· pressure (ptio2) in the hippocampus, ! corresponds to the beginning of treatment. *p "...
TRANSCRIPT
!"#$%&'()*$+&*,-*.++!"#$%&"'()*+",-./,%"0#/*+%1*-%2+'&.%#3#4%&*5"6''723$"5'89:%-*5';%$%56'!-#*,<23#4'
=#23:"';.2&''>+,"#1'?@@@A'B'CD'EFGH'0'IJK!+
/"#$%0'()*$10*,-*.2(),#%.-,".34#,516,+'
!"#$%&'()*+#&,-.&(!!D&*(/1%L3"'M''=CNDO6'>7!CNJ''!!;2+P/#"+&%"#'M'DQR6'J!S'!!DQO8T'M'I%+*+&"1"+-'%+(3,-#%"5':*#'3+'&2+,2#-%31'U*1<2+6'?#426'O%"##"'I*<#"6'V22-,6'8":*-2316'V%2&2("W6'!*+2X6'QVN6'=!R6'DOQ6'V"55,'8"*5-.&*#"6'O%+"Y22(6'K'Z'N6'C#+",-'[*&\,2+M''
RICHET CHARLES (1850-1935)
En 1902, Charles Richet découvre, avec Paul Portier, l'anaphylaxie, phénomène biologique d'une importance extrême, aux conséquences théoriques et pratiques considérables, et qui lui vaut le prix Nobel de médecine en 1913.
PAUL PORTIER (1866-1962)
/012(3(4#567895:%;(<#;(=%'&"%-;(>-5#?5%';(
@6%),A%"9"B%;(
1989 n=821
1992 n=813
1994 n=1030
1996 n=734
1998 n=486
2000 n=518
2002 n=502
2004 n=406
2007 n=602
NMBAs 81,0 70,2 59,2 61,6 69,2 58,2 54,0 49,6 48
Latex 0,5 12,5 19,0 16,6 12,1 16,7 22,3 26,4 20,3 Hypnotics 11,0 5,6 8,0 5,1 3,7 3,4 0,8 1,4 0,8
Opioids 3,0 1,7 3,5 2,7 1,4 1,3 2,4 1,4 1,8 Colloids 0,5 4,6 5,0 3,1 2,7 4,0 2,8 4,6 2,3
Antib 2,0 2,6 3,1 8,3 8,0 15,1 14,7 12,2 17,9
Others 2,0 2,8 8,3 2,6 2,9 1,3 3,0 4,4 7,1
Drugs responsible for HSI-IgE peranesthesic reactions
(8 epidemiologic surveys of GERAP)
AFAR 1990-1994-1996-1999-2004, BJA 2001, Anesthesiology 2003, JACI 2011, Minerva 2012
n=821 n=813 n=734 n=486 n=518
NMBAs 81,0 70,2 59,2 61,6 69,2 58,2 54,0 49,6 48
!"#$%&'()%**+%,)-*.-('*.')/0)12!3$'(-%&'()%,,'42-.)4'%.#/*")(+4-*2)%*'"&5'"-%(
Causal agents Estimated annual number
of case
!"#$%&'()%**+%,)-*.-('*.')-*)64%*.')78$-,,-/*9median [5th-95th perc]
Male Overall Female
Overall 780 [555-1005] 100.6 [76.2-125.3]
55.4 [42.0-69.0] 154.9 [117.2-193.1]
NMBAs 458 [326-590] 105.5 [79.7-132.0]
184.0 [139.3-229.7] 250.9 [189.8-312.9]
Latex 155 [110-200] 59.1 [44.8-73.6]
32.6 [24.7-40.5] 91.0 [68.9-113.4]
Antibiotics 101 [72-131] -
Others agents 80 [57-103] -
PM Mertes et al, JACI 2012
:;4-/(')<===3<=><)!! A'&3#*#",'&211"#&%*5%,/,''!!D##]-'(3':*+&3#2+%31'"+'HF@@'!! E'&3#*#",'4/+/#%L3/,'^*-#*&3#%316'&%,*-#*&3#%316',3W*1/-.2+%31_'
!! HH`a'ND',3#$"+3",'"-'+2-%X/",'"+-#"'HFFF'"-'HF@H'!! H`A'&*,'"+'HF@H'HH`a'ND',3#$"+3",'"-'+2-%X/",'"+-#"'HFFF'"-'HF@H'
!
"#$%&
$'($$#
$'% $(& $)($&'
$*&
)(%)&*
)** )*+
)%%% )%%$ )%%) )%%( )%%' )%%& )%%+ )%%" )%%# )%%* )%$% )%$$ )%$)
!"#$%&'(&')*+',*--.&'(&'+/%0&-/&1
C"-&59%&,();'(D4(!! b6bc'("'HFFF'd'HF@H'!! Gc'"+'HF@H'!! A6bc'"+'HFFFe'
!
"
! !#
$!
"% "% "%
"$ "$
&"
%
!
"%
"!
&%
&!
&%%% &%%" &%%& &%%# &%%$ &%%! &%%' &%%( &%%) &%%* &%"% &%"" &%"&
+,-./0123 4123 56+786/0194123:
6?@A!BCD)?DDE@1FD)G)H?)IECA?H1AF)!! C-3("',3#'5",'@`E@'&*,',3#$"+3,'"+-#"'HFFF'"-'HF@@'!! D+*5f,"'135-%$*#%/"'"P*&-"3#,'("'#%,L3"'%+(/:"+(*+-,M''
!! ,"W"'1*,&35%+'!! &2+-"W-"'( 3#4"+&"'!! *+-/&/("+-'( .f:"#-"+,%2+6'!! *+-/&/("+-'&*#(%2$*,&35*%#"'^*3-#"'L3"'5 .f:"#-"+,%2+_''!! 1"+-%2+'( 3+'<]-*<52L3*+-'
Reitter, Petitpain, Mertes, Allergy in press
E"FGH5F"#'(;&(65-&'();(A5-H7,();'()%I,-;#&'(HJ-5-;'(
!!S"'HFFF'd'HF@HM'
!! !"#$%&'()*+"%,-',.)/".)*+"%,-*,0120,,",3,4)+5,67"5,8-,*)'+9/$'+)*5,,:"-,7-5,$"'.-5,/".$.-5;,6)".,7-,%<%-,*)%=.-,8>$%6)"7-5,?-*8"-5,
10
MIV
PAN
ROC
SUX
VEC
CIS
ATR
?*%J5K,%L-")&/)*'+4/$+".+,%4)M,/.N-*2)(4+2"O)-*.-('*.')%*().4/""34'%.#P-&K)-*)Q'"&'4*)?+"&4%,-%)
04/$)<==<)&/)<=>>(!! ,721<#"'("'&.2&'*+*:.f5*&-%L3",'M''gF'^4#*("'H'd'b_''!!N%,L3"'#"5*-%P''M''
!! -"HJ-"#%JA((RS=8)>==)===)K0LM(!+(LNO3//P/11(111Q(!! R;HJ-"#%JA(2NOP/11(111(K0LM(!+(/NS3LNSP/11(111Q(!! 5&-5HJ-%JA(TN1/P/11(111(K0LM(!+(/NU3ONSP/11(111Q(
''!!O#/$*5"+&"'("'#/*&-%$%-/'%,/"'':53,'P*%<5"'*$"&'5"'&%,0*-#*&3#%31'
11 Sadleir et al, BJA 2013, doi:10.1093/bja/aes506
V-5R%&,();'(-,5HF"#'(!!@.$8-,A'M':#/,"+&"'("',%4+",'&3-*+/,h'!!@.$8-,AA'M':#/,"+&"'("',f1:-91",'-"5,'L3"'#/*&-%2+'&3-*+/"6'.f:2-"+,%2+'*#-/#%"55"'^(/X+%"':*#'3+"'<*%,,"'("'EFc'*,,2&%/"'d'3+"'-*&.f&*#(%"'%+"W:5%L3/"_6'-23W'23'-#23<5"'("'5*'$"+-%5*-%2+'1/&*+%L3"6'1*%,'$=5-*/-,8-,%+5-,-*,B-",8",6.)*)5'+/,?+'$7h'
!!@.$8-,AAA'M'6.&5-*/-,8-,5C%6'D%-5,%-''$*',-*,B-",7-,6.)*)5'+/,?+'$7,-"5,'L3"'&255*:,3,'&*#(%2$*,&35*%#"6'-*&.f&*#(%"6'<#*(f&*#(%"6'*#f-.1%"6'<#2+&.2,:*,1"',/$i#"h'
!!@.$8-,AE'M'*##]-'&%#&35*-2%#"6'*##]-'&*#(%*L3"'23'#",:%#*-2%#"h'
12
#
W"'%F"#(V;#J6;H&"-59;(+#&;-R;#F"#(
HSI –IgE médiée et moment de survenue
F?$*',7>+*8"/'+)*,$*-5'(&5+:"-,,!! D+-%<%2-%L3",'M'</-*5*&-*1%+",'jj''!! O#2(3%-,'("'#"1:5%,,*4"M'4/5*-%+",jj''!! Q*-"W'M'<#2+&.2,:*,1"'%+*343#"'5",',f1:-91",''
HSI –IgE médiée et moment de survenue
G-*8$*',7>+*8"/'+)*,$*-5'(&5+:"-,'!! ;3#*#",'M'#/*&-%2+',/$i#"'(i,'5",':#"1%i#",',"&2+(",'''!! 8f:+2-%L3",'M'#*#"''!!J2#:.%+21%1/-%L3",'M'"W&":-%2++"5'
HSI –IgE médiée et moment de survenue
G-*8$*',7$,/(+.".H+-,
!! Q*-"W'M'#/*&-%2+',23$"+-',/$i#"'M'@a'd'HE'c6'(*+,'5",'1%+3-",'L3%',3%$"+-'5)%+&%,%2+'&.%#3#4%&*5"'
!! O#2(3%-,'("'#"1:5%,,*4"''
!! O#2(3%-,'("'(/,%+P"&-%2+'M'&.52#."W%(%+"6':2$%(2+"'
!! O#2(3%-,'("'&2+-#*,-"'%2(/,'
!! ;252#*+-,'M'<5"3':*-"+-/6'<5"3'("'1/-.f5i+"6'k32#",&/%+"'
'
<-FH5%-;(=X/1(
HSI et moment de survenue
F",8&/)".5,8-,7$,/(+.".H+-,'!! D>7!M'3#-%&*%#"'*,,2&%/"'d'3+'*+4%2"(i1"'(3'$%,*4"''^5i$#",'"-':*3:%i#",_'%+,"+,%<5"'*3W'*+-%0.%,-*1%+%L3",'
'!!J2#:.%+"'
Y%5B#"'FH(
C");'(;&(&;A6'();(6-,9ZR;A;#&'('5#BJ%#'(6"J-(9;'()"'5B;'()*7%'&5A%#;(;&();(&-86&5';(
Dosages Tube Prélèvement < 30 min
Prélèvement 1 à 2h
Prélèvement > 24 h
Histamine EDTA + (+) Tryptase EDTA/sec + + + IgE anti-AQ Sec + (+) (+)
+ : recommandé ; (+) : si non réalisé au moment de la réaction
RPC SFAR 2011
Y%5B#"'FH([59J;("\(=%'&5A%#;(5#)(]-86&5';(!"#H;#&-5F"#'(%#(^;R;-;(4#567895:%'(_%&7(^7"H`("-(
!5-)%5H(4--;'&()J-%#B(4#;'&7;'%5(!! K.#",.25(,'%+(%&*-%+4'*+'*55"#4%&'1"&.*+%,1'Y"#"M'!! 'AhEa'+125l5'P2#'.%,-*1%+"'!! GhEa'm4l5'P2#'-#f:-*,"'
!! N",3,&%-*-%2+'1*+2"3$#",'<f'-."1,"5$",'(%('+2-'12(%Pf'1"(%*-2#'&2+&"+-#*-%2+,h''
!! n%#-3*55f'*55'5%P"0-.#"*-"+%+4'#"*&-%2+,'(3#%+4'*+",-.",%*'*,,2&%*-"('Y%-.'1"(%*-2#'&2+&"+-#*-%2+,'"W&""(%+4'-."'-.#",.25(,'Y"#"'*55"#4%&'"$"+-,h'
D Laroche, P Gomis, E Gallimidi, JM Malinovsky, PMi Mertes: Anesthesiology, in press
G Volcheck and Paul Michel Mertes, Immunol Allergy Clin N Am , in press
]-5%&;A;#&(!!N"1:5%,,*4"'!!D(#"+*5%+"'d'(2,"'-%-#/"'!! o'&2#-%&2p(",'!!n*,2:#",,%+"q'!!=53&*42+q'!! !34*11*("Wq'
Table 4 : Management of cases with a fatal outcome
Early death n=23
Delayed death n=8
Fully documented cases 22 8
Mean interval from NMDA injection to first symptom
(range) (min)
2.27 (1;5) 1.75 (1;4)
Mean interval from first symptom to epinephrine bolus
(range) (min)
3.93 (0;10) 1.8 (0;5)
Mean cumulative epinephrine bolus dose (range) (mg) 15.34 (1;60) 13.9 (4;26)
Mean interval from anaphylaxis to death (range) (hr)
- in patients with CPB (ECMO/ECC) (n=9)
85.7 (4;385)
- in patients without CPB 1.23 (0.5;4)
Mean volume of vascular filling(mL) 1957 (500;5500) 2500 (1000;4500)
CPB, CardioPulmonary Bypass; ECMO, ExtraCorporeal Membrane Oxygenation; ECC, Extracorporeal Circulation; NA: not applicable
Reitter, Petitpain, Mertes, Allergy in press
D+2%$$%('L)-*)&5')$%*%2'$'*&)/0))4/.+4/*-+$3-*(+.'()%*%J5K,%L-"((
•! EE'*+,6'5*:*#2,&2:%"6'.)/".)*+"%,1;IJ,%HKLH6'*(#/+*5%+"'b'146'1j@`'5"H$%%$8-#,M;N,%HKLH6':3%,'*(#/+*5%+"'F6Aa'"-'1"-*#*1%+25'@'14'!"#$%%&''(&)(*'+(,-.(/01(2345(/66730/(230//4(
•! AA'*+,6'&%1"+-2:5*,-%"6'.)/".)*+"%,1;M,%HKLH6'4#*("'>>>6''*(#/+*5%+"'F6H'146'OD'#"12+-"'d'Ga'11.46'5"H$%%$8-#,3,%HKLH,#"$"#,%2+'(3'<52&6'OD'@FF'1184h'!$)*8&9(&)(*'+(-.:;(30/3(
•! 'bG'*+,6'&.25"&f,-"&-21%"6'Gg'\46'.)/".)*+"%,N1%H6'4#*("'>>>6'*(#/+*5%+"'F6@G'1&4l\4l1%+6'-#*+,P"#-'"+'>;?h'D:#i,'@'.6'5"H$%%$8-#,311%H;,#/(3&-%2+'(",'(2,",'()*(#/+*5%+"'("'12%-%/h'I3++"5'"-'*56'V[D6'(2%M@Fh@F`El<r*l*"#H@@'
•! 'a@'*+,6'."#+%"'21<%5%&*5"6'@@H'\46'.)/".)*+"%,,1;3N,%HKLH6''4#*("'>>>6'*(#/+*5%+"'F6a'14'"+'@a'1%+6'@g'1%+'M'*(#/+*5%+"'F6H'14'"-'5"H$%%$8-#,0111,%H,O2P,%HKLH_6'*1/5%2#*-%2+6'!C'*(#/+*5%+"'F6a'14l.',"$#/"'"+'AF'1%+h'N*P-'"-'*56'DIDN'E@'^HF@H_'@agB@A@'
•! 'AH'*+,6'1*,-"&-21%"6'ba'\46'Q)/".)*+"%,01,%H6'4#*("'>>6':*,'*(#/+*5%+"6'6'EF'1%+'M'5"H$%%$8-#,011%H6'#"4#",,%2+'"#f-."1"6'R*Y*+2'"-'*5h6'[23#+*5'2P';5%+%&*5'D+",-.",%*'^HF@H_'Hb6'AHBAb'
C/.+4/*-+$3-*(+.'()%*%J5K,%L-")-")J4/M%M,K)*/&)$-#2%&'()MK)"+2%$$%('LO)'P-('*.')04/$)%*)-*)P-&4/)'LJ'4-$'*&)
Leysen et al, Anaesthesia, 2011, 66, pages 519–531
A5')4/,')/0)"+2%$$%('L)-*)&5')('P',/J$'*&)%*()$/(-T.%#/*)/0)%*)%,,'42-.)4'"J/*"')&/)4/.+4/*-+$O)'P-('*.')04/$)%).+&%*'/+")$/(',)
Clarck et al, Anaesthesia 2012, 67, 266–273
499;-B%;(5J:(H8H9");:&-%#;'(!!F77-.HC,'),7)R,8)5-,5"H$%%$8-#S,8211"'@G'*+,6'4#*("'>>6':#%&\'js(!&%<%9&=>?="$@9@((.%*&A)B&A@*C(30//(!*DE112F453/G>6C(
!!T(.--,/$5-5,)4,5"56-/'-8,5"H$%%$8-#U+*8"/-8,(C6-.5-*5+'+?+'C,.-$/'+)*5S,=#*("'>':#%&\'j6'=#*("'>>>':#%&\'j6'=#*("'>>'+2'-",-h''H$9*@(&)(*'+(,D(-(.%*&A)BC(30/3(.IJE/0623453/1>K(
!!VC6-.5-*5+'+?+'C,.-$/'+)*,6.)=$=7C,+*8"/-8,=C,5"H$%%$8-#+1+C+P*+-'G'*+,7+=#*("'>>>'+2'-",-h'D,*.%'"-'*56'D&-*'D+*",-.",%2524%&*'K*%Y*+%&*'aF'^HF@H_'@gE'0@gb'
!!!-?-.-,Q-$/'+)*,W)77)R+*H,!"H$%%$8-#,A*B-/'+)*X,VC6-.5-*5+'+?+'CY'8211"'AH'*+,6'=#*("'>>>6'>SNjh'!2#%*'"-'*56'-(L%M&A)@J(.''&DJ$'(:'@%(L88I%$'(HF@Hs'n25h'HH^a_M'EGH0E`H+
'''
["9JA;(@:65#'%"#(
Tajima, et al, Anaesth Intensive Care. 2013 Nov;41(6):765-73.
C;&789;#;(a9J;(]%A;(H"J-';("\(H;-;b-59(H"-FH59(b9"")($"_c(F''J;(":8B;#(65-F59(
6-;''J-;(
Time course of cerebral cortical blood flow (CBF) , tissue oxygen partial pressure (PtiO2) in the hippocampus, ! corresponds to the beginning of treatment. *p " 0.05 vs. the CON group, +p " 0.05 between-group differences MB–EPI group vs. MB group, &p " 0.05 between-group differences EPI group vs. MB group.
Zheng F, et al Crit Care Med. 2013 Jan;41(1):195-204.
BM 1 à 3 mg/kg
d-%B%#;();(95(';#'%b%9%'5F"#(5J:(HJ-5-;'e(
!!=/+/-%L3"q'!!;2,1/-%L3",q'!!t3%+252+",q'!!O.25&2(%+"qhhh'
;*,"0&2+-#25'M'@`@':*-%"+-,'*+('HFF'&2+-#25,''
^!*1"':25f12#:.%1,'*,'-."'>-*5%*+'*+('!:*+%,.'VQ',-3(%",_'
D;'J9&'f(5('%#B9;(5''"H%5F"#(_%&7(+gTD4(hLL/D((
Influence of genetic determinant in allergic reactions against muscle relaxants
Design
•!a cohort study conducted in six vocational schools
•! follow-up, every six months after inclusion
Population
•!Apprentices (2 year training) in bakery and hairdressing (quaternary amonium compounds)
Subjects
•!BHR determined by a metacholine challenge test (conducted at every visit, V1 to V4).
•!Genetic polymorphisms •!Allergy ocurrence
Allergy to reated allergens, including quaternary amonium compounds
Personal habits(smoking
habits#)
Early occupational
exposure Atopic Status, Polymorphisms
Personalhabits(smoking
habits#)
Polymorphisms
Influence of occupationnal exposure in allergic reactions
against muscle relaxants: The MIBAP study
Guéant et al, doi: 10.1111/cea.12189 Clinical & Experimental Allergy, 1–7, in press
Names and formula of the quaternary ammonium compounds commonly used by hairdressers
Predictors of sIgE against quaternary amoniums ) O.R. (95% C.I.) P
Age 1.13 (0.95-1.33) 0.157
Sex 2.93 (0.93-9.19) 0.065
Total IgE 7.10 (2.26-22.30) 0.001
Phadiatop 1.67 (0.61-4.53) 0.318
Hair dressing 4.97 (1.69-14.66) 0.004
Pastry and bakery 0.99 (0.20-4.95) 0.987
]7;(W7"9H")%#;(=86"&7;'%'(!! D+*:.f5*&-%&'#"*&-%2+,'-2'7JVD,'*#"',%W'-%1",'12#"'&2112+'%+'72#Y*f'-.*+'%+'!Y"("+'
!! >4C'*+-%<2(%",'-2':.25&2(%+"6'3,"('%+'&234.',3::#",,*+-,'%+'72#Y*f'<3-'+2-'%+'!Y"("+6'Y"#"'P23+('%+',%W':"#'&"+-'2P'<522('(2+2#,'P#21'72#Y*f'<3-'%+'+2+"'2P'-."'!Y"(%,.'(2+2#,h''
!! O2,%-%$"'#"*&-%2+,'-2',3&&%+f5&.25%+"'%+'Fhb':"#'&"+-'*+('EhG':"#'&"+-6'2P'72#Y"4%*+'<522('(2+2#,'*+('*55"#4%&',3<r"&-,'#",:"&-%$"5fh'72',"#31'P#21'!Y"("+'Y*,':2,%-%$"h'
Florvaag et al, Allergy 2005: 60: 1312–1315
W-;R59;#H;'("\(+B@(';#'%F'5F"#(Ki1NSL(`<4PgQ(&"(W=dc(CdD(5#)(^<j(%#(S11(k599;-B%H'l(5m;-(_%&7)-5_59(
Before Years after Tuxi® withdrawal 1 2 3 Trend P-value P-value LbL
PHO 33 (11.0) 15 (5.0) 17 (5.7) 8 (2.7) -0.418 <0.001 <0.001* MOR 30 (10.0) nt 8 (2.7) 4 (1.3) -0.667 <0.001 <0.001* SUX 11 (3.7) 2 (0.7) 1 (0.3) 1 (0.3) 0.002 0.002 <0.001*
-
2,0
4,0
6,0
8,0
10,0
12,0
Before 1 year 2 years 3 years
SUX MOR PHO
n&J);(
CFA 18/04/2013 40
?*%J5KH%L-')%+L).+4%4'")'&)'LJ/"-#/*)U),%):VE,./(-*')C'.5'4.5')W-/$;(-.%,')X)F&+(')@%"3A;$/-*")4R%'(\5R"-5b9;(!WW(1oP1SP21/S(((((((((((4J&"-%'5F"#(4E^C(S1P1OP21/S((
Étude de l’association entre l’exposition à la pholcodine et le risque de réaction anaphylactique peranesthésique liée à un curare
Étude cas- témoins
Début de l’étude février 2014, fin prévue en 2016
Dès la survenue d’un CHOC ANAPHYLACTIQUE à l’induction anesthésique
composez sans tarder
le 0 800 871 943 (n°vert)
?P'.),')"/+#'*)('))H%)D/.-;&;)64%*Y%-"')(Z?*'"&5;"-')'&)(')C;%*-$%#/*)
!&)('),%)D/.-;&;)64%*Y%-"')(Z?,,'42/,/2-')
!"#H9J'%"#'(!!D+*:.f5*W%"':./+21i+"'#*#"'1*%,':2-"+-%"55"1"+-'4#*$"'
!!>1:2#-*+&"'("'5*',3#$"%55*+&"'/:%(/1%2524%L3"'^#%,L3"':#2(3%-6'+23$"55",'125/&35",6':#/$"+-%2+6'-#*%-"1"+-e_'
!!V",2%+'/$%("+-'("'+23$"*3W'-#*%-"1"+-,'
!!?+'",:2%#'M'>("+-%X&*-%2+'(",'P*&-"3#,'("'#%,L3",'$!C-3("'D5:.2'M'(/&5*#"u'*3'+31/#2'$"#-' 0 800 871 943 '' ' ''
Merci
Pour Votre
Attention
!
Source GERAP