P Scheinmann

Université René Descartes - Paris 5, Lutetia Parisorum, Île-de-France, France

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Publications (462)1044.55 Total impact

  • C. Karila · P. Scheinmann · J. de Blic
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    ABSTRACT: L’enfant multi-allergique réagit à au moins deux allergies, alimentaires et/ou respiratoires ; c’est souvent un enfant présentant plusieurs comorbidités atopiques (dermatite atopique, rhinite allergique, asthme). D’où vient-il ? L’héritabilité de l’allergie est évidente. Outre les déficits en filaggrine, de très nombreux polymorphismes génétiques sont surreprésentés chez les patients allergiques. Mais la génétique n’explique pas tout ; l’environnement moderne urbanisé, caractérisé par une diminution de l’exposition antigénique aux agents infectieux (quasi-disparition des helminthes) et aux substances biologiques environnementales (aliments, antigènes atmosphériques…), participe de l’allergie. Des modifications épigénétiques, transmissibles de génération en génération, en réponse à ce nouvel environnement, sont également constatées chez les patients allergiques. L’environnement, directement, ou par modifications épigénétiques, peut orienter le système immunitaire du fœtus et du nouveau-né prédisposé génétiquement vers un profil allergique Th2. Qui est-il ? Et que devient-il ? La trajectoire de l’enfant multi-allergique débute souvent avec une dermatite atopique. L’altération de la barrière cutanée facilite la multi-sensibilisation ou allergie précoce et sévère, vis-à-vis d’allergènes alimentaires puis respiratoires. Cet enfant vit dans un environnement intérieur riche en allergènes pro-inflammatoires, et notamment en moisissures. L’asthme sera volontiers précoce et sévère avec exacerbations et altération de la fonction respiratoire, et perdurera chez le grand enfant et l’adulte. Cet enfant multi-allergique s’inscrit dans « la marche atopique » qui va de la dermatite atopique du nourrisson à la rhinite et l’asthme de l’adulte.
    No preview · Article · Oct 2015 · Revue Française d'Allergologie
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    ABSTRACT: Severe asthma accounts for 0.5% of the general paediatric population and 4.5% of children with asthma, representing the major burden of asthma-health-care-associated costs. After ensuring a diagnosis of asthma and excluding difficult-to-treat patients with co-morbidities and non-adherence profiles, there remains children with real therapy-resistant asthma for whom the recommendations are to treat beyond guidelines. We describe new insights into the treatment of severe asthma in children, regarding both "classic drugs" (corticosteroids, bronchodilators) and innovative biological therapies targeting airway inflammation and impaired innate immunity. All of these new avenues remain to be studied and validated in children and will require fine clinical and biological phenotyping.
    No preview · Article · Aug 2014 · Paediatric respiratory reviews
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    R Matar · M Le Bourgeois · P Scheinmann · J de Blic · C Ponvert

    Full-text · Article · Jan 2014 · Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society
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    ABSTRACT: Beta-lactam hypersensitivity (HS) is suspected in 5-12% of the children, but proven in only 10-15% of those children, based on skin and challenge tests results. In contrast, 30-60% of patients with cystic fibrosis (CF) are diagnosed allergic to beta-lactams, based mainly on the clinical history of the patients. To confirm or rule out a suspected beta-lactam HS in CF children and to determine the prevalences of suspected and confirmed beta-lactam HS in those children. Children with CF and suspected beta-lactam HS were explored by means of skin and challenge tests with the suspected and alternate beta-lactams. The results in CF children were compared with those reported in the literature in non- CF children. Eight of the 701 CF children followed in our center between 1990 and 2011 (1.14%), and 11 other children from other centers were explored for suspected beta-lactam HS. Beta-lactam HS was diagnosed in nine of these children (47.3%). Based on the results in the children followed in our center, the prevalence of beta-lactam HS was 0.71% (5/701) in CF children vs. a mean estimated prevalence of 1-1.5% in the general pediatric population. Our results contrast with those of most previous studies. Although half of the CF children with suspected beta-lactam HS were truly allergic to beta-lactams, the general prevalence of beta-lactam HS in CF children was very low. This may result from tolerance induced by frequent and/or prolonged treatments with beta-lactams.
    Full-text · Article · Nov 2013 · Pediatric Allergy and Immunology
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    R. Matar · C. Ponvert · M. Le Bourgeois · P. Scheinmann · J. De Blic

    Full-text · Article · Apr 2013 · Revue Française d Allergologie
  • G. Lezmi · C. Karila · J. de Blic · P. Scheinmann
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    ABSTRACT: Allergic rhinitis is a common chronic disease in children and adults, responsible for important changes in their quality of life. The results of several recent cohort studies have provided a better description of its risk factors and its association with asthma. Allergic rhinitis often begins during childhood and persists into adulthood; it is more frequent in females. Exposure to tobacco smoke during pregnancy and early childhood, a parental history of allergy, and sensitization may be risk factors for the development of allergic rhinitis. The presence of allergic rhinitis in non-asthmatic individuals may predict the subsequent development of asthma, while its presence in asthmatics predicts persistence of their asthma. Allergic rhinitis and asthma might be two distinct diseases, but they seem more likely to represent two different expressions of a unique airway disease.
    No preview · Article · Apr 2013 · Revue Française d'Allergologie
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    ABSTRACT: According to the Global Initiative for Asthma (GINA) classification, mild asthma includes intermittent and mild persistent asthma. It represents more than 75% of asthmatic children. The symptoms and functional impact are well described. Mild asthma can lead to severe exacerbations. Progression to more severe disease may occur. Consequently, it is important to diagnose mild asthma, to initiate the appropriate treatment early, and to identify the risk factors for aggravation. Nevertheless, mild asthma is under-diagnosed and under-treated. Bronchial inflammation and remodeling are observed in mild asthma. A daily low-dose of inhaled corticosteroids is the reference treatment for mild persistent asthma. Intermittent inhaled corticosteroids cannot be recommended in children with mild persistent asthma.
    No preview · Article · Feb 2013 · Revue des Maladies Respiratoires
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    ABSTRACT: According to the Global Initiative for Asthma (GINA) classification, mild asthma includes intermittent and mild persistent asthma. It represents more than 75% of asthmatic children. The symptoms and functional impact are well described. Mild asthma can lead to severe exacerbations. Progression to more severe disease may occur. Consequently, it is important to diagnose mild asthma, to initiate the appropriate treatment early, and to identify the risk factors for aggravation. Nevertheless, mild asthma is under-diagnosed and under-treated. Bronchial inflammation and remodeling are observed in mild asthma. A daily low-dose of inhaled corticosteroids is the reference treatment for mild persistent asthma. Intermittent inhaled corticosteroids cannot be recommended in children with mild persistent asthma.
    No preview · Article · Feb 2013 · Revue des Maladies Respiratoires
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    C. Ponvert · P. Scheinmann · C. Delacourt · J. De Blic

    Full-text · Article · Apr 2012 · Revue Française d Allergologie
  • P Scheinmann · N Pham Thi · C Karila · J de Blic
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    ABSTRACT: Allergic rhinitis (AR) is a common IgE dependent disorder. AR is maybe one of the steps of the allergic march, which starts with atopic dermatitis and food allergy and includes atopic asthma. AR and asthma are frequently associated. AR is frequently under-diagnosed and undertreated although it affects quality of life and school performance. Management of AR depends on its severity and will associate environmental control (best guided by environmental investigation and skin testing of specific IgE antibodies), pharmacotherapy (with antihistamines and intranasal corticosteroids as first line drugs). At present allergen immunotherapy is considered in patients with severe AR, insufficiently controlled by pharmacotherapy and who demonstrate specific IgE antibodies to relevant allergens. Sublingual immunotherapy is well tolerated. Only immunotherapy with the right allergens has the potential to alter the natural history of the allergic march, by preventing the development of new allergen sensitizations and reducing the risk for the subsequent development of asthma. This fact might extend the indications of specific allergen immunotherapy. Patients (and parents) education is of utmost importance in the management of allergic disorders.
    No preview · Article · Mar 2012 · Archives de Pédiatrie
  • P. Scheinmann · N. Pham Thi · C. Karila · J. de Blic
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    ABSTRACT: Allergic rhinitis (AR) is a common IgE dependent disorder. AR is maybe one of the steps of the allergic march, which starts with atopic dermatitis and food allergy and includes atopic asthma. AR and asthma are frequently associated. AR is frequently under-diagnosed and undertreated although it affects quality of life and school performance. Management of AR depends on its severity and will associate environmental control (best guided by environmental investigation and skin testing of specific IgE antibodies), pharmacotherapy (with antihistamines and intranasal corticosteroids as first line drugs). At present allergen immunotherapy is considered in patients with severe AR, insufficiently controlled by pharmacotherapy and who demonstrate specific IgE antibodies to relevant allergens. Sublingual immunotherapy is well tolerated. Only immunotherapy with the right allergens has the potential to alter the natural history of the allergic march, by preventing the development of new allergen sensitizations and reducing the risk for the subsequent development of asthma. This fact might extend the indications of specific allergen immunotherapy. Patients (and parents) education is of utmost importance in the management of allergic disorders.
    No preview · Article · Mar 2012 · Archives de Pédiatrie
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    ABSTRACT: The aims were to assess 1) the relationship of asthma control assessed by combining epidemiological survey questions and lung function to Health-Related Quality of Life (HRQL) and 2) whether individuals with controlled asthma reach similar generic HRQL levels as individuals without asthma. The analysis included 584 individuals without asthma and 498 with asthma who participated in the follow-up of the Epidemiological study on Genetics and Environment of Asthma (EGEA). Asthma control was assessed from survey questions and lung function, closely adapted from the 2006-2009 Global Initiative for Asthma guidelines. The Asthma Quality of Life Questionnaire (AQLQ, scores range:1-7) and the generic SF-36 (scores range: 0-100) were used. Adjusted mean total AQLQ score decreased by 0.5 points for each asthma control steps (6.4, 5.9 and 5.4 for controlled, partly-controlled and uncontrolled asthma respectively, p < 0.0001). The differences in SF-36 scores between individuals with controlled asthma and those without asthma were minor and not significant for the PCS (-1, p = 0.09), borderline significant for the MCS (-1.6, p = 0.05) and small for the 8 domains (<5.1) although statistically significant for 4 domains. These results support the discriminative properties of the proposed asthma control grading system and its use in epidemiology.
    Full-text · Article · Feb 2012 · Respiratory medicine
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    Full-text · Article · Aug 2011
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    ABSTRACT: Studies based on skin and challenge tests have shown that 12-60% of children with suspected betalactam hypersensitivity were allergic to betalactams. Responses in skin and challenge tests were studied in 1865 children with suspected betalactam allergy (i) to confirm or rule out the suspected diagnosis; (ii) to evaluate diagnostic value of immediate and non-immediate responses in skin and challenge tests; (iii) to determine frequency of betalactam allergy in those children, and (iv) to determine potential risk factors for betalactam allergy. The work-up was completed in 1431 children, of whom 227 (15.9%) were diagnosed allergic to betalactams. Betalactam hypersensitivity was diagnosed in 50 of the 162 (30.9%) children reporting immediate reactions and in 177 of the 1087 (16.7%) children reporting non-immediate reactions (p<0.001). The likelihood of betalactam hypersensitivity was also significantly higher in children reporting anaphylaxis, serum sickness-like reactions, and (potentially) severe skin reactions such as acute generalized exanthematic pustulosis, Stevens-Johnson syndrome, and drug reaction with systemic symptoms than in other children (p<0.001). Skin tests diagnosed 86% of immediate and 31.6% of non-immediate sensitizations. Cross-reactivity and/or cosensitization among betalactams was diagnosed in 76% and 14.7% of the children with immediate and non-immediate hypersensitivity, respectively. The number of children diagnosed allergic to betalactams decreased with time between the reaction and the work-up, probably because the majority of children with severe and worrying reactions were referred for allergological work-up more promptly than the other children. Sex, age, and atopy were not risk factors for betalactam hypersensitivity. In conclusion, we confirm in numerous children that (i) only a few children with suspected betalactam hypersensitivity are allergic to betalactams; (ii) the likelihood of betalactam allergy increases with earliness and/or severity of the reactions; (iii) although non-immediate-reading skin tests (intradermal and patch tests) may diagnose non-immediate sensitizations in children with non-immediate reactions to betalactams (maculopapular rashes and potentially severe skin reactions especially), the diagnostic value of non-immediate-reading skin tests is far lower than the diagnostic value of immediate-reading skin tests, most non-immediate sensitizations to betalactams being diagnosed by means of challenge tests; (iv) cross-reactivity and/or cosensitizations among betalactams are much more frequent in children reporting immediate and/or anaphylactic reactions than in the other children; (v) age, sex and personal atopy are not significant risk factors for betalactam hypersensitivity; and (vi) the number of children with diagnosed allergy to betalactams (of the immediate-type hypersensitivity especially) decreases with time between the reaction and allergological work-up. Finally, based on our experience, we also propose a practical diagnostic approach in children with suspected betalactam hypersensitivity.
    Full-text · Article · Jun 2011 · Pediatric Allergy and Immunology
  • T. N. Pham Thi · P. Scheinmann · C. Karila · J. Laurent · E. Paty · J. de Blic
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    ABSTRACT: La dermatite atopique est souvent la première étape de la marche atopique conduisant à l’asthme. L’asthme succédant à la dermatite atopique sera d’autant plus fréquent et plus sévère que les manifestations cutanées seront sévères et associées à une polysensibilisation IgE dépendante. Les déficits en filaggrine renforcent cette tendance, surtout en cas d’allergie alimentaire. Il est indispensable de traiter la peau mais il n’est pas certain que cela suffise à prévenir la survenue d’asthme et/ou de rhinite allergiques.
    No preview · Article · Apr 2011 · Revue Française d Allergologie

  • No preview · Article · Feb 2011 · Journal of Allergy and Clinical Immunology

  • No preview · Article · Feb 2011 · Journal of Allergy and Clinical Immunology
  • J. de Blic · P. Scheinmann
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    ABSTRACT: El asma es la enfermedad crónica más frecuente de la infancia. El diagnóstico suele ser fácil cuando se producen episodios de disnea espiratoria con sibilancias reversibles de forma espontánea o mediante el uso de broncodilatadores. Las radiografías de tórax, la exploración funcional respiratoria y el estudio alérgico constituyen el aspecto fundamental de las pruebas complementarias necesarias. El tratamiento de la crisis consiste en el uso de β2-adrenérgicos inhalados y, si es necesario, corticoides orales. El tratamiento de fondo tiene como objetivo limitar al máximo los síntomas y restaurar o mantener las funciones pulmonares normales. Se debe adaptar a la gravedad y al control de la enfermedad y los corticoides inhalados tienen un papel de elección.
    No preview · Article · Dec 2010
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    C Ponvert · P Scheinmann · J de Blic
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    ABSTRACT: Anaphylaxis to pneumococcal vaccines is rare. In the only one child with anaphylaxis to a first injection of the 23-valent pneumococcal vaccine that has been explored, skin tests and specific IgE determination diagnosed immediate-type hypersensitivity to pneumococcal antigens. We report the case of a child who tolerated three injections of the 7-valent pneumococcal vaccine, but experienced anaphylaxis to a fourth injection of the 23-valent vaccine. Immediate responses in skin tests diagnosed immediate-type hypersensitivity to the two vaccines. Immunizations with the 7-valent pneumococcal vaccine may induce IgE-dependent sensitization to pneumococcal antigens, responsible for anaphylaxis to subsequent injections of pneumococcal vaccines.
    Full-text · Article · Oct 2010 · Vaccine
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    ABSTRACT: Single nucleotide polymorphisms (SNPs) at chromosome 17q21 confer an increased risk of early-onset asthma. The objective was to study whether 17q21 SNPs modify associations between early respiratory infections and asthma. Association analysis was conducted in 499 children (268 with asthma, median age 11 yrs) from the Epidemiological Study on the Genetics and Environment of Asthma (EGEA). The 12-yr follow-up data were used to assess persistent or remittent asthma in young adulthood. Respiratory infection before 2 yrs of age was assessed retrospectively. For the 12 17q21 SNPs studied, the odds ratios (OR) for association between infection and early-onset asthma (age at onset <or=4 yrs) were higher in carriers of risk genotypes (OR 3.42-6.36) than in noncarriers (OR 1.84-2.44; p-value for interaction 0.02-0.04 for five SNPs). Risk genotypes also increased the association between infection and childhood asthma that remits in adulthood (OR 4.84-7.16 in carriers and 1.74-2.25 in noncarriers; p-value for interaction 0.008-0.05 for 10 SNPs). In children with 17q21 risk genotypes and early-life environmental tobacco smoke (ETS) exposure, associations between infection and asthma were further enhanced. 17q21 genetic variants and early ETS exposure enhance the association between early respiratory infections and early-onset asthma and childhood asthma that remits in adulthood.
    Preview · Article · Jul 2010 · European Respiratory Journal

Publication Stats

6k Citations
1,044.55 Total Impact Points

Institutions

  • 2001-2014
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • University of Nice-Sophia Antipolis
      Nice, Provence-Alpes-Côte d'Azur, France
  • 2004-2009
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2000-2008
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France
  • 1984-2008
    • Centre de Pneumologie et d'Allergologie
      Avinyó, Provence-Alpes-Côte d'Azur, France
  • 2007
    • University Joseph Fourier - Grenoble 1
      • Institut Albert Bonniot
      Grenoble, Rhone-Alpes, France
  • 2006
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2003
    • Centre Hospitalier Universitaire de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2001-2003
    • SickKids
      Toronto, Ontario, Canada
  • 1990
    • Hôpital Ambroise Paré Paul Desbief
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1982
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France