The role of component-resolved diagnosis in Hymenoptera venom allergy in clinical practice.

Background: Hymenoptera venom allergy is an immunoglobulin (Ig) E mediated hypersensitivity reaction to Hymenoptera venoms. Obvious identification of the culprit insect that causes the clinical symptoms and, hence, the accurate selection of venom for curative treatment, is of great importance for the effectiveness and safety of venom immunotherapy. Objective: In this study, the contribution of component-resolved diagnostics (CRD) is evaluated in the diagnosis of Hymenoptera venom allergy. Method: Ninety-three patients from four different centers in Turkey were included in the study. Conventional tests, including prick and intradermal skin tests, with commercial venom extracts and serum specific IgE (sIgE) levels for whole venoms were performed. An sIgE analysis for venom allergen components, including rApi m 1, rApi m 2, rApi m 10, rVes v 1, rVes v 5, were evaluated by immunoblotting. Results: In conventional test results, 17 of 35 patients with bee venom allergy were positive to honey bee venom, whereas 18 patients were positive to bee and wasp venoms. In 28 of 35 patients with bee venom allergy, the diagnosis was confirmed with CRD. CRD revealed a sensitivity of 80% in patients with bee venom allergy. According to conventional tests, 7 of 24 patients with vespid venom allergy demonstrated sensitivity only to Vespula species, whereas 17 patients revealed double positivity. The total diagnostic sensitivity of Ves v 1 and Ves v 5 was calculated as 87.5%. Ten of 23 patients with a history of hypersensitivity to both venoms showed double sensitivity with CRD; one patient had cross-reactivity, one patient was found to be sensitive only to bee venom, and, eight patients were sensitive only to Vespula species. Eleven patients had an uncertain history in terms of the culprit insect type and six of them had double sensitivity in CRD. Conclusion: CRD seemed to be more helpful in diagnosing vespid venom allergy than bee venom allergy. It can also discriminate clinically significant sensitizations from irrelevant ones.

[The correlation between the distant metastases and organ-specific symptoms in the patients with lung cancer]. / Akciger kanserli hastalarda uzak metastaz ile organa özgül semptomlarin iliskisi.

In this study, the correlation between distant metastases and metastatic organ-specific abnormalities in patients with lung cancer was evaluated. There were 197 patients who have lung cancer with distant metastases in this study. 141 (71.5%) of them were nonsmall cell lung cancer and 56 (28.5%) of them were small cell lung cancer. While one site of liver, brain and bone metastases were detected in 128 (64.9%) patients, remainders (69 patients, 35.1%) had surrenal, renal, pancreatic, skin, lung, thyroid, abdominal lymph node metastases. Organ-specific symptoms, findings on physical examination and abnormalities in laboratory data were detected in 121 (56.5%), 45 (21%) and 52 (24.2 %) patients, respectively. Sensitivity of predilection of organ-specific symptoms for bone, liver and brain metastases were 67%, 43% and 74% and specificity were 86%, 90% and 76%, respectively. We concluded that organ-specific abnormalities were not so effective to predict metastases in lung cancer. We considered that this result could be due to retrospective analysis and not included enough patients.

The prevalence of latex allergy in sixth-year medical students: assessment of knowledge, risk, and attitudes about future specialty direction.

BACKGROUND: In the prevention of latex allergy, knowledge levels and risk determination for latex allergy of medical students gain importance. OBJECTIVES: To evaluate the latex allergy knowledge levels of sixth-year medical students and their latex allergy risk. METHODS: Students completed a questionnaire that assessed basic knowledge of latex allergy and that evaluated latex-related symptoms and latex exposure. The specialty branch students were going to choose in the Medical Specialty Examination was also asked. Skin prick tests (SPTs) with latex and inhalant allergens and patch tests with latex-related products were then performed. Finally, students were asked again about any changes in branch selection after learning their individual risks. RESULTS: Two hundred twenty sixth-year students were enrolled. Forty-four percent of the students gave the right answer for description of latex. Correct identification of at least 1 latex-related product used outside and inside hospitals was 55.5% and 95.5%, respectively. The prevalence of latex sensitization was 4.4% according to SPT results. The positivity of SPT to any inhalant allergen was 35% (n = 64). None of the students changed their mind about their specialty branch after learning their latex allergy risk. CONCLUSIONS: Last-year medical students have a remarkably low latex allergy knowledge level, which imposes a serious professional risk. Training strategies based on the benefit to this risk group and reevaluation are strongly recommended before graduation from medical school.