màj : 23/07/98 |
Asthmology :
from basic science to management Friday morning August 29, 1997
... |
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màj : 23/07/98 |
Asthmology :
from basic science to management Friday morning August 29, 1997
... |
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The IgE immune response H. Yssel
Objectives of the course
1 - Regulation of human IgE synthesis by cytokines
2 - Cellular interactions in the induction of IgE synthesis
3 - Approaches to intervene in IgE synthesis
| 1- Which human cytokines play an important role in allergic diseases due to their ability to directly induce B cells to swhich to synthesis of IgE ? | Before course | After course | Expert |  |
| a- IL-4 | 97% | 97% | a=yes | |
| b- IL-13 | 68% | 91% | b=yes | |
| c- IL-5 | 35% | 6% | ||
| d- IL-10 | 12% | 6% | ||
| e- IFN-a | 6% | 3% |
| 2- The observation that B cells from patients with X-linked hyper IgM syndrome are unable to produce IgG and IgE antibodies implies that: | Before course | After course | Expert | |
| a - CD40/CD40L interactions are required for the differentiation of naive B cells into IgM producing plasma cells | 18% | 16% | 84% | |
| b - CD40/CD40L interactions are not required for the differentiation of naive B cells into IgM producing plasma cells | 7% | 6% | b=yes | 63% |
| c - CD40/CD40L interactions are required for the differentiation of naive B cells into IgE- producing plasma cells. | 75% | 66% | c=yes | 6% |
| 3- IL-4 is not only produced by Th2 cells upon stimulation 12with allergen, but also by activated basophils and mastcells. Based on experiments with IL-4 deficient mice, what is the contribution of "non-T cell"-produced IL-4 to the induction of IgE synthesis (non-cognate IgE synthesis), as compared to IL-4 produced by Th2 cells (cognate IgE synthesis) ? | Before course | After course | Expert | |
| a - Negligible contribution. | 40% | 38% | a=yes | 44% |
| b - Similar contribution as Th2 cell-produced IL-4. | 53% | 50% | 38% | |
| c - More important than Th2 cell-produced IL-4. | 7% | 6% | 19% |
| 4- IL-4 antagonists, which due to certain amico acid substitutions can still bind to the IL-4 receptor on B cells, but can no longer transduce signals are able to inhibit IL-4, as well as IL-13-induced IgE synthesis. | Before course | After course | Expert | |
| a- True | 57% | 65% | a=yes | 66% |
| b- False | 43% | 35% | 34% |
Mechanism of specific immunotherapy J. Pene
Objective of the course : Hallmarks of human allergic inflamationare the IgE-dependent activation of mast cells and basophils and tissue eosinophilia in which cytokines play a major role. Recent studies have provided insight into the mechanism of this form of treatment. Whereas earlier work focused on circulating antibody and effector cells, recent studies suggest that these changes may be secondary to an influence of immunotherapy on T cell response to allergen either by immune deviation (increase in Th0/Th1) or T cell anergy (decrease in Th2/Th0) or more likely both, depending on a number of factors including the nature of the allergen, the allergen doce, adjuvants used etc. Further studies are required to identify more "targeted" strategies, which are both more efficacious and safe.
| 1- Th2 cells | Before course | After course | Expert | |
| 1 - Are associated with delayed type hypersensitivity | 7% | 11% | 6% | |
| 2-Release IL-4 and IL-13 | 57% | 49% | 2=yes | 48% |
| 3-Are associated with immediate type allergy | 43% | 43% | 3=yes | 27% |
| 4-Are decreased during successful immunotherapy | 40% | 51% | 30% | |
| 5-All the above are correct. | 47% | 40% | 42% |
| 2- Serum specific IgG | Before course | After course | Expert | |
| 1 - May be anaphylactogenic | 10% | 27% | 18% | |
| 2-Is associated with successful venom immunotherapy | 29% | 55% | 2=yes | 32% |
| 3-is increased during mite allergen immunotherapy but the increase is usually not related to efficacy | 16% | 33% | 3=yes | 29% |
| 4-May represent a blocking antibody | 32% | 55% | 4=yes | 38% |
| 5-All the above are correct. | 61% | 58% | 47% |
| 3- Successful immunotherapy | Before course | After course | Expert | |
| 1 - Is associated with a switch from Th2 to Th1 cells | 59% | 74% | 1=yes | 52% |
| 2-Is associated with a reduction of larget organ sensitivity | 48% | 68% | 2=yes | 42% |
| 3-Is always associated with decreased allergen-specific IgE | 24% | 12% | 18% | |
| 4-Is associated with T cell anergy (decrease in Th2/Th0) | 45% | 41% | 4=yes | 42% |
| 5-All the above are correct. | 34% | 26% | 39% |
Desensitization in allergic respiratory diseases P. Demoly
Objective of the course :
1. To know indications and safety concerns of the immunotherapy
for allergic respiratory deseases.
2. To know the contra indications and non indications of the
immunotherapy for allergic respiratory diseases.
| 1- First question (several choices) | Before course | After course | Expert | |
| 1) Immunotherapy is specificaly indicated in polysensitive subjects. | 0% | 0% | 3% | |
| 2) Immunotherapy has to be proposed as a first line treatment of allergic respiratory diseases. | 9% | 17% | 15% | |
| 3) Immunotherapy has to be performed by a MD and in a place where intensive care is possible. | 88% | 97% | 3=yes | 59% |
| 4) Subjects have to have a follow-up during 20 min. | 85% | 80% | 4=yes | 3% |
| 5) Immunotherpy could modify natural history of respiratory allergy. | 79% | 91% | 5=yes | 21% |
| 2- Second question (several choices) | Before course | After course | Expert | |
| 1) Immunotherapy has not to be begun in unstable asthmatic. | 88% | 86% | 1=yes | 6% |
| 2) Pregnancy is an absolute contra indication to begin immunotherapy. | 53% | 63% | 2=yes | 56% |
| 3) House dust immunotherapy is a good treatment. | 50% | 40% | 15% | |
| 4) A children who is less than 10 years old has not to be desensitized. | 24% | 14% | 3% | |
| 5) A pollinic rhino-conjunctivitis is not an indication for immunotherapy if the duration of the pollinic season is short. | 50% | 74% | 5=yes | 21% |
RESPIRATORY FUNCTION
IN ASTHMATICS.
M. Hayot J. Mercier
Objective of the course :
1. Connaître les indications et les contre-indications de
l'épreuve d'exercice musculaire
2. Connaître les modalités pratiques de réalisation de
l'épreuve d'exercices musculaire
3. Savoir diagnostiquer une bronchoconstriction induite par
l'exercice en laboratoire d'explorations fonctionnelles
| 1- Absolute contra-indications for cardiopulmonary exercise testing are : | Before course | After course | Expert | |
| 1 - unstable angina | 81% | 100% | 1=yes | 100% |
| 2- hypoxemia with a PaO2 equal to 60 mmHg | 52% | 33% | 24% | |
| 3- Severe COPD | 68% | 36% | 18% | |
| 4- Bradyarrhythmia (=55 beats/min). | 32% | 28% | 15% |
| 2- The criteria for maximal exercise effort are : | Before course | After course | Expert | |
| 1 - a VO2 plateau | 44% | 31% | 1=yes | 91% |
| 2- heart rate equal to 180 beats/min | 74% | 31% | 15% | |
| 3- Maximal ventilation equal to 60-90 liters | 41% | 31% | 15% | |
| 4- Subjects is not able to maintain pedaling rate> 40 rpm. | 15% | 36% | 4=yes | 26% |
| 3- Exercise-induced bronchospasm : | Before course | After course | Expert | |
| 1 - is rarely observed in children without a history of EIB | 29% | 32% | 21% | |
| 2- is diagnosed when post-exercise FEV1 falls by 10% | 36% | 38% | 2=yes | 50% |
| 3- indicates the need for a long (15 min) sub-maximal exercise test | 57% | 26% | 21% | |
| 4- indicates the need for an 8-min high intensity exercise test. | 43% | 74% | 4=yes | 56% |
Allergens, skin prick tests. J. Bousquet H. Dhivert
Objective of the course :
1. To learn how to use skin test in the diagnosis of allergy
2. The methodology of performing skin prick-test which is the
cornerstone of the diagnosis of allergy
3. To integrate the value of skin prick-test with the other
allergy test.
| 1- Skin prick test : | Before course | After course | Expert | |
| 1 - Can be performed early (in infancy) | 42% | |||
| 2- Cannot be performed in old patients | 6% | |||
| 3- Is difficult to interpret when there is a dermographism | 82% | |||
| 4- Can be performed in severe atopic dermatis | 0% | |||
| 5 - All the above are correct | 18% |
| 2- Skin prick test performance requires : | Before course | After course | Expert | |
| 1 - A positive control solution | 43% | |||
| 2- A negative control solution | 17% | |||
| 3- If possible, high quality extract in standardized form | 37% | |||
| 4- To be carried out in normal skin | 26% | |||
| 5 - All the above are correct | 57% |
| 3- The waiting period between drug cessation and skin prick-test is : | Before course | After course | Expert | |
| 1 - Less than 72 hours for all H1 blockers | 6% | |||
| 2- Around a week for Cetirizine, Loratadine | 66% | |||
| 3- A week for Astemizole | 19% | |||
| 4- There is no waiting period for inhaled steroids | 63% | |||
| 5 - Skin-tests are not to be performed when patients are under oral corticosteroids | 34% |
.
EAACICongrès Conçue et réalisée
par: Michel Godard (at) Top
Date de création: 1997- Dernière mise à jour: 23/07/98
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