Publications by authors named "Pauline Pralong"

14 Publications

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Unique molecular signatures typify skin inflammation induced by chemical allergens and irritants.

Allergy 2021 Jun 26. Epub 2021 Jun 26.

CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy), INSERM, U1111, Univ Lyon, Université de Lyon 1, Ecole Normale Supérieure de Lyon, CNRS, UMR 5308, Lyon, France.

Background: Skin exposure to chemicals may induce an inflammatory disease known as contact dermatitis (CD). Distinguishing the allergic and irritant forms of CD often proves challenging in the clinic.

Methods: To characterize the molecular signatures of chemical-induced skin inflammation, we conducted a comprehensive transcriptomic analysis on the skin lesions of 47 patients with positive patch tests to reference contact allergens and nonallergenic irritants.

Results: A clear segregation was observed between allergen- and irritant-induced gene profiles. Distinct modules pertaining to the epidermal compartment, metabolism, and proliferation were induced by both contact allergens and irritants; whereas only contact allergens prompted strong activation of adaptive immunity, notably of cytotoxic T-cell responses. Our results also confirmed that: (a) unique pathways characterize allergen- and irritant-induced dermatitis; (b) the intensity of the clinical reaction correlates with the magnitude of immune activation. Finally, using a machine-learning approach, we identified and validated several minimal combinations of biomarkers to distinguish contact allergy from irritation.

Conclusion: These results highlight the value of molecular profiling of chemical-induced skin inflammation for improving the diagnosis of allergic versus irritant contact dermatitis.
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http://dx.doi.org/10.1111/all.14989DOI Listing
June 2021

Improvement of patient outcomes following therapeutic optimization of chronic urticaria: two-year data from France as part of the international real-life AWARE study.

Eur J Dermatol 2021 Apr;31(2):217-224

Dermatologie et Dermato-allergologie, CHU de Poitiers, Poitiers, France.

Background: It is important to assess the burden of chronic urticaria (CU) with real-life studies. The AWARE study was performed in 36 countries over two years in CU patients resistant to H1-antihistamines.

Objectives: To correlate patient-reported outcomes and available therapeutic options in CU patients.

Materials & Methods: The AWARE study was a prospective, non-interventional, international study that included adult patients who have had H1-antihistamine-resistant CU for at least two months. The primary endpoints were the evolution of disease activity (UAS7), urticaria control (UCT), dermatological quality of life (DLQI) and treatment satisfaction (visual analogic scale) during a two-year follow-up. The data from French centres are reported.

Results: Ninety-two patients were included (mean age: 47.8 years; women: 70.7%; mean disease duration: 6.5 years; angioedema: 34.1%). The percentage of patients with CU treatment increased from 56.5% at inclusion to 86.0% after two years (for patients with non-sedative H1-antihistamines from 52.2% to 74.4%, and omalizumab from 2.2% to 25.6%). During the follow-up, the percentage of patients with UAS7 score <6 increased from 12.5% to 60.9%, and patients with well-controlled CU (UCT score >12) increased from 11.1% to 62.2%. The negative impact on quality of life (DLQI >10) decreased from 34.1% to 10.5%. The mean score of patient satisfaction for treatment increased from 4.6 to 7.6.

Conclusion: The management of CU patients resistant to H1-antihistamines was not optimal at inclusion with uncontrolled disease, impaired quality of life and insufficient treatment. After a two-year follow-up, disease symptoms and quality of life improved, but the therapeutic management could be further optimized.
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http://dx.doi.org/10.1684/ejd.2021.4023DOI Listing
April 2021

The burden of chronic urticaria: French baseline data from the international real-life AWARE study.

Eur J Dermatol 2019 Feb;29(1):49-54

Dermatology Department, Larrey Hospital, CHU Toulouse, Toulouse, France.

Background: The AWARE study is an ongoing international study of patients with chronic urticaria refractory to H1-antihistamines. The aim of this study is to evaluate the burden of disease and the use of healthcare resources in real-life conditions.

Objectives: To analyse the baseline data of French patients included in the AWARE study.

Materials & Methods: AWARE is a prospective, non-interventional, international study that includes adult patients who have had chronic urticaria, refractory to at least one H1-antihistamine, for at least two months.

Results: Ninety-four patients (mean age: 47.9 years; 71.3% women) with chronic urticaria (50.0% spontaneous only, 9.6% inducible only, and 40.4% both) were included in French centres. The median duration from diagnosis was three years and angioedema was present in 31.5% of patients for the past six months. In 63.8% of cases, the patients received at least one treatment for urticaria (H1-antihistamine for 66.0%). Chronic urticaria was poorly controlled (UCT score <12) in 88.9% of patients and quality of life was severely impaired (mean DLQI score: 8.6). The use of healthcare resources was significant with frequent visits to general practitioners (80.8% of patients; mean: 8.1 visits). However, more than half of patients had not previously consulted a dermatologist.

Conclusion: These baseline data of French patients in the AWARE study show that patients suffering from chronic urticaria, refractory to H1-antihistamines for a median of three years, are insufficiently treated and that their quality of life is impaired. Despite the significant use of healthcare resources, access to specialised consultations remains insufficient.
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http://dx.doi.org/10.1684/ejd.2018.3495DOI Listing
February 2019

Fixed drug eruption caused by fulvestrant confirmed by skin tests: First case.

Contact Dermatitis 2019 Mar 21;80(3):184-186. Epub 2018 Nov 21.

Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.

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http://dx.doi.org/10.1111/cod.13161DOI Listing
March 2019

Bradykinin mechanism is the main responsible for death by isolated asphyxiating angioedema in France.

Clin Exp Allergy 2019 02 10;49(2):252-254. Epub 2018 Dec 10.

National Reference Center for Angioedema (CREAK), Grenoble Alpes University Hospital, Grenoble, France.

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http://dx.doi.org/10.1111/cea.13297DOI Listing
February 2019

Which opioids in case of mast cell activation disorders?

J Allergy Clin Immunol Pract 2019 Apr 29;7(4):1317-1318. Epub 2018 Aug 29.

Clinique de l'angioedème-Médecine Interne, CHU-Grenoble-Alpes, Grenoble, France; Centre de référence des angioedèmes bradykiniques (CREAK), CHU-Grenoble-Alpes, Grenoble, France.

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http://dx.doi.org/10.1016/j.jaip.2018.08.011DOI Listing
April 2019

Drug-induced aseptic meningitis: A possible T-cell-mediated hypersensitivity.

J Allergy Clin Immunol Pract 2018 Jul - Aug;6(4):1409-1411. Epub 2018 Jan 6.

Allergy and Clinical Immunology Department, Lyon Sud University Hospital, Pierre Benite, France; CIRI (International Center for Infectiology Research), University of Lyon, Lyon, France.

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http://dx.doi.org/10.1016/j.jaip.2017.11.034DOI Listing
November 2019

Antituberculosis Drug-Associated DRESS: A Case Series.

J Allergy Clin Immunol Pract 2018 Jul - Aug;6(4):1373-1380. Epub 2017 Dec 20.

Severe Cutaneous Adverse Drug Reaction National Reference Center, Dermatology, Hôpital Edouard Herriot, Lyon, France.

Background: Although antituberculosis drug-associated drug reaction with eosinophilia and systemic symptoms (DRESS) is rarely reported, its diagnosis should not be dismissed. Its management implies an early withdrawal of suspected drugs.

Objective: The objective of this study was to describe the characteristics of antituberculosis drug-associated DRESS and to identify the most likely involved drugs.

Methods: We searched for potential cases of DRESS with rifampicin, isoniazid, pyrazinamide, and ethambutol reported from January 1, 2005, to July 30, 2015, in the French pharmacovigilance database. A literature review was also performed.

Results: Sixty-seven cases of antituberculosis drug-associated DRESS were analyzed (40 women and 27 men, median age of 61 years). Liver and kidneys were the most frequently involved organs. Two patients died from DRESS. Skin tests were performed in 11 patients and were positive in 8 cases. Discrepancies between epicutaneous tests and reintroduction of the culprit drugs were observed for 2 patients with a premature reintroduction of antituberculosis drugs in 1 case. Antituberculosis drugs were the only suspects in 20 cases. As for the literature data, rifampicin was the most suspected drug because of its larger indications, but in case of tuberculosis infections, isoniazid was the most suspected drug.

Conclusions: We described the largest case series of first-line antituberculosis drug-associated DRESS in the literature. All antituberculosis drugs pose a risk of DRESS. An early withdrawal of the culprit drugs is essential. A drug allergy evaluation must be performed to optimize the second-line treatment of tuberculosis infection.
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http://dx.doi.org/10.1016/j.jaip.2017.11.021DOI Listing
November 2019

Airborne allergic contact dermatitis caused by isothiazolinones in water-based paints: a retrospective study of 44 cases.

Contact Dermatitis 2017 Sep 27;77(3):163-170. Epub 2017 Apr 27.

Dermatology and Allergology Department, Tenon Hospital (AP-HP), Sorbonne Universities, UPMC University Paris 06, 75020, Paris, France.

Background: Airborne allergic contact dermatitis caused by paints containing isothiazolinones has been recognized as a health hazard.

Objectives: To collect epidemiological, clinical and patch test data on airborne allergic contact dermatitis caused by isothiazolinone-containing paints in France and Belgium.

Methods: A descriptive, retrospective study was initiated by the Dermatology and Allergy Group of the French Society of Dermatology, including methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI)- and/or MI-sensitized patients who developed airborne allergic contact dermatitis following exposure to isothiazolinone-containing paint.

Results: Forty-four cases were identified, with mostly non-occupational exposure (79.5%). Of the patients, 22.5% of also had mucosal symptoms. In several cases, the dermatitis required systemic corticosteroids (27.3%), hospitalization (9.1%), and/or sick leave (20.5%). A median delay of 5.5 weeks was necessary to enable patients to enter a freshly painted room without a flare-up of their dermatitis. Approximately one-fifth of the patients knew that they were allergic to MI and/or MCI/MI before the exposure to paints occurred.

Conclusion: Our series confirms that airborne allergic contact dermatitis caused by paints containing isothiazolinones is not rare, and may be severe and long-lasting. Better regulation of isothiazolinone concentrations in paints, and their adequate labelling, is urgently needed.
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http://dx.doi.org/10.1111/cod.12795DOI Listing
September 2017

Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department: a French consensus statement.

Eur J Emerg Med 2017 Oct;24(5):318-325

aDepartment of Anaesthesiology and Intensive care, Edouard Herriot University Hospital bDepartment of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon cEmergency Department, Louis Mourier University Hospital, Paris 7 University dDepartment of Internal Medicine, Saint Antoine University Hospital, Paris 6 University, Assistance Publique-Hôpitaux de Paris, Paris eDepartment of Internal Medicine, Grenoble University Hospital, Grenoble-Alpes University, Grenoble fDepartment of Dermatology, Gabriel-Montpied University Hospital, Clermont-Ferrand gDepartment of Internal Medicine, Niort Hospital, Niort hDepartment of Internal Medicine, Archet 1 University Hospital, Nice Sophia-Antipolis University, Nice iDepartment of Medicine, Saint Louis University Hospital, Saint Pierre, Réunion jDepartment of Internal Medicine, Caen University Hospital, Caen kDepartment of Dermatology and Allergology, Grenoble University Hospital, Grenoble lDepartment of Internal Medicine, Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille mDepartment of Dermatology, Saint Eloi University Hospital, Montpellier nDepartment of Dermatology, Besançon University Hospital, Franche-Comté University, INSERM UMR 1098, Besançon oDepartment of Internal Medicine Toulouse University Hospital, Toulouse University, Toulouse pDepartment of Internal Medicine, Lille University Hospital, Lille University, INSERM U995 Lille, Lille, France.

Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.
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http://dx.doi.org/10.1097/MEJ.0000000000000446DOI Listing
October 2017

The basophil activation test: a sensitive test in the diagnosis of allergic immediate hypersensitivity to pristinamycin.

Int Arch Allergy Immunol 2015 22;167(2):94-8. Epub 2015 Jul 22.

Laboratoire d'Immunologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.

Immediate hypersensitivity (IHS) reactions to macrolides and to macrolide-derived antibiotics like pristinamycin are uncommon. In this context, there is little data available to appreciate the true value of biological tools regarding the diagnosis of immediate allergy to pristinamycin. Here we assess the clinical usefulness of the basophil activation test (BAT) to differentiate allergic from nonallergic IHS to pristinamycin. Thirty-six patients were tested with skin tests as the gold standard and BAT. The BAT achieved a sensitivity of 76% and a specificity of 100%, implying an absence of false positive results. Multicenter studies remain to be performed to better define the sensitivity, specificity and interlaboratory variation of BAT in the diagnosis of allergy to pristinamycin and macrolides.
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http://dx.doi.org/10.1159/000435812DOI Listing
November 2015

Disseminated porokeratosis transiently healed by cancer chemotherapy.

Eur J Dermatol 2014 Mar-Apr;24(2):260-1

Allergology and Clinical Immunology Department, INSERM U 1111-CIRI, Lyon-Sud University Hospital, Lyon 1 University, 69495 Pierre-Bénite cedex, France.

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http://dx.doi.org/10.1684/ejd.2014.2289DOI Listing
July 2015

Special locations dermoscopy: facial, acral, and nail.

Dermatol Clin 2013 Oct 23;31(4):615-24, ix. Epub 2013 Aug 23.

Department of Dermatology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Piere Bénite Cedex 69495, France. Electronic address:

Although dermoscopy reflects the anatomy, skin anatomy is different on facial and acral skin as well as in the nail unit. Malignant patterns on acral sites include the parallel ridge pattern and irregular diffuse pigmentation, whose presence should lead to a biopsy. Malignant patterns on the face include features of follicular invasion (signet-ring images, annular granular images, and rhomboidal structures) and atypical vessels. Malignant patterns on the nail unit include the micro-Hutchinson sign and irregular longitudinal lines.
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http://dx.doi.org/10.1016/j.det.2013.06.006DOI Listing
October 2013

[Angioedema and anaphylaxis].

Rev Prat 2012 Jun;62(6):829-35

Service d'immunologie clinique et allergologie, Centre hospitalier Lyon-Sud, Pierre-Bénite, France.

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June 2012