· pressure (ptio2) in the hippocampus, ! corresponds to the beginning of treatment. *p "...

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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

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11 Sadleir et al, BJA 2013, doi:10.1093/bja/aes506

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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

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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

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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

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Clarck et al, Anaesthesia 2012, 67, 266–273

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Tajima, et al, Anaesth Intensive Care. 2013 Nov;41(6):765-73.

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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

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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

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Florvaag et al, Allergy 2005: 60: 1312–1315

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Before Years after Tuxi® withdrawal 1 2 3 Trend P-value P-value LbL

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CFA 18/04/2013 40

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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)

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Merci

Pour Votre

Attention

!

Source GERAP