraction du parasite est rapidement favorable, avec disparition totale de tous les symptômes. We report an exceptional case of hemoptysis observed in a 71-year-old woman with an uneventful past history. After 48hours of admission, the patient spontaneously expelled a leech from the nose. The parasite was examined in parasitology laboratory, which confirmed the hemiptera. The infestation of the airway by a leech is not uncommon; however, this diagnosis is rarely mentioned. The clinical symptoms are variable depending on location and the diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.