Inhaler Steroid Use Changes Oral and Airway Bacterial and Fungal Microbiome Profile in Asthma Patients

INTRODUCTION

The full spectrum of bacterial and fungal species in adult asthma and the effect of inhaled corticosteroid use is not well described. The aim was to collect mouthwash and induced sputum samples from newly diagnosed asthma patients in the pretreatment period and in chronic asthma patients while undergoing regular maintenance inhaled corticosteroid therapy, in order to demonstrate the bacterial and fungal microbiome profile.

METHODS

The study included 28 asthmatic patients on inhaler steroid therapy, 25 steroid-naive asthmatics, and 24 healthy controls. Genomic DNA was isolated from induced sputum and mouthwash samples. Analyses were performed using bacterial primers selected from the 16S rRNA region for the bacterial genome and "panfungal" primers selected from the 5.8S rRNA region for the fungal genome.

RESULTS

Dominant genera in mouthwash samples of steroid-naive asthmatics were Neisseria, Haemophilus, and Rothia. The oral microbiota of asthmatic patients on inhaler steroid treatment included Neisseria, Rothia, and Veillonella species. Abundant genera in induced sputum samples of steroid-naive asthma patients were Actinomyces, Granulicatella, Fusobacterium, Peptostreptococcus, and Atopobium. Sputum microbiota of asthma patients taking inhaler steroids were dominated by Prevotella and Porphyromonas. Mucor plumbeus and Malassezia restricta species were abundant in the airways of steroid-naive asthma patients. Choanephora infundibulifera and Malassezia restricta became dominant in asthma patients taking inhaled steroids.

CONCLUSION

The oral and airway microbiota consist of different bacterial and fungal communities in healthy and asthmatic patients. Inhaler steroid use may influence the composition of the oral and airway microbiota.

Real-world patient-level cost-effectiveness analysis of omalizumab in patients with severe allergic asthma treated in four major medical centers in Turkey

Aims. To evaluate the cost-effectiveness of standard-of-care treatment (SoC) to SoC in combination with omalizumab (OML + Soc) in patients with severe asthma using real-world prospective clinical data from 4 major medical centers in Turkey.Materials and methods. Between February 2018 and November 2019, a total of 206 patients with severe astma, including 126 of whom were in the OML + SoC group and 80 in the SoC group, were followed for 12 months to evaluate their asthma status and quality of life. Cost data for this patient-level economic evaluation were sourced from the MEDULA database of the hospitals and expressed in Turkish Lira (₺). Efficacy data were obtained by means of Turkish versions of the Asthma Control Test for asthma status, and the 5-level EQ-5D-5L version (EQ-5D-5L) and the Asthma Quality of Life Scale for quality of life. A Markov model with 2-week cycles was specified, comparing costs and treatment effects of SoC versus OML + SoC over a lifetime from the Turkish payer perspective.Results. Per-patient costs were ₺23,607.08 in the SoC arm and ₺425,329.81 in the OML + Soc arm, for a difference of ₺401,722.74. Life years (LY) and quality-adjusted life years (QALY) were 13.60 and 10.08, respectively, in the SoC group; and 21.26 and 13.35, respectively, in the OML + SoC group, for differences of 7.66 LYs and 3.27 QALYs. This yielded an incremental cost-effectiveness ratio of an additional ₺52,427.04 to gain 1 LY and an incremental cost-utility ratio of an incremental ₺122,675.57 to gain 1 QALY; the latter being below the ₺156,948 willingness-to-pay threshold for Turkey referenced by WHO. One-way and multivariate sensitivity analyses confirmed that base-case results.Conclusion. Whereas most economic evaluations are based on aggregate data, this independent cost-effectiveness analysis using prospective real-world patient-level data suggests that omalizumab in combination with standard-of-care is cost-effective for severe asthma from the Turkish public payer perspective.

Prevalence and clinical features of pollen-food allergy syndrome in adults with seasonal allergic rhinitis

OBJECTIVE

Pollen-food allergy syndrome (PFAS) is an IgE-mediated allergic reaction to certain foods due to prior sensitization to pollen allergens. The data about the prevalence of PFAS in adults in Turkey is not sufficiently reported. Our objective was to investigate the frequency and clinical features of PFAS in adult patients with seasonal allergic rhinitis (SAR).

PATIENTS AND METHODS

A total of 222 patients with SAR were enrolled in our outpatient allergy clinic at Hacettepe University, during a ten-month period. A questionnaire was used to evaluate patients and to categorize those who experienced obvious allergy symptoms consistent with PFAS. Atopy was assessed by a standard skin prick test panel including common aeroallergen extracts.

RESULTS

Among 222 patients with a diagnosis of SAR, 31 had patient reported PFAS (31/222, 14%). Among them, 23 (74.2%) were females, and their mean age was 32.29±9.24 years. The most common symptoms were isolated oropharyngeal symptoms (58.1%), followed by urticaria (51.6%) after culprit food ingestion. The most frequent culprit foods were eggplant, walnut, kiwi, peach, and melon. The predominant sensitizing aeroallergen was grass pollen.

CONCLUSIONS

PFAS can be frequently observed in adults who are followed up for SAR. The most frequently involved foods are eggplant, walnut, kiwi, peach, and melon in Ankara Province. The symptoms of PFAS are usually localized in the oropharyngeal area and are self-limited.

The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort

Background and objectives

Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity.

Methods

Patients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation.

Results

We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011).

Conclusion

Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

Successful desensitization with chemotherapeutic drugs: a Tertiary Care Center Experience

Summary

Introduction. Hypersensitivity reactions to chemotherapeutic drugs are increasing all over the world, and desensitization to them has become the standard treatment approach. This study aimed to evaluate the characteristics of chemotherapeutic drug hypersensitivity reactions and the outcome of desensitization procedures. Methods. Between January 2017 and 2019, patients who have been desensitized to chemotherapeutic drugs were included retrospectively. Data were obtained from the medical records of the patients. Results. A total of 35 patients were evaluated; of whom 24 (68.5%) were female and 11 were male (31.5%). The mean age was 54.54 ± 13.39 (min-max: 41-69) years. Colorectal cancer was the most common malignancy (n:14, 40%). Desensitization was performed with oxaliplatin in 17 (48.5%), carboplatin in nine (25.7%), paclitaxel in four (11.4%), cisplatin in two (5.7%), irinotecan in two (5.7%), rituximab in two (5.7%), and docetaxel in one (2.8%) patients. Thirty four (97.1%) were successfully desensitized without any reactions. Anaphylaxis occurred during desensitization with rituximab and the procedure could not be completed. The reactions occurred during the first administration of the chemotherapeutic agent in five (14.2%) patients. Skin tests were performed on 26 (74.2%) patients. Skin prick and intradermal tests were positive in 7 (26.9%) and 12 (46.1%) patients, respectively. Conclusions. Desensitization is an effective and safe treatment approach for chemotherapeutic drug hypersensitivity and can be performed safely by observing general precautions to anaphylaxis.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Is the Perioperative Period No Longer a Problem for Adult Asthmatics under Control?-OPERA Study

OBJECTIVES

Asthma is a global problem and chronic condition that persists through patient's entire life, during which the possibility of a surgical procedure is common. An accurate clinical and functional evaluation of respiratory functions and asthma control is needed in patients undergoing surgical procedures and requiring general anesthesia. The aim of this study was to disclose any possible relation between postoperative complications and some pre- and postoperative factors.

MATERIALS AND METHODS

In this prospective cross-sectional study, randomly selected 111 asthmatic patients who presented to 10 different tertiary centers were included. The patients were evaluated at three different periods; any day between 1-7 days before surgery, and postoperative third and seventh to tenth days.

RESULTS

Among the patients included in the study, 86 (77.5%) were women and mean age was 52.2±13.8 years. General anesthesia was the most common anesthesia type (89.2%), and 33.3% of patients had had a thoracoabdominal surgery. There was a statistically significant difference between pre- and postoperative third-day values, including ACT scores (22.2±3.16 and 21.59±3.84, respectively; p<0.001); forced expiratory volume during the first second (84.92±19.12 and 78.26±18.47, respectively; p<0.001); peak flow rate (79.51±21.12 and 70.01±19.72, respectively; p<0.001); and SaO2 (96.95±1.82 and 95.8±3.32, respectively; p<0.001). Bronchospasm and pain were the most common complications during the postoperative period.

CONCLUSION

Controlled asthma under treatment steps 1-2-3 does not cause any serious postoperative pulmonary complications (PPCs). Therefore, achieving an optimal control level of asthma during the preoperative period must be considered the "gold standard" to reduce the risk of PPCs in asthmatic patients.

The Frequency and Risk Factors for Oropharyngeal Candidiasis in Adult Asthma Patients Using Inhaled Corticosteroids

OBJECTIVES

Worldwide, asthma is a major health problem and inhaled corticosteroids (ICS) are the mainstay of asthma treatment. High-dose and long-term use of ICS can result in some side effects. The present study aimed to determine the frequency of oral and systemic candidiasis infections in adult asthma patients using ICS, and to identify possible risk factors.

MATERIAL AND METHODS

This study included 186 randomly selected adult asthma patients that presented to allergy clinic between May 2011 and September 2012.

RESULTS

Among the patients, 147 (79%) were female. The lifelong incidence of oral candidiasis was 19.4% (n=36), whereas 5.38% (n=10) of the patients already had it by the time of the study. The lifelong incidence of any fungal infection was 59.7% (n=111). There weren't any significant differences in gender, age, age at onset of asthma, oral hygiene, atopy, or comorbid diseases between the oropharyngeal candidiasis (OPC)-positive and -negative groups. A history of persistent rhinitis, use of a leukotriene receptor antagonist together with ICS, and use of ciclesonide as an ICS were associated with a higher incidence of OPC.

CONCLUSION

In the present study the incidence of OPC in adult asthma patients was quite high, but no definitive risk factors were identified. Further studies are needed to distinguish these individual differences.

Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project)

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

Asthma phenotypes in Turkey: a multicenter cross-sectional study in adult asthmatics; PHENOTURK study

BACKGROUND AND AIMS

To evaluate asthma phenotypes in patients with asthma from different regions of Turkey.

METHODS

A total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011-January 2012.

RESULTS

The disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P < 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P < 0.01). Uncontrolled asthmatics have more severe disease (P < 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P < 0.01). Chronic rhino-sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P < 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P < 0.05).

CONCLUSION

In conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes.

Minimum prick test panel for adult patients with asthma and rhinitis in Ankara, Turkey

OBJECTIVE

Determination of the number and type of allergens needed to be tested in epidemiological studies is important in order to identify most of the sensitized subjects with a cost-effective approach. This study aimed to investigate the minimum skin prick test panel for the identification of at least 95% of the sensitized subjects with symptoms of asthma and/or allergic rhinitis (AR) in Ankara, Turkey.

METHODS

Skin prick test results of 7492 patients who were referred to our outpatient clinic with clinical symptoms of asthma and/or AR between 1991 and 2005 were evaluated retrospectively. Seven allergens were tested in all and 13 allergens in 4202 patients. The allergen group needed for detection of 95% of the sensitized subjects was determined for both the 7 and 13 allergen panels. The study protocol was approved by the local ethics committee of Hacettepe University.

RESULTS

The atopy prevalences in the whole study population and in 4202 patients tested with the 13 allergen panel were calculated as 32.2% and 42.6%, respectively. Three allergens (Phleum pratense, Dermatophagoides pteronyssinus and Artemisia vulgaris) within the 7 allergen panel were adequate for the identification of at least 95% of the sensitized subjects. Olea europae was added to the previous three allergens when the 13 allergen panel was applied.

CONCLUSION

Three to four allergens are sufficient for identification at least 95% of sensitized subjects with asthma and/or AR in Ankara, Turkey.

Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.

[ARIA (Allergic Rhinitis and its Impact on Asthma) achievements in 10 years and future needs]

Allergic rhinitis and asthma represent global health problems for all age groups. Asthma and rhinitis frequently co-exist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization (WHO) workshop in 1999 and was published in 2001. ARIA has reclassified allergic rhinitis as mild/moderate-severe and intermittent/persistent. This classification schema closely reflects the impact of allergic rhinitis on patients. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of allergic rhinitis and asthma co-morbidities based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation). ARIA has been disseminated and implemented in over 50 countries of the world. In Turkey, it is important to make a record of ARIA achievements and to identify the still unmet clinical, research and implementation needs in order to strengthen the 2011 EU Priority on allergy and asthma in children.

The analysis of Hymenoptera hypersensitive patients in Ankara, Turkey

BACKGROUND

Although there are some published data about the prevalence of honeybee and vespid venom allergy from Turkey, there has been no report about Hymenoptera venom immunotherapy practice. Our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara, Turkey.

METHODS

Demographic and clinical data, intradermal test, and serum specific IgE results of 65 Hymenoptera venom allergic patients who were followed up in our department from February 2005 to August 2009 were analysed.

RESULTS

Serum Vespula specific IgE class (p:0.02) and Apis specific IgE class were high (p<0.0001) and Apis intradermal test results were positive (p<0.001) in accordance with the patients' history. However, intradermal test results with Vespula were not consistent with self-reported Hymenoptera type (p:0.15). While Apis specific IgE and intradermal test results were correlated with each other (rho: 0.59, p<0.0001), Vespula specific IgE and intradermal test results were not (rho: 0.2, p:0.17). Intradermal test against Vespula did not discriminate between Apis and Vespula hypersensitive patients. There were no significant differences when the grade of reaction and specific IgE and intradermal test results were compared between Apis and Vespula.

CONCLUSIONS

Vespula venom hypersensitivity was more common among our patients. However, intradermal tests with Vespula had limited diagnostic sensitivity and were not correlated with serum specific IgE. Based on our results and previous reports, we recommend that negative skin test responses, especially with Vespula, need further investigation.

Does nasal hair (vibrissae) density affect the risk of developing asthma in patients with seasonal rhinitis?

BACKGROUND

Large particles entering the nose are collected by nasal hair present in the anterior nares. Increased hair density provides an improvement in the filtering efficiency of the nose, while reduced amounts of nasal hair cause a decrease in its efficiency. The amount of nasal hair can vary between individuals, which can make a difference in the filtering efficiency of the nose. Reduced filter function of the nose leads to increased exposure of the airways to allergens. The aim of this study was to determine the effect of nasal hair density on the risk of developing asthma in seasonal rhinitis (SR) patients.

METHODS

A standard questionnaire was filled in, and physical examination and allergy tests were performed in 233 patients. Patients were divided into 3 groups according to the amount of nasal hair [few (few or none), moderate and many]. The association between asthma and nasal hair density was assessed.

RESULTS

Asthma was detected in 75 patients (32.2%), and of these, 45 (60%) also had pollen asthma. The rate of asthma was 44.7, 26.2 and 16.7% in the few, moderate and many groups, respectively (p = 0.002). Few nasal hairs significantly increased the risk of developing asthma [odds ratio (95% confidence interval): few, reference; moderate, 0.41 (0.21-0.78); many, 0.19 (0.06-0.55); p = 0.002].

CONCLUSION

Our findings suggest that the amount of nasal hair providing a nose filtration function has a protective effect on the risk of developing asthma in SR patients. To the best of our knowledge, this is the first report on this subject in the literature.

Are chronic urticaria, analgesic intolerance and seasonal rhinitis markers of different severities and phenotypes of the asthma they accompany?

BACKGROUND

Asthma is a heterogeneous disease that presents with different clinical phenotypes. We aimed to compare the patients with asthma diagnosis alone with the patients, who, in addition to their asthma had accompanying analgesic intolerance (AI), chronic urticaria (CU) or seasonal rhinitis (SR) if there are any distinctions and specific characteristics of these defined patient groups.

METHODS

Eighty-four asthma patients diagnosed with SR, 46 with CU, 75 with AI and 71 patients with asthma alone were enrolled to the study retrospectively. The reference group for the comparisons was the group with asthma diagnosis alone.

RESULTS

The mean age of all patients was 37.2±13 (15-80) and 70.7% of them were females. Asthma patients with SR had a significantly earlier onset of asthma (age: 27.4±10.8 and 34.5±15.9; respectively, p<0.01), significantly better pulmonary function tests and were significantly more atopic (92.9% and 28.8%; p<0.001). Moderate-to-severe asthma significantly correlated with older age at the time of diagnosis, older age of asthma onset, higher body mass index, less atopy and fewer pollen sensitivity. Asthma severity of patients with SR was significantly milder than the reference group (OR: 0.6, 95% CI 0.5-0.8). Asthma with AI tended to be more severe although the relation was insignificant (OR:1.6 95% CI:0.8-3.5).

CONCLUSIONS

Asthma patients with SR have significantly milder and earlier onset of asthma, better pulmonary function tests and are significantly more atopic while asthma with AI tends to be more severe. Asthma with CU does not show a specific phenotypic characteristic.

Asthma and allergic diseases in school children from 1992 to 2007 with incidence data

BACKGROUND

Information about change in the prevalence of asthma and allergic diseases and factors related with these diseases would be beneficial in decreasing the burden of these diseases.

OBJECTIVE

To assess (i) change in prevalence of asthma and allergic diseases; (ii) factors associated with asthma and wheeze; and (iii) incidence of asthma and wheeze.

METHODS

A questionnaire was administered to children aged 7-12 years in first five grades in the same primary school in 1992 (n: 1036), 1997 (n: 738), 2002 (n: 621), and 2007 (n: 422) and filled by the parents. A second survey in 2007 (n: 474, in eight grades) was conducted in the same schoolchildren, 6 months apart, to assess the incidence of asthma and wheeze and the associated factors.

RESULTS

Comparison of 1992, 1997, 2002, and 2007 surveys revealed that prevalence of asthma (8.3%, 9.8%, 6.4%, 3.3%, respectively), wheeze (11.9%, 13.3%, 6.4%, 3.1%, respectively), hay fever (15.4%, 14.1%, 7.2%, 3.1%, respectively), and eczema (4.0%, 4.3%, 1.8%, 1.2%, respectively) were significantly lower in 2002 and 2007 compared with that in 1992. Percentage of passive smoking decreased after 1992 (74.0%, 64.0%, 64.1%, and 65.5%, respectively). Incidence of asthma and wheeze in 2007 surveys were 0.9/100 and 1.1/100, respectively. After the adjustment for age and gender, infection in the past, family atopy, and presence of atopic disease (eczema or hay fever) were associated with asthma and wheeze. Maternal smoking and lack of breast feeding were associated with asthma. Male gender, pet ownership in the past, lack of health insurance coverage, snoring, and wood or coal used as fuel were associated with wheeze.

CONCLUSIONS

Decreased prevalence of asthma and allergic diseases in the last 10 years could be related to decreased rate of passive smoking. Lower socioeconomic status and lack of breast feeding could increase the risk of asthma in children.

Association between asthma, rhinitis and NSAID hypersensitivity in chronic urticaria patients and prevalence rates

BACKGROUND

The coexistence of allergic diseases and chronic urticaria (CU) is not uncommon. Our aim was to show the prevalence of allergic diseases in chronic urticaria patients and whether possible risk factors precipitate the development of these conditions.

METHODS

The data of 953 patients diagnosed with CU in our adult allergy clinic between January 1991 and June 2006 were retrospectively evaluated.

RESULTS

The mean ages of the CU patients with and without non-steroidal anti-inflammatory drug hypersensitivity (NSAIDH) were 39.0 +/- 11.8 and 36.7+/- 12.3, respectively (p = 0.014). There was a female predominance in both groups (74.6 and 68.2%, respectively, p = 0.06). Apparently, some conditions occurred significantly more often in CU patients with NSAIDH compared to those without NSAIDH: 16.4 and 8.4% for asthma (p < 0.001), 4.2 and 0.8% for nasal polyps (p < 0.01), 20.8 and 7.3% for antibiotic hypersensitivity (p < 0.001), 21.6 and 12.3% for metal sensitization (p < 0.01), and 8 and 0.6% for familial NSAIDH (p < 0.001), respectively. Dermographism was more common in CU patients without NSAIDH compared to those with NSAIDH (29.4 and 21.2%, respectively; p < 0.05). NSAIDH increased the risk of asthma and rhinitis development [odds ratios: 52.9 (18.1-154.6) and 5.2 (2.0-13.4)].

CONCLUSION

Based on our data, the incidence rates of asthma, nasal polyps, antibiotic hypersensitivity, metal sensitization and familial NSAIDH are increased in patients with CU with NSAIDH compared to those with CU only. Coexistence of NSAIDH and CU increases the risk of developing asthma and rhinitis.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.2-11.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.3-15.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 12.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.3-11.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

Successful heparin desensitization after anaphylactic shock due to heparin

A successful desensitization protocol in a patient with low molecular weight heparin induced anaphylactic reaction is being presented. A 72-years-old patient who was known to have multiple drug allergies and asthma was admitted with acute renal insufficiency. She had an anaphylactic reaction with a low molecular weight heparin during a hemodialysis session. Peritoneal dialysis was not feasible. Anticoagulation with warfarin was not considered appropriate; alternative anticoagulants were not available. Therefore a desensitization protocol was planned and applied, comprising of IV administration of diluted heparin by gradually increasing doses (0.1 to 5000 units), at 15 minute intervals, completing 8 hours before the procedure. By this way, IV heparin could be administered during the subsequent hemodialysis sessions with no reactions. The Naranjo probability scale revealed a probable adverse reaction associated with nadroparin for this patient. Anaphylactic reaction to low molecular weight heparins is reported rarely in the literature. To the best of our knowledge, this is the third case of successful heparin desensitization. When other anticoagulants are not available and anticoagulation is indispensible, heparin desensitization can be an option.

Childhood onset analgesic intolerance: a marker for bronchial asthma in adulthood?

Analgesic intolerance (AI) which is classically known as a disease of the middle-aged adults, not uncommonly starts in childhood. In this study we sought to identify the characteristics of childhood onset AI and evaluated its association with the development of asthma. Among 729 analgesic intolerant patients followed in our institution between January 1991 and July 2004, 50 (16 male, 34 female, 6.8% of the total AI population) had history of AI starting before the age of 18. The prevalence of asthma was 24% in childhood and increased to 40% during adulthood. Atopy was more common in patients with bronchial asthma (p<0.05). The mean (+/-SD) age of onset for asthma (18.6+/-9.7years) was significantly greater than the onset of both rhinitis and AI (13.0+/-6.5 and 13.2+/-4.0 years, respectively). This finding is different than the chronology of events reported in the literature for adult onset AI patients, in which rhinitis and asthma usually precede the development of AI. The presence of such a difference in the sequence of disease patterns may be a clue for the pathophysiologic differences underlying childhood and adult onset AI. The role of childhood onset AI as a risk factor for developing for asthma in adulthood should be further assessed in prospective patient cohorts.

[Allergic rhinitis and its impact on asthma update (ARIA 2008). The Turkish perspective]

In this article, it is aimed to summarize the newly updated and published version of "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008" and add the recent Turkish epidemiological data on it.

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.

Multidrug-induced erythema multiforme

Adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1%. We describe a 29-year-old woman admitted with a history of itching, rash, vesicles on her hands and soles, and edema on her tongue and oropharynx after trimethoprim-sulfamethoxazole, ciprofloxacin, methenamine anhydromethylene citrate, piroxicam, azithromycin, and ceftriaxone intake. Erythema multiforme (EM) was diagnosed by skin biopsy after oral challenge with piroxicam. EM lesions reappeared after oral challenge with levofloxacin. Although EM is quite common with trimethoprim-sulfamethoxazole and there are some reports of EM appearing after intake of ciprofloxacin, it has rarely been attributed to piroxicam and no reports have identified levofloxacin as a cause.

Sarcoidosis following specific immunotherapy: more than just coincidence?

Although not yet clear, the etiology of sarcoidosis may be linked to seasonal, environmental and genetic factors; mycobacterial or other infections. To the best of our knowledge there is no data suggesting any connection between the onset of sarcoidosis and specific allergen immunotherapy in the medical literature. During the 11-year period between 1993 and 2005, a total of 91 sarcoidosis cases have been diagnosed at our institution. Out of these, here we present 3 cases of de novo sarcoidosis occurring after receiving specific immunotherapy (SIT) at the same institution (two of which had acquired the disease in Sweden where they had resided for a short time). We suggest that sarcoidosis may occur in patients following (SIT) probably via an abnormal immunological host response to an unknown antigenic trigger.

The natural course of atopy determined by skin prick tests in patients with bronchial asthma and/or rhinitis

BACKGROUND

The skin prick test (SPT) is the cheapest, most widely used and practical method for the diagnosis of allergic diseases. The results of repeat test might show variations due to aging.

OBJECTIVE

To perform repeat SPTs to determine possible changes in the atopy rate in general as well as changes in the allergen spectrum of atopic patients occurring over time and to identify the factors that could affect this change.

METHODS

A total of 222 patients who received a diagnosis of bronchial asthma and/or persistent rhinitis in our Adult Allergy Unit and who attended follow-up visits in the outpatient unit over a 2-year period were enrolled. SPT with 10 visit common aeroallergens were performed at the first and the second test was performed after an interval of at least 2 years.

RESULTS

The mean age was 36.4 +/- 11.4 years and 77.5 % of the patients were women. The mean interval between the two tests was 43.4 +/- 20.0 (minimum = 24-maximum = 105) months. Repeat tests showed that the atopy rate decreased from 58.6 % to 47.7 %; sensitivity rates to 10 allergens also decreased. These differences were statistically significant (p <0.05).

CONCLUSION

The atopy rate determined by SPTs tends to decrease over time. The most important factor affecting this decrease is time itself.

Hereditary Angioedema Associated with Heterozygous Factor V Leiden Mutation in a Patient with Purpura Fulminans

BACKGROUND

Hereditary angioedema (HAE) is an autosomal dominant, quantitative or functional defect of the C1 esterase inhibitor. The main role of the C1 esterase inhibitor is to regulate the activation of the complement system, the contact phase of the intrinsic coagulation system. On the other hand, factor V Leiden is the most common cause of primary and recurrent venous thromboembolism and displays a strong interaction with oral contraceptives. Here we report the case of a patient with HAE associated with the factor V Leiden mutation who had purpura fulminans when put on an oral contraceptive therapy.

CASE

A 42-year-old woman presented to the emergency room with a history of livid skin changes on her legs during a flight. On physical examination, the vital signs were normal, but there were edemas in her legs. The livid skin changes tended to increase, eventually leading to skin necrosis on the next day. She had a history of a similar episode two months before and experienced both episodes of necrotic skin lesions just after she had been put on a hormone replacement therapy due to irregular menstruations. She also had a history of recurrent angioedema attacks since her childhood, triggered by stress and physical stimulants such as pressure and heat. Subsequent investigations revealed heterozygous factor V mutation, activated protein C resistance and reduced C1 inhibitor levels.

CONCLUSION

Thrombosis is a multifactorial disease. The coexistence of multiple hereditary and acquired factors eases its occurrence. Women with HAE should be screened for the factor V Leiden mutation before pregnancy or the start of a hormone replacement therapy.

Bee and bee products allergy in Turkish beekeepers: determination of risk factors for systemic reactions

BACKGROUND

The prevalence of allergic reactions due to bee stings in beekeepers varies in different regions of the world. The aim of this study was to evaluate the characteristics of sting reactions and the risk factors for developing systemic reactions in Turkish beekeepers.

METHODS

A self-administered questionnaire was distributed to 1250 beekeepers to be completed in seven different cities of Turkey. A total of 494 (39.6 %) questionnaires were returned.

RESULTS

There were 444 subjects (89.9 %) with a history of sting exposure in the previous 12 months. Systemic reactions were present in 29 subjects (6.5 %) and nine (2 %) reactions were anaphylactic. Fifty-five percent of beekeepers reported more than 100 bee stings in the previous year. When systemic reactions were controlled by age and duration of beekeeping in a logistic regression model, seasonal rhinitis (OR: 4.4, 95 % CI: 1.2-11.5), perennial rhinitis (OR: 4.6, 95 % CI: 1.2-18.2), food allergy (OR:7.0, 95 % CI: 2.0-25.0), physician-diagnosed asthma (OR: 8.0, 95 % CI: 2.5-25.6), having an atopic disease of any type (OR: 3.3, 95 % CI: 1.2-8.7) and having two or more atopic diseases (OR: 10.9, 95 % CI: 3.5-33.8) were significantly associated with systemic reactions due to bee sting in the previous 12 months.

CONCLUSION

The incidence of systemic reactions in Turkish beekeepers is low, which might be due to the protective effect of a high frequency of bee stings. The risk of systemic reactions increases approximately three-fold when one atopic disease is present and eleven-fold when two or more concurrent atopic diseases are present with respect to no atopic disease.

Anaphylactic reaction to drugs commonly used for gastrointestinal system diseases: 3 case reports and review of the literature

Proton pump inhibitors and H2 receptor antagonists, which are commonly used to treat peptic ulcer and gastroesophageal reflux diseases, are associated with a low incidence of adverse reactions. We report 3 cases of anaphylactic reactions induced by lansoprazole or ranitidine diagnosed in a population of 8304 first-referral patients over a 13-year period. Cutaneous sensitivity to famotidine, ranitidine, omeprazole, pantoprazole, and lansoprazole was evaluated by skin prick tests with a concentration of 10 mg/mL (at 1:1000, 1:100, 1:10 and 1:1 dilutions), and if they were negative, intradermal skin tests were performed with the same dilutions of the extracts. Single-blind, placebo-controlled oral provocation tests were performed with lansoprazole, omeprazole, famotidine, and ranitidine in 2 cases. One case involved anaphylaxis during an oral provocation test with lansoprazole, and 2 cases were anaphylactic reactions to ranitidine. In both cases the skin test was positive for ranitidine and in 1 case an oral provocation test was also positive. The second patient refused that test. Cross reactivity to other H2 receptor antagonists was not demonstrated and a safe alternative drug was found for all 3 patients. Although incidences of anaphylactic reactions induced by proton pump inhibitors or H2 reactions are rare, they can be life threatening.

A New Method of Oral Drug Provocation Testing for Determining Safe Alternatives for Patients with Non-Steroidal Anti-Inflammatory Drug Intolerance: The Triple Test

BACKGROUND

Although some of the non-steroidal anti-inflammatory drugs (NSAIDs) are reported to be safe for NSAID-intolerant patients, they should not be suggested before confirming the safety by single-blind oral drug provocation tests. Various test protocols are used in different allergy centers. The aim of this survey was to find out if testing three drugs a day could be a safe, time-saving and cost-effective method.

METHODS

We have enrolled 84 patients into this survey between September 1, 2002, and July 31, 2004.

RESULTS

Their mean age was 37.3+/-11.0 years; 63 (75%) patients were female. By reliable history, the NSAID most commonly causing intolerance was aspirin (46.4%), and the most common reaction to analgesic intolerance was angioedema (60.7%). Eighty-seven tests were performed with meloxicam, rofecoxib, celecoxib, benzydamine, azapropazone, codeine and paracetamol in various triple combinations. Seventeen of the triple tests were positive, and one of them was suspiciously positive. After repeating these 18 tests with the same analgesics in the same order on 54 separate days, we have determined the responsible analgesics for 14 of the triple tests. There were no reactions when four of the triple tests were repeated on separate days (two of the triple tests demonstrated urticaria and the other two angioedema). Five patients had nausea and vomiting, and 2 had abdominal pain and other dyspeptic complaints during the tests. If we had performed the tests by the classical method, 264 days would have elapsed instead of 148 days (including the extra tests that we have performed after positive triple tests and gastrointestinal symptoms).

CONCLUSION

The triple oral drug provocation testing seems to be a safe, time-/manpower-saving and cost-effective method for determining safe alternatives for NSAID-intolerant patients.

Seasonal rhinitis, clinical characteristics and risk factors for asthma

BACKGROUND

The aim was to determine the clinical characteristics of patients with seasonal rhinitis (SR) and to disclose differences in the treatment of SR between an adult allergy clinic and other clinics over time.

METHODS

A retrospective study was conducted based on clinical records of 774 out of 955 patients diagnosed with SR in an adult allergy clinic between 1 January 1991 and 31 December 2003.

RESULTS

The mean age of the patients was 29.1 +/- 9.29 years and 62.7% were female. The most common major complaints of the patients were nasal symptoms in 82.3%. The mean duration of the disease was 6.76 +/- 6.8 years. The patients were symptomatic with a mean of 3.5 +/- 1.7 months a year, mostly during the period between April and July. Skin prick tests were positive in 685 patients (90.3%), where the most common sensitivity was against timothy grass (85.1%). The most common accompanying allergic diseases were food hypersensitivity in 14%, bronchial asthma in 13.4%, and drug allergy and/or intolerance in 9.6%. Although the use of specific immunotherapy and short-acting sedative antihistamines decreased over time, the use of nasal steroids and long-acting nonsedative antihistamines tended to increase before admission to our clinic. Older age (OR: 1.77, 95% CI: 1.06-2.94), presence of familial atopy (OR: 1.72, 95% CI: 1.04-2.85), respiratory symptoms (OR: 2.10, 95% CI: 1.75-2.50), ocular symptoms (OR: 0.77, 95% CI: 0.61-0.98) and metal allergy (OR: 0.25, 95% CI: 0.07-0.89) were associated with the development of asthma in patients with SR.

CONCLUSION

SR lasts approximately 3.5 months and the main cause in Ankara, Turkey is grass pollen sensitivity. Patients with any other allergic conditions make up 39.8% of the patients. SR patients are referred to allergy clinics quite late, which might be due to SR not being considered as a serious disease.

Lung health in workers exposed to reed dust

We conducted a cross-sectional survey in a cellulose plant among 109 reed workers, exposed to reed dust and 78 unexposed office workers, to investigate respiratory health effects of reed dust exposure. Investigations included dust measurements, serum total IgE, skin prick test, pulmonary function testing and questionnaire on respiratory symptoms. Total dust level in the reed processing unit was higher than the office (9.7 and 0.02 mg/m3, respectively). Reed workers had a higher rate of current smoking (67% and 46%, respectively). After the adjustment for smoking status and age, reed dust exposure was significantly associated with wheezing, chronic cough, dyspnea, itching eyes and itching nose. Chest tightness and ODTS symptoms were only reported by reed workers (27.5% and 23.9%, respectively). After the adjustment for pack-years of smoking, percentage of predicted FEV1, FVC, FEV1/FVC and FEF25-75 in reed workers were significantly lower than office workers. Among reed workers, wheezing was associated with older age (>40 years) and ever smoking, and cross-shift decline in FVC and FEV1 with shorter duration of work. Reed dust exposure in the workplace could provoke respiratory symptoms, possibly due to an irritating effect. Health selection bias is likely, and could have underestimated the health effects of reed dust exposure.

Food hypersensitivity in patients with seasonal rhinitis in Ankara

BACKGROUND

Food hypersensitivity (FH) affects 1-2 % of the adult population and is more common in atopic individuals. The aim of this study was to determine the frequency of FH and risk factors for its development in patients with seasonal rhinitis (SR) in our allergy clinic.

METHODS

We performed a retrospective study based on the medical records of 774 patients out of 955 patients diagnosed with SR in an adult allergy clinic between 1 January 1991 and 31 December 2003.

RESULTS

The mean age of the patients was 29.1 +/- 9.29 and 62.7 % were females. The most common major complaints were due to nasal symptoms in 82.3 %. The mean duration of SR was 6.8 +/- 6.8 years. Patients were symptomatic for a mean of 3.5 +/- 1.7 months per year. Skin prick tests (SPT) with common aeroallergens were positive in 685 patients (90.3 %), and the most common sensitivity was against timothy (85.1 %). The most common accompanying allergic disease was FH in 14 %. FH according to history and the results of SPT performed with food allergens were discordant. The most common clinical manifestations of FH were oral allergy (49.1 %) and cutaneous symptoms (38.9 %). Risk factors for the development of FH in patients with SR were dermatological symptoms, rhinitis duration > 5 years, symptom duration > 3 months per year, SPT reactivity to Artemisia vulgaris, tree pollen allergens (Corylus avellena, Betula verrucosa), and bee allergy.

CONCLUSION

FH was the most common (14 %) accompanying allergic disease in patients with SR. SPT with food allergens have limited diagnostic value for food allergy and/or intolerance. Risk factors for developing FH in patients with SR in Turkey were dermatological symptoms, duration of rhinitis > 5 years, duration of rhinitis symptoms > 3 months per year, and SPT reactivity to Corylus avellena.

Tolerability of moxifloxacin in patients with antibiotic hypersensitivity

BACKGROUND

Allergic reactions to antibiotics are commonly reported in the clinical practice. The treatment of antibiotic hypersensitivity (AH) consists of suggesting to avoid the offending antibiotics and to use safe alternatives after performing oral provocation tests (OPT). Moxifloxacin is a new fluoroquinolone antibacterial agent with a broad spectrum activity. Allergic reactions to moxifloxacin have rarely been described and therefore it could be tolerated by antibiotic allergic subjects.

OBJECTIVES

The aim of this survey was to investigate the tolerability of moxifloxacin in antibiotic intolerant patients.

MATERIALS AND METHODS

A prospective study was conducted in 20 patients diagnosed with AH at our clinic between 1 January 2003 and 31 December 2003. We performed single blind, one day OPT protocol for moxifloxacin with a total dose of 1000 mg.

RESULTS

The mean age of the patients was 38.05 +/- 14.1 and 17 (85 %) of them were females. There were only two patients with accompanying allergic diseases; one with bronchial asthma and the other with chronic urticaria. The rates of common anamnestic antibiotic hypersensitivities were 50 % with amoxicillin, 40 % with penicillin, 20 % with sulphonamides, respectively. Urticaria (80 %) was the leading reaction appearing after antibiotic ingestion. Seventeen of 20 patients tolerated moxifloxacin at therapeutic doses without any problem. One patient experienced generalized urticaria 4 hours after ingestion of the first dose of the drug, which resolved spontaneously 5 hours after the onset. Another patient experienced tachycardia (heart rate did not exceed beyond 115 per minute) 2.5 hours after ingestion of first dose of the drug, which resolved spontaneously 2 hours after the onset. And a third one developed severe nausea lasting for two hours.

CONCLUSION

Given the high incidence of hypersensitivity reactions to beta-lactam antibiotics the use of new fluoroquinolone, moxifloxacin might represent a therapeutic alternative.

[Respiratory symptoms and functions in tea workers]

Respiratory symptoms and function tests were studied in tea workers and in a control group. The prevalance of acute and chronic respiratory symptoms were not different in two groups except for an acute burning sensation of eye-nose-throat and a chronic cough. Also the comparison of the respiratory function tests between tea workers (both smokers and nonsmokers) and the controls were not different at preshift and postshift 30th minute and 8th hour. When preshift and postshift results were compared in tea workers (both in smokers and nonsmokers); statistically significant reductions of FEV1, FEV1/FVC, FEF25-75 and FEF25 were seen at the postshift values. However statistically significant reductions were not observed in controls. Thus we conclude acute tea dust exposure may cause bronchial obstruction particularly in small airways.

General anesthesia and postoperative pain management in analgesic intolerant patients with/without asthma: is it safe?

BACKGROUND

Analgesic intolerance (AI) appears in approximately 1 % of the general population. The triad of bronchial asthma, nasal polyposis, and analgesic intolerance is called analgesic-induced asthma (AIA). These patients are frequently referred to adult allergy clinics for preoperative evaluation for possible analgesic cross reactivity and intolerance to anesthetic agents.

OBJECTIVE

To determine allergic problems related to anesthesia and postoperative pain management in AI patients with and without asthma.

METHODS

The medical records of 45 patients who had been diagnosed with AI between January 1991 and December 2002 in the adult allergy unit and who underwent surgery in the same hospital in the last 4 years were retrospectively analyzed.

RESULTS

The mean age of the patients was 44.4 13.4 years and 30 (66.6 %) were female. Thirty-six (80 %) had AIA, 34 (75.6 %) had persistent allergic rhinitis and 21 (46.7 %) had nasal polyps. Fifty-one surgical procedures were performed in 45 patients, in whom ear, nose and throat surgery was the main procedure (64.7 %). Anesthesia was induced with propofol, fentanyl, and vecuronium and was maintained by sevoflurane or isoflurane. Fentanyl was used for early postoperative pain relief. No complications appeared in relation to anesthesia or early pain management except in a 44-year-old AIA woman who had a reaction in the postoperative period after receiving an inappropriate analgesic.

CONCLUSIONS

None of the patients had anesthesia-related allergic problems. Atropine and diazepam in the premedication, propofol and fentanyl during induction, muscle relaxation facilitation by vecuronium, and sevoflurane or isoflurane for maintenance seem to be a safe general anesthetic choice for analgesic intolerant patients with and without asthma.

A case of anaphylaxis due to rose pollen ingestion

BACKGROUND

Recent publications have demonstrated that in Güneykent (Turkey), a rose-cultivating area, some workers experience various allergic reactions due to contact with rose or its pollen.

CASE REPORT

A 47-year-old man, originally from Güneykent although he no longer lived there, suffered perennial rhinitis, asthma and rhinoconjunctivitis in spring related to sensitization to dust mites and various pollens, respectively. On several occasions, he had presented oral and cutaneous symptoms and angioedema due to contact with rose or intake of honey or other products. Finally, he had an anaphylactic reaction on drinking dew collected in the tulips of a rose that possibly contained rose pollen.

METHODS

Specific IgE was evaluated with Rosa rugosa extract and was 30.3 IU (class IV). Sensitization to other pollens and to mites was also confirmed. Oral provocation test was not deemed ethical.

CONCLUSION

This may be the first reported case of anaphylactic reaction due to rose pollen ingestion.

Analgesic intolerance with or without bronchial asthma: is there a marker?

BACKGROUND

The prevalence of analgesic intolerance (AI) is less than 1% in the general population and about 10% in adult asthmatics, in whom the disease tends to be more severe.

OBJECTIVE

A possible clinical-laboratory marker was sought that would differentiate patients who have AI with/without asthma, AI with asthma, and AI without asthma from the healthy subjects.

METHODS

In the survey, 66 analgesic-intolerant patients (36 having asthma) were compared with 50 healthy subjects using a nickel patch-test, 65 patients (39 having asthma) with 55 healthy subjects for the presence of a genetic marker (A38G and A444C SNPs in CC16 and LTC4S genes), and 32 patients (14 having asthma) with 118 healthy subjects for presence and frequency of human leukocyte antigens (HLA).

RESULTS

The mean age of the patients with AI with/without asthma and the healthy subjects for the nickel patch-test group, genetic marker group, and the HLA group was 39.8 +/- 10.5 and 33.3 +/- 11.1, 41.5 +/- 11.6 and 38.1 +/- 13.4, and 39.4 +/- 12.5 and 41 +/- 2.6, respectively. The frequency of the females in the same groups, in the same order, was 72.7% and 54%, 81.5% and 62%, and 71.9% and 59.3%, respectively. The frequency of positive nickel patch-test results and the A38G and A444C frequency in CC16 and LTC4S genes were not significantly different (p > 0.05). The frequency of HLA antigens HLA-A3, -B52, -DR16, -DQ5, -DQ8 and -DQ9 were significantly higher; and -A24, -B35, -B44, -DQ6 and -DQ7 were significantly lower in the AI group with/without asthma compared to the control group (p < 0.05).

CONCLUSION

As a result, nickel patch-test positivity and the genes which we have studied do not seem to be markers for AI with/without asthma. However, there might be a relation between AI with/without asthma and the types of the HLA system. Further surveys are needed with other genes and possible markers.

Paracetamol and asthma

Paracetamol (acetaminophen) is one of the over-the-counter analgesics that is used frequently for the self-management of some of the common disorders. There seems to be two types of relations between paracetamol and asthma - paracetamol intolerance leading to bronchospasm in analgesic-induced asthmatics; and the relation between asthma and the amount and frequency of consumption of paracetamol. Paracetamol is generally recommended as one of the safer analgesics in both analgesic tolerant and intolerant asthmatics, without the fear of severe bronchospasm that aspirin and other non-steroidal anti-inflammatory drugs can induce in these patients. However, Paracetamol is reported to cross-react with aspirin at a rate of approximately 20-30% in a dose-dependent way. Therefore, it should not be recommended to analgesic intolerant asthmatics, without performing oral provocation tests to prove its safety. The possible association between the amount and frequency of paracetamol consumption and the prevalence and degree of asthma as suggested by some of the recent surveys, needs to be investigated further.