L’asthme à la farine : étude clinique de 27 cas (nécessité d’un algorithme décisionnel)

Published on Nov 1, 2002in Revue Francaise D Allergologie Et D Immunologie Clinique
· DOI :10.1016/S0335-7457(02)00217-4
G Fourgaut1
Estimated H-index: 1
,
E Popin1
Estimated H-index: 1
+ 2 AuthorsG. Pauli39
Estimated H-index: 39
Sources
Abstract
Resume Objectifs. – A partir de l’etude de patients retenus comme ayant un asthme professionnel dans le milieu de la boulangerie par des cliniciens experts, les auteurs precisent l’apport des differents examens complementaires. Materiel et methodes. – Les dossiers de 27 sujets diagnostiques entre 1983 et 1999, presentant un asthme professionnel de gravite variable, sont etudies. Le bilan allergologique complet a ete effectue avec recherche des sensibilites a la farine par tests cutanes (associee a des IgE specifiques dans 23 cas). Les epreuves fonctionnelles respiratoires ont ete realisees chez tous les patients, une mesure de l’hyperreactivite bronchique non specifique chez 19 d’entre eux, 14 ont enregistre leur debit de pointe en periode de travail et de conges, un test de provocation bronchique realiste a ete effectue dans 11 cas. Le suivi evolutif a ete etudie chez 9 patients. Resultats. – L’âge moyen des patients est de 27,9 ans ; 19 d’entre eux sont boulangers. Dans deux tiers des cas une rhinite est associee, la duree d’exposition avant l’apparition des symptomes est de 6 ans pour l’asthme et de 3 ans pour la rhinite. Trois patients seulement ont un asthme intermittent, la majorite d’entre eux (19 cas) a un asthme persistant modere. La sensibilisation a la farine de ble est demontree dans 21 cas sur 23. Une co-sensibilisation a la farine de seigle est observee dans 14 cas sur 16. Un syndrome obstructif intercritique n’est mis en evidence que dans 3 cas. L’hyperreactivite bronchique non specifique est augmentee chez 14 patients sur 19. Le diagnostic a ete confirme chez 14 patients par l’etude des enregistrements du debit de pointe en periode de travail et de conges. Dans 11 cas, le diagnostic est etabli par la positivite du test de provocation bronchique realiste a la farine (reaction immediate dans tous les cas, double dans un cas, reaction immediate prolongee dans 6 cas). L’evolution clinique etudiee chez 9 patients dont 4 ont eu une eviction complete montre que l’etat clinique des asthmatiques de stade III ne s’ameliore pas malgre un traitement par corticoides inhales. Le devenir professionnel conduit souvent a une perte d’emploi ou a un reclassement professionnel (dans 4 cas sur 6). Conclusion. – Le diagnostic d’asthme professionnel a la farine doit etre etabli par etapes : l’algorithme decisionnel base sur un interrogatoire effectue par un clinicien expert se base successivement sur les resultats des tests immunologiques, l’enregistrement du debit de pointe en periode de travail et de repos et le test de provocation bronchique.
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Observatoire National des Asthmes Professionnels (ONAP) was created in 1996 by two French professional societies to estimate the incidence of occupational asthma and to promote preventive measures against it. Occupational and chest physicians were asked to report newly diagnosed cases of work-related asthma and reactive airway dysfunction syndrome (RADS), the information collected included age, sex, occupation, suspected causal agents and diagnostic methods. In 1997, 82.3% of 559 cases reported ...
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Systematic reports from chest and occupational physicians under the SWORD and OPRA (Occupational Physicians Reporting Activity) surveillance schemes continue to provide a picture of the incidence of occupational respiratory disease in the UK. An estimated total of 4393 incident cases (comprising 4530 diagnoses) were reported during the 1999 calendar year, an increase of 1427 cases over the previous year. Benign pleural disease was the single most frequently reported condition (28% of all diagnos...
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The aim of this study was to investigate the relationship between specific bronchial reactivity and respective nonspecific bronchial and immunological reactivities. Twenty-one patients underwent bronchial challenges with lactose and flour. The aerosol of particles was generated by a computer-controlled aerosolizer. Specific bronchial challenge results were expressed as the provocative dose of flour (PDf) that caused a 20% or 15% decrease in the forced expiratory volume in one second (FEV1). For ...
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In industrialized countries, occupational asthma caused by allergens and irritants due to workplace exposure is increasing. More than 8,000 such claims were made in Germany (10.5% of all decided occupational disease claims) in 1995; 1,900 were confirmed (6.5% of all confirmed claims). The legal basis and the occupational disease-related regulations of trade-assigned statutory accident insurance institutions (‘Berufsgenossenschaften’) in Germany are described. Hitherto, three occupational disease...
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The study's objectives were to measure flour antigen exposure in bakeries and define the determinants of exposure. Ninety-six bakery workers, employed in seven different bakeries, participated in the study. Two side-by-side full-shift inhalable dust samples were obtained from each study participant on a single occasion. The flour antigen exposure was measured as wheat antigen and fungal α-amylase content of the water-soluble fraction of inhalable dust, assayed via enzyme-linked immunosorbent ass...
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: The gold standard in the diagnosis of occupational asthma is the specific bronchial provocation test (sBPT), but other diagnostic criteria have been proven to have a similar sensitivity, mainly in asthma due to high molecular weight compounds. In order to assess wether some clinical findings can predict the positive response to sBPT, we studied 37 subjects (14 millers and 23 bakers) with suspected occupational asthma who underwent sBPT with wheat flour dust (dust exposure in a small cabin: geo...
Cited By2
Newest
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Summary The follow-up of patients with asthma should focus on asthma control (disease course over a number of weeks)→ There are 3 levels of asthma control•Acceptable:All control criteria (Table 1 below) are met•Unacceptable:One or more criteria are not met•Optimal:All control criteria are normal or, in a patient with acceptable control, the best compromise has been achieved between degree of control, acceptance of treatment and possible side effectsTable 1 Criteria defining acceptable asthma con...
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Resume L’asthme professionnel est la plus frequente des maladies professionnelles ; son diagnostic est difficile et les agents causals de plus en plus nombreux. Les donnees epidemiologiques concernant l’asthme professionnel sont imprecises et resultent pour la plupart de donnees fondees sur le recueil volontaire des cas par les medecins dans certains pays comme la France, l’Angleterre ou l’Afrique du Sud. Certaines etudes cliniques tentent de preciser son ampleur dans certains milieux profession...
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