70 Comparative study between PIMS and Kawasaki disease

Background

Kawasaki disease (kDa) is a multisystemic vasculitis affecting medium and small vessels with a predilection for the coronary arteries. It appears to be very similar to the pediatric multisystemic inflammatory syndrome (PIMS), which is a post-infectious inflammatory condition occurring after SARS-COV2 infection. Although these two entities have clinical and biological similarities, marked differences are identified. The aim of this study is to compare the two conditions in order to highlight the specific criteria of each of these related entities and to describe their demographic, clinical, biological and therapeutic characteristics in our context.

Method

Single center prospective observational study from January 2021 to March 2022 was conducted, comparing children admitted for PIMS on the basis of persistent fever, inflammatory syndrome, and positive COVID-19 IgG serology to patients hospitalized for kDa according to American Heart Association criteria.

Results

42 cases were recruited, among them 24 PIMS and 18 kDa, with a male predominance. The average age was 5 years for PIMS and 2 years and 7 months for kDa. All had a persistant fever with an average duration of 8 days as reason for consultation. Conjunctivitis was found in 88% of kDa vs 75% of PIMS and cheilitis in 94% of kDa vs 75% of PIMS. Skin rash, extremity involvement, cervical adenopathy were reported in both pathologies with respective percentages of 62.5%, 17.4% and 25% for PIMS vs 61.1%, 33.3% and 33.3% for kDa. Abdominal pain was reported in 54.2% of PIMS patients vs 5.6% of kDa. All patients had an inflammatory syndrome. The mean sedimentation rate was 67 mm at the first h in PIMS and 99 mm at the first h in kDa. The mean CRP was 147 mg/l in PIMS vs 132 mg/l in kDa. Lymphopenia was predominant in PIMS with 33% vs 11% in kDa. Cardiac enzymes were higher in PIMS with 29% of myocarditis and 15% of coronary dilatation vs 16.7% of coronary involvement in kDa. All PIMS patients received immunoglobulin infusion IV-IG, corticosteroid therapy, and an antiplatelet agent, whereas patients with kDa received IV-IG and acetyl salicylic acid in anti-inflammatory doses. Apyrexia was obtained at day 1 of treatment in the majority of patients, whereas 5.6% of kDa had persistent aneurysm.

Conclusion

PIMS cases predominated over kDa cases during this pandemic period. The distinction between the two entities could be difficult given the clinico-biological similarities. Abdominal pain was significantly more frequent in PIMS patients, whereas lymphopenia and myocarditis were not. The prognosis was better in PIMS.

Differences in protein expression, at the basal state and at 2 h of insulin infusion, in muscle biopsies from healthy Arab men with high or low insulin sensitivity measured by hyperinsulinemic euglycemic clamp

BACKGROUND

Skeletal muscle is the main site for insulin-dependent glucose disposal. The hyperinsulinemic euglycemic clamp (HIEC) is the gold standard for the assessment of insulin sensitivity (IS). We have previously shown that insulin sensitivity, measured by HIEC, varied widely among a group of 60 young healthy men with normoglycemia. The aim of this study was to correlate the proteomic profile of skeletal muscles to insulin sensitivity.

METHODS

Muscle biopsies from 16 subjects having the highest (M ≥ 13; n = 8, HIS) and lowest (M ¾ 6, n = 8, LIS) IS were obtained at baseline and during insulin infusion after stabilization of the blood glucose level and glucose infusion rate at the end of the HIEC. The samples were processed using a quantitative proteomic analysis approach.

RESULTS

At baseline, 924 proteins were identified in the HIS and LIS groups. Among the 924 proteins detected in both groups, three were suppressed and three were increased significantly in the LIS subjects compared with the HIS subjects. Following insulin infusion, 835 proteins were detected in both groups. Among the 835 proteins, two showed differential responsiveness to insulin; ATP5F1 protein was decreased, and MYLK2 was higher in the LIS group compared with that in the HIS group. Our data suggest that alteration in mitochondrial proteins and an increased number of proteins involved in fast-twitch fiber correlate to insulin sensitivity in healthy young Arab men.

CONCLUSIONS

These results suggest a change in a small number of differentially expressed proteins. A possible reason for this small change could be our study cohorts representing a homogeneous and healthy population. Additionally, we show differences in protein levels from skeletal muscle in low and high insulin sensitivity groups. Therefore, these differences may represent early events for the development of insulin resistance, pre-diabetes, and type 2 diabetes.

Insulin sensitivity variations in apparently healthy Arab male subjects: correlation with insulin and C peptide

INTRODUCTION

Decreased insulin sensitivity occurs early in type 2 diabetes (T2D). T2D is highly prevalent in the Middle East and North Africa regions. This study assessed the variations in insulin sensitivity in normal apparently healthy subjects and the levels of adiponectin, adipsin and inflammatory markers.

RESEARCH DESIGN AND METHODS

A total of 60 participants (aged 18-45, body mass index <28) with a normal oral glucose tolerance test (OGTT) completed hyperinsulinemic-euglycemic clamp (40 mU/m²/min) and body composition test by dual-energy X-ray absorptiometry scan. Blood samples were assayed for glucose, insulin, C peptide, inflammatory markers, oxidative stress markers, adiponectin and adipsin.

RESULTS

The subjects showed wide variations in the whole-body glucose disposal rate (M value) from 2 to 20 mg/kg/min and were divided into three groups: most responsive (M>12 mg/kg/min, n=17), least responsive (M≤6 mg/kg/min, n=14) and intermediate responsive (M=6.1-12 mg/kg/min, n=29). Insulin and C peptide responses to OGTT were highest among the least insulin sensitive group. Triglycerides, cholesterol, alanine transaminase (ALT) and albumin levels were higher in the least responsive group compared with the other groups. Among the inflammatory markers, C reactive protein (CRP) was highest in the least sensitivity group compared with the other groups; however, there were no differences in the level of soluble receptor for advanced glycation end products and Tumor Necrosis Factor Receptor Superfamily 1B (TNFRS1B). Plasma levels of insulin sensitivity markers, adiponectin and adipsin, and oxidative stress markers, oxidized low-density lipoprotein, total antioxidant capacity and glutathione peroxidase 1, were similar between the groups.

CONCLUSIONS

A wide range in insulin sensitivity and significant differences in triglycerides, cholesterol, ALT and CRP concentrations were observed despite the fact that the study subjects were homogenous in terms of age, gender and ethnic background, and all had normal screening comprehensive chemistry and normal glucose response to OGTT. The striking differences in insulin sensitivity reflect differences in genetic predisposition and/or environmental exposure. The low insulin sensitivity status associated with increased insulin level may represent an early stage of metabolic abnormality.

The metabolic footprint of compromised insulin sensitivity under fasting and hyperinsulinemic-euglycemic clamp conditions in an Arab population

Metabolic pathways that are corrupted at early stages of insulin resistance (IR) remain elusive. This study investigates changes in body metabolism in clinically healthy and otherwise asymptomatic subjects that may become apparent already under compromised insulin sensitivity (IS) and prior to IR. 47 clinically healthy Arab male subjects with a broad range of IS, determined by hyperinsulinemic-euglycemic clamp (HIEC), were investigated. Untargeted metabolomics and complex lipidomics were conducted on serum samples collected under fasting and HIEC conditions. Linear models were used to identify associations between metabolites concentrations and IS levels. Among 1896 identified metabolites, 551 showed significant differences between fasting and HIEC, reflecting the metabolic switch in energy utilization. At fasting, 336 metabolites, predominantly di- and tri-acylglycerols, showed significant differences between subjects with low and high levels of IS. Changes in amino acid, carbohydrate and fatty acid metabolism in response to insulin were impaired in subjects with low IS. Association of altered mannose and amino acids with IS was also replicated in an independent cohort of T2D patients. We identified metabolic phenotypes that characterize clinically healthy Arab subjects with low levels of IS at their fasting state. Our study is providing further insights into the metabolic pathways that precede IR.

Development of perfluorocarbon tracer technology for underground leak location

A method has been developed for the atmospheric sampling and analysis of four perfluorocarbon tracer (PFT) compounds simultaneously at the parts per trillion (ppt) level. PFTs were pre-concentrated using adsorbent tube air sampling. Analysis was achieved by thermal desorption (TD) and gas chromatography (GC) with electron capture detection (ECD). Efficient separation of the PFTs from the other sample constituents was achieved by use of a capillary porous layer open tubular (PLOT) GC column without the need to cool the GC oven to sub-ambient temperatures using liquid coolants (M. de Bortoli and E. Pecchio, J. High Resolut. Chromatogr., 1985, 8, 422) or for a catalytic destruction step to remove interferents (T. W. D'Ottavio, R. W. Goodrich and R. N. Dietz, Environ. Sci. Technol., 1986, 20, 100). Results from test field trials with two volatile PFTs that were buried to simulate an underground leaking cable were successful. The PFTs were detected above ground level to pinpoint the leak position. The highest tracer concentrations were detected within 1 m of the simulated leak positions 2 days after tracer burial. The developed technology was applied to an oil leaking high voltage electricity cable. One PFT was added to the cable oil which enabled detection of the oil leak to within 3 m. The reported method has many advantages over currently used leak detection methods and could, in the future, be applied to the detection of underground leaks in a variety of cables and pipes.

[The wasp-mosquito syndrome: extension of cross-allergenicity to the horsefly]

The crossed allergenicity between wasp venom and mosquito extract was shown during recent work based on clinical observations and correlation studies between different biological parameters, indicating an IgE-dependent biological mechanism. A common protein was identified by Immunoblot. From observation of one of our patients involved in this work, we examined the possibility of the extension of crossed reactivity between wasp, mosquito and horsefly. In effect, our patient presented an anaphylactic reaction with neurological complications from attack on the central grey nucleus, shown by IRM; the immunological study showed a common protein between wasp venom and the total extracts of mosquito and horsefly.

A catalogue of urban hydrocarbons for the city of Leeds: atmospheric monitoring of volatile organic compounds by thermal desorption-gas chromatography

A method has been developed for the speciation and quantitative determination of hydrocarbons in urban air in the city of Leeds. Hydrocarbons were pre-concentrated by adsorbent tube air sampling and analyzed using thermal desorption and gas chromatography with flame ionization detection and structural confirmation by mass spectrometric detection. While automated volatile organic compound (VOC) analyzers produced data for a maximum of about 30 compounds simultaneously, with the method described here, a total of 68 C6-C12 hydrocarbons were measured simultaneously in one analysis at parts per billion (ppb) levels. Several monitoring surveys were performed, one during the winter of 1993 and the other in the summer of 1994, at a number of sites to investigate the levels of VOCs identified in the urban air of Leeds.

[Anaphylaxis caused by a mosquito: 2 case reports]

Allergy to mosquitoes that produces anaphylaxis is very exceptional. We present two observations of anaphylaxis to mosquitoes with good correlation between the clinical history and the immunological indications of which the basophil activation test proved to be effective. The many allergens of mosquitoes are contained in the juices and salivary glands and their molecular weights are between 22 and 95 kD. Specific immunotherapy, which uses whole body extracts of mosquito, gives good results of protection that induces excellent tolerance and has very good efficacy.

[The wasp/mosquito syndrome]

The authors describe for the first time the Wasp/Mosquito syndrome. The allergenic cross-reactivity between Vespula wasp venom and mosquito extract and the reverse rest objectively on several criteria. The frequency of the association between sensibilization to Vespula wasp venom and mosquito: In 10 subjects who had specific IgE to Vespula wasp venom 3 also had mosquito-specific IgE (30%), but out of 11 subjects with positive mosquito-specific IgE 10 also were positive with Vespula wasp venom specific IgE (about 91%). Three observations were documented showing a clinical and biological relationship between sensitisation to mosquito and wasp venom. A first patient had an anaphylactic reaction after a dozen mosquito bites. The allergy assessment confirmed sensitisation to the mosquitos, but also to Vespides (wasp, hornet) venoms. A second patient had an anaphylactic reaction after a wasp sting in 1997. From that date, he had local reactions, indeed loco-regional, to mosquito bites. The allergy assessment confirmed the double sensibilization to mosquito and wasp venom. Finally, a third patient at first had local reactions, also loco-regional, to mosquito bites, then two systemic reactions after mosquito bites. A first allergy assessment, made exclusively to hymenoptera venoms (not to mosquitos), showed a sensitivity to wasp venom and the patient, by mistake, was desensitised to wasp venom, which did not prevent recurrence after mosquito bites. After a second time, the allergy assessment for hymenoptera and mosquito, confirmed a double sensitisation (mosquito and Vespula wasp). Indirect criteria such as parallel increase in specific IgEs to Vespula wasp venom and mosquito in a patient who was desensitised only to mosquito and who had not been re-stung by wasps. Finally on direct criteria, such as: The inhibition technique by CAP RAST, which was positive in two ways: Vespula wasp--specific IgE was inhibited by mosquito extract, and vice versa. Electrophoresis, which showed a protein common to Vespula wasp venom and mosquito extract of M.W. of the order or 42KD and isoelectric point between 4.5 and 5. An immunoblot study identified this common protein with a M.W. of 44KD which is the same as hyaluronidase.

[Corticosteroids]

The corticosteroids or glucocorticoids have a preponderant place in the treatment of allergic manifestations. They are used to ward of the inflammatory process triggered and auto-maintained by some mediators (histamine, tryptase, leucotrienes, prostaglandin, ECP, MBP ...) that are released by some cells (mastocytes, basophils, eosinophils ...) during the contest of antigen--antigen receptor site. It is essential to understand the mechanism of action of the glucocorticoids as well as their secondary effects to adapt prescriptions better.

[Chronic urticaria caused by cow's milk allergy: immediate or delayed allergy? (apropos of a case)]

Chronic urticaria has multiple etiologies, amongst them food allergy, which is not the most frequent. We report a clinical case of chronic urticaria due to cow milk, where paradoxically the responsibility of the food was shown by an epidermo test when the prick test was negative. Development confirmed the responsibility of cow milk. We discuss the mechanisms that relate chronic urticaria to delayed hypersensitivity.

[Non-allergic rhinitis or intrinsic rhinitis? Unusual features of nickel allergy]

The clinical expression of nickel is known for its great diversity, from classical contact eczema to rhinitis, including work-related allergy, and by secondary hyperthermia to a metallic heart valve. Very often, hypersensitivity which may be of type I or type IV is secondary to contact of the hapten with sensitive cells, however some authors have reported the possibility of reactivation of lesions, especially dermatological (urticaria-eczema) by tests of oral ingestion. However, review of the literature does not mention the possibility of O.R.L. problems of the rhinitis type, from rhinosinusitis following ingestion of nickel and the two clinical cases that we report that involve one child of 11 years and one patient of 59 years, both of whom presented a serious rhinitis with a tendency to surperinfection, developing to perennial, where a patch-test to nickel was strongly positive, and who have seen an improvement in their clinical problems with a strict diet without this hapten. This confirms that the need is eventually physiopathological and suggests the necessity to search systematically for a possibility of hypersensitivity to haptens by the patch test technique in rhinitis that is labelled "non-allergic", by a negative reaginic history to pneumoallergens and trophallergens.

[Importance of realistic tests for drug allergy: apropos of a clinical case]

Drug allergy is the most difficult area in Allergology because: Clinical polymorphism and specially physiopathology (IgE-dependent hypersensibility reaction, cyclo-oxygenase inhibitor, etc.). Feeble specificity and sensitivity in the basic immunoallergic investigation (Skin tests, specific IgE). Very frequently his necessitates recourse to REALISTIC TESTS of drug re-introduction under clinical and biological surveillance (HSI mediators: histamine/tryptase/urinary methyl histamine) to produce a diagnosis.

[Predictive value of the allergologic profile in anesthesia and resuscitation]

The allergic history to anaesthetics in general and especially to synthetic myorelaxants, poses few etiological diagnostic problems in practice, because of on one hand the excellent collaboration between Anesthetists and Allergologists in the CHU at Angers and on the other because of the great sensitivity of skin testing. Why then have a predictive history for myorelaxants? The results of a study at the CHU at Angers on 15 patients showed sensitivity to anaesthetics in general (myorelaxants 86%, Diprivan) and/or an antibiotic, latex were very encouraging. One 15 new general anaesthetics a single minor incident was seen: the 15 patients had benefited from a predictive history.

[Allergic immunobiology and anesthesiology]

A protocol has been produced for the study of anaphylactic accidents that occur post-operatively that allows definition of the anaphylactic origin, and so reactions that are mediated by IgE in post-operative accidents. This protocol occurs in two stages, the first is done in the minutes and hours that follow the anaphylactic accident, and the second a month or 6 weeks afterwards. At first, we evaluate the sequential study of the liberation of the mediators of anaphylaxis, plasma histamine, serum tryptase, urinary methylhistamine and, more recently, leucotriene E4. The second study is devoted to reactions that are mediated by IgE, essentially, specific serum IgE, tests of activation of basophils by flow cytometry, measurement of leucotriene C4 and skin tests. A study on 16 subjects has evaluated and validated the protocol and shown a significant level of correspondence of results between the sequential measurement of mediators on one hand and on the other the search for IgE-mediated reactions every time that there was an anaphylactic reaction.

[Postoperative allergic complications: the role of the anesthetist in conducting the immuno-allergic investigation]

When peri-anaesthesia anaphylactic and/or anaphylactoid reactions occur, anaesthetist is the first investigator: the quality of immuno-allergological investigations depends on these initial investigational procedures. We have used sample kits for several years in order to make easier the immediate investigation. From retrospective analysis of the allergic complications which happened in 1997, the importance of these sample kits as well as the anaesthetist's part in the immuno-allergological management are examined. Nine observations were itemized (0.047%): 3 generalized erythema observations (grade I), in which atracurium was incriminated twice, and propacetamol once; 2 observations of grade II, in which vecuronium (elevated tryptase) and atracurium were incriminated; 4 anaphylactic shocks, in which three neuromuscular blocking drugs (suxamethonium, vecuronium and pancuronium), and one antibiotic (cloxacilline) were incriminated. The use of sample kits allowed an early diagnosis approach, confirmed by skin tests. Diagnosis should be thought closely between anaesthetists and immunologists for investigations.

[Gelatin allergy]

Allergy to the gelatin used as a plasma filler product has not been recognised until now. Methods used have not been validated but are composed of specific serum IgE, skin tests and histamine release by leucotrienes. The clinical observation that we report has the merit of showing the reality of an allergy that is dependent on plasma filler products due to development of a protocol which includes firstly, during anaphylactic shock, measurement of the mediators of immediate hypersensitivity and secondly, after the clinical accident, test of the activation of basophils by flow cytometry (TAB) and measurement of leucotrienes.

[Food allergy: definition--physiopathology]

Food allergy is defined by a mixture of digestive and or extra-digestive clinical symptoms, "rhinitis, asthma, eczema, etc" secondary to contact with a food and/or a preservative and/or addition to the immune system of the organism, with its origin in an excessive humoral and/or cellular response, called HYPERSENSITIVITY. For this to occur, food allergy needs conjunction of several parameters. Predisposing factors Genetics, with facility to produce IgE. Reduction of the defences of the digestive system. Usual foods.

[Allergy to mosquitoes and use of new immunobiological parameters]

With regard to an observation of anaphylaxis after a mosquito bite, we have shown by new immunobiological parameters and clinical investigations: Skin tests, specific IgE, Tests of Activation of basophils by flow cytometry (on basophils and total blood) and measurement of Leucotriene LTC4, the objective reality of the mechanism of IgE-dependent hypersensitivity (HS). This observation is correlated with rare work in support of true IgE-mediated allergy to mosquito 9 authors having used skin tests, PK in 1984 and immunoblot.

[Physiopathology of food allergy]

Food allergy is defined by a mixture of digestive and or extra-digestive clinical symptoms, "rhinitis, asthma, eczema, etc" secondary to contact with a food and/or a preservative and/or addition to the immune system of the organism, with its origin in an excessive humoral and/or cellular response, called HYPERSENSITIVITY. For this to occur, food allergy needs conjunction of several parameters. Predisposing factors Genetics, with facility to produce IgE. Reduction of the defences of the digestive system. Usual foods

[Histamine liberation (or histamine release HR): study of the positivity threshold in hymenoptera venom allergy]

Dialysis of Hymenoptera venoms for measurement of HR by the radioimmunoassay technique (RIA, Immunotech) lowers the threshold of positivity of the HR titre from 30% to 12%. This modification of dialysis of the venoms significantly improves the sensitivity and specificity of the technique.

[Survey of pathologies caused by sulfites in allergology]

Increased use of sulphites as a preservative for foods and drugs is partly the origin of increasing prevalence of allergy to this anti-oxidant. All organs that are concerned with allergic problems may be affected, especially skin and the digestive tract. We have noted a frequent association between the pathology to aspirin (ORL, bronchial, skin) and that of sulphites: 30.8%. The history is fundamental and compensates for the lack of effectiveness of skin tests.

[The pork-cat syndrome or crossed allergy between pork meat and cat epithelia (1)]

This work is a study of the frequency of the association between sensitivity to pork meat and cat epithelia. Comparison with a reference population that was not sensitized to pork meat, shows that this association is highly significant. This suggests therefore the possibility of a crossed allergenicity. If there is a real crossed allergenicity between pork meat and cat epithelia, we suggest that this crossed allergenicity is without doubt much greater and concerns more the meats and epithelia of mammals.

A double-blind, placebo-controlled trial by the sublingual route of immunotherapy with a standardized grass pollen extract

Fifty-eight patients with well-documented history of seasonal rhinoconjunctivitis caused by grass pollens were allocated randomly on a double-blind basis to receive either sublingual therapy with a solution of purified, standardized allergen preparation (Stallergènes) or a matched placebo for 17 weeks. The assessment of the effect of oral immunotherapy, done with drops of five-grass allergen extract, was on the clinical symptoms and on the medication score of the authorized rescue treatments. The actively treated patients had significantly (P < 0.05 to P < 0.01) fewer symptoms of rhinitis (sneezing and rhinorrhea) and of conjunctivitis (redness and tears) during the pollen season than the placebo group. Consumption of nasal solution of sodium cromoglycate and of betamethasone and dexchlorpheniramine was significantly less in the desensitized group (P < 0.01). Side-effects were negligible. This study concludes that perlingual immunotherapy with grass pollen extract in grass-pollen-sensitive seasonal hay fever and conjunctivitis patients is effective, easy to perform, inexpensive, and safe.

[Cross allergies]

The first descriptions of crossed allergenicity were concerned with the associations between Pollen/Food allergy: birch pollen/apple, grass pollen/wheat-tomato etc. Since then other crossed reactions have been described, involving pneumoallergens, tropallergens, drugs, hymenoptera venoms. Crossed reactions are the combination of an antigen with a recognition molecule other than that which stimulated its synthesis, because of epitope(s) that are common or sufficiently close between two antigens. The techniques of immunoprints and RAST inhibition give confirmation of crossed reactions that are suspected clinically.

[Dynamic diagnosis of allergy by the sequential measurement of mediators: apropos of a case of food allergy]

Objective improvement in the diagnosis of immuno-allergology can only be obtained by application of reliable and reproducible immuno-biological methods, but until now, only measurements of total and specific IgE can be used and this has certain limitations. Presence of specific serum IgE, correlated with skin tests, favours a sensitization and implies nothing about the responsibility of the allergens. This is why we must consider if a definite improvement of diagnostic methods can be obtained by measurement of mediators. From an observation of food allergy to pork meat, we now show that it is possible to use sequential measurements of the mediators plasma histamine and urinary methylhistamine, ECP and serum tryptase to refine the diagnosis and provide proof of the responsibility of the food allergen. We report here a didactic observation which is characterised by reproducibility and specificity of the measurements. It illustrates the progress in diagnostic methods in allergy: we give a statistical diagnosis by measurement of antibodies and a dynamic diagnosis by measurement of mediators.

[Sublingual specific immunotherapy for rhinoconjunctivitis caused by grass pollens]

Fifty eight patients with rhino-conjunctivitis caused by grass pollen were included in a double-blind study in which they received, by the sub-lingual route over 5 months, either a solution of purified and standardised allergen or a placebo. Assessment of the effect of this immunotherapy, which was done with drops of Stallergenes "5-grass pollen" was by clinical symptoms and the use of authorized drugs and treatments. Compared with the placebo group, the patients on active treatment showed significantly less (P = 0.05 to P = 0.01) rhinitis symptoms (sneezing and rhinorrhea) and conjunctivitis (reddening and tears) during the pollen season. Consumption of nasal cromoglycate solution, of betamethasone and dexchlorpheniramine was significantly lower (p = 0.01) in the desensitised group. Secondary effects were negligible. From this study, it can be concluded that immunotherapy with grass pollen extract, by the sub-lingual route, of patients with rhino-conjunctivitis who were sensitive to these allergens, is efficacious, easy to do, economic and sure.

[Immunology of the eye]

Due to its vascularisation and system of lymphatic drainage, the eye is privileged territory for development of immunological phenomena. The tears, because of lactoferrin, lysozymes, mucins, different immunoglobulins: IgA (CALT), IgG and IgM, are the first line of defence against physical, chemical, infectious and extra-ocular antigenic attack. ACAID, "Anterior Chamber Associated Immune Deviation", by its type of defence against intra-ocular aggressors, assures some protection of the eye and explains the development of some intra-ocular tumours and tolerance to corneal grafts.

[Complementary examinations in atopic dermatitis]

The complementary assessment of atopic eczema involved a biological assessment: one part in vitro (total IgE, specific IgE, T4/T8 immunoregulator index); one part in vivo (skin tests: skin reaction intradermal reaction, patch test).

[Immunological causes of male infertility]

Sperm (spermatozoa and the various secretions of the accessory glands) with its very complex antigenic system is only produced from puberty and thus at a time when the body has already had a for a long time the facility to respond to an antigenic stimulation with an immune reaction. Because of this, the spermatozoa, in contrast to other cells of the organism, are considered as strangers and may behave as auto-antigens. However, the existence of a haemato-testicular barrier, that prevents all contact between the sperm and the immune system must be recognized in man, its rupture has the consequence of formation of anti-spermatozoa antibodies. It is estimated that 5% of cases of sterility are of immunological origin and linked to the presence in man and/or woman of anti-sperm antibodies. The production is greater in man than in women because of the roles, in the first of macrophages and in the second of polynuclear neutrophils in the destruction of the spermatozoa. Anti spermatozoal antibodies play a part in sterility by: Spontaneous agglutination in ejaculation, thus preventing their progression in the female genital tract. Free spermatozoa, charged with antibody are retained at the level of the cervical secretion = SHAKING phenomenon. The anti-spermatozoal antibodies mask some antigens, so preventing penetration of the spermatozoa into the ovule. Contact of spermatozoa with antibody fixed to the uterine tissue is followed by secretion of histamine and this encourages the expulsion of an implanted egg. This is before the existence of: Spontaneous agglutination in ejaculation, Oligospermatosis, Indeterminate cause sterility, Immobilisation of the spermatozoa in the cervical secretion, Failure of repetition.