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ABSTRACT: Spontaneous pneumomediastinum (SPM) is rare in children, mainly affecting male adolescents. It is usually secondary to alveolar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The clinical diagnosis is based on the symptom triad of chest pain, dyspnea, and subcutaneous emphysema, and is also based on Hamman's sign. The diagnosis is confirmed by chest radiography. The main differential diagnosis is esophageal perforation, which requires an esophagogram with contrast when there is the slightest doubt in the diagnosis. Spontaneous pneumomediastinum generally resolves spontaneously within a few days, meaning that ambulatory treatment is usually appropriate. Management consists of treating the underlying cause (if identified), rest, analgesics, and simple clinical monitoring. Predisposing factors should be identified and controlled to prevent recurrence. Cases of idiopathic SPM necessitate diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma.
Pediatric Pulmonology 02/2001; 31(1):67-75. · 2.53 Impact Factor
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L Le Clainche,
M Le Bourgeois,
B Fauroux,
N Forenza,
J P Dommergues,
J C Desbois,
G Bellon,
J Derelle,
G Dutau,
C Marguet,
I Pin,
I Tillie-Leblond,
P Scheinmann,
J De Blic
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ABSTRACT: We retrospectively analyzed the long-term outcome of idiopathic pulmonary hemosiderosis (IPH) in 15 children. IPH started at a mean age of 5 years, and the mean duration of follow-up was 17.2 years (range, 10-36 yr). Four patients developed immune disorders, 3 cases of rheumatoid polyarthritis or rheumatoid polyarthritis-like diseases and 1 case of celiac disease. Respiratory outcome showed that 3 patients had severe symptoms: 2 patients developed severe pulmonary fibrosis resulting in major chronic respiratory insufficiency, and 1 patient had severe asthma. Twelve patients (80%) had mild or no respiratory problems and were able to lead a normal life. According to chest X-ray and pulmonary function test data, 4 patients had normal chest X-ray and no evidence of restrictive syndrome, 6 patients had an interstitial pattern on chest X-ray and evidence of restrictive pattern, 1 patient had an interstitial pattern but normal lung function, and 1 patient had a normal chest X-ray but evidence of mixed obstructive and restrictive pattern. Our results show that long-term survival is possible in patients with IPH. Factors of poor prognosis seem to be the presence of antineutrophil cytoplasm antibodies (ANCA) or other autoantibodies. No other clinical or biological predictive factors for prolonged survival were found.
Medicine 10/2000; 79(5):318-26. · 4.35 Impact Factor
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ABSTRACT: Skin tests with soluble beta-lactams can be used to diagnose immediate and delayed hypersensitivity (HS) reactions to beta-lactam antibiotics. Very few studies have been performed with children with suspected beta-lactam allergy. In these studies, immediate HS to beta-lactams was diagnosed by skin tests in 4.9% to 40% of children. The diagnostic and predictive values of immediate responses in skin tests are good, because very few children with negative skin test results have positive oral challenge (OC) test results. Delayed responses in skin tests (intradermal and patch tests) have been reported in adult patients and children suffering with urticaria, angioedema, and maculopapular rashes during treatments with beta-lactam antibiotics. However, the diagnostic and predictive values of late responses are unknown. Semi-late responses in skin tests with beta-lactams have never been studied in adults or children.
The aims of this study were to confirm or rule out the diagnosis of allergy to beta-lactams in children with histories of adverse reactions to these antibiotics, to determine whether allergic children were sensitized to one or several classes of beta-lactams, and to evaluate the frequency and diagnostic value of immediate, accelerated, and delayed responses in skin tests with beta-lactam antibiotics in children.
We studied 325 children with suspected beta-lactam allergy. Skin tests (prick and intradermal) were performed with soluble forms of the suspected (or very similar) beta-lactams and with one or several beta-lactams from other classes. The reaction was assessed after 20 minutes (immediate), 8 hours (accelerated), and 48 to 72 hours (delayed). OCs with the suspected beta-lactams were performed in patients with negative skin test results, except those with severe serum sickness-like reactions and potentially harmful toxidermias.
Skin tests and OCs led to the diagnosis of beta-lactam allergy in 24 (7.4%) and 15 (4.6%) of the children, respectively. Thus, only 12% of the children were diagnosed as allergic to beta-lactams by means of skin tests and OC. HS to beta-lactams was suspected from clinical history in 30 (9.2%) children reporting serum sickness-like reactions and potentially harmful toxidermias. In a few children, we diagnosed food allergy and intolerance to excipients or nonsteroidal antiinflammatory drugs. No cause was found in the other children. Based on skin tests and OC, the prevalences of immunoglobulin E-dependent and of semi-late or delayed sensitizations to beta-lactam assessed were similar (6.8% vs 5.2%, respectively). Most immunoglobulin E-dependent sensitizations were diagnosed by means of skin tests (86.4%). In contrast, most semi-late and delayed sensitizations were diagnosed by OC (70.6%). The likelihood of beta-lactam allergy was significantly higher for anaphylaxis (42.9% vs 8.3% in other reactions) and immediate reactions (25% vs 10% in accelerated and delayed reactions). Of the children diagnosed as allergic to beta-lactam by means of skin tests, OC, and clinical history, 11.7% were sensitized to several classes of beta-lactams. The risk was significantly higher in children with anaphylaxis (26. 7% vs 7.5% of the children with other reactions) and in children reporting immediate reactions (33.3% vs 8.5% of the children with accelerated and delayed reactions). Finally, age, sex, personal history of atopy, number of reactions to beta-lactams, and number of reactions to other drugs were not significant risk factors for beta-lactam allergy.
The skin tests were safe, and the immediate reaction to skin tests successfully diagnosed allergy to beta-lactam antibiotics in children reporting reactions suggestive of immediate HS. In contrast, most accelerated and delayed reactions were diagnosed by OC. Thus, our results suggest that the diagnostic and predictive values of skin tests for nonimmediate HS to beta-lactams in children are low. (ABSTRACT TRU
PEDIATRICS 11/1999; 104(4):e45. · 4.47 Impact Factor
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Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 05/1998; 53(2):119-22.
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Pediatric Allergy and Immunology 02/1998; 9(11 Suppl):37-41. · 2.46 Impact Factor
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Inorganic Chemistry 39(16):3436-7. · 4.60 Impact Factor
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ABSTRACT: Hepatitis B (HBV) vaccines seldom induce adverse reactions suggestive of immediate-type hypersensitivity (HS), such as anaphylaxis, urticaria and/or asthma. Therefore, we assessed 4 children with histories of adverse reactions to HBV vaccines, such as accelerated urticarias (3 cases) and asthma (1 case) ; one of them reported also recurrent idiopathic urticaria. Immediate-reading skin tests (prick-tests and ID) performed with vaccines were constantly negative. Also, RAST-formaldehyde performed in 2 children were negative. Booster immunizations were well tolerated in 3 children ; however, booster injection of HBV vaccine induced a generalized urticaria in the child reporting recurrent idiopathic urticaria. Our results strongly suggest that most reactions induced by HBV vaccines are not related to an underlying HS to components of the vaccines.
Revue Française d'Allergologie et d'Immunologie Clinique. 38(4):315-318.
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ABSTRACT: Acute bronchiolitis is a disease affecting infants and occurring by epidemics, due to its highly contagious nature. The increased number of visits and hospital admissions caused by bronchiolitis make it a real public health problem. Its management is a subject of passionate debate by various paediatric teams. The treatment of acute bronchiolitis is essentially symptomatic and is based on hydration, oxygen therapy (when necessary) and respiratory physiotherapy. No drug class, particularly bronchodilators or corticosteroids, has yet been shown to be effective. However, in children with a personal and/or family history of atopy, or in children presenting with severe respiratory distress, the prescription of a β2-mimetic nebulizer can be proposed, but it does not appear logical to continue such treatment when it is ineffective.
Revue Française d'Allergologie et d'Immunologie Clinique.
