Cutaneous drug reactions to antiepileptic drugs and relation with HLA alleles in the Turkish population.

Summary: Background and objective. Many studies have shown associations between HLAB*15:02, HLA-A*31:01 and carbamazepine (CBZ)-induced delayed cutaneous hypersensitivity reactions. The aim of this study is to evaluate a possible association between delayed cutaneous reactions to antiepileptic drugs (AEDs) and certain HLA-A and HLA-B alleles in the Turkish population. Methods. The study consisted of 3 groups: Group I (reactive group) included the patients who had documented delayed cutaneous reactions to any antiepileptic drug. Group II (non-reactive group) included the patients who have been on antiepileptic treatment at least for three months without any adverse reactions. Group III consisted of healthy subjects. The HLA-A and B alleles were analyzed in all groups. Results. Forty patients (29 female) had experienced different hypersensitivity reactions due to AEDs: maculopapular exanthema (26 patients), Stevens-Johnson syndrome (6 patients), drug rash with eosinophilia and systemic symptoms (7 patients), toxic epidermal necrolysis (1 patient). Lamotrigine (11) and CBZ (10) were the most common culprit drugs involved in the reactions. The HLA-B*15:02 was not present in any of the study groups. However, HLA-B*35:02 was found in 4 patients from the reactive group, while it was not observed in non-reactive patients and was detected in only one healthy subject (p = 0.021). Conclusion. Although our preliminary results did not indicate a strong allele association with AED hypersensitivity, HLA-B*35:02 appears to be a candidate allele for MPE / DRESS / DIHSS induced by AED's in Turkish population. Further studies with a larger sample size may result in more comprehensive data about the genetic tendency for AED hypersensitivity in the Turkish population.

Evaluation of hypersensitivity reactions to nonsteroidal anti-inflammatory drugs according to the latest classification.

BACKGROUND/AIM: The consensus document for hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) proposed by the European Network for Drug Allergy (ENDA) interest group (2011) was revised in 2013. We aimed to evaluate the usability of the latest NSAID hypersensitivity classification of ENDA. METHOD: A total of 370 patients with a history of hypersensitivity reactions to NSAIDs among the 1250 outpatients referred for suspected drug allergy between July 2013 and June 2014 were evaluated, and 308 patients who were confirmed as having NSAID hypersensitivity were included in this study. After confirming the diagnosis, a single-blind placebo-controlled drug provocation test was performed with aspirin or diclofenac to categorize the patients according to the ENDA classification. The reactions not meeting the ENDA classification criteria were grouped as blended reactions. RESULTS: Among the 308 patients (224 female, mean age 42.12 ± 13.24), the leading cause of hypersensitivity reactions was metamizol (30.5%) followed by aspirin (30.2%). The most common NSAID hypersensitivity subgroup was SNIUAA (46.4%) and the least common type was SNIDR (1.6%). Cross-reactivity was identified in 50.3% of the patients. In five patients (1.6%), the hypersensitivity reactions to NSAIDs did not meet the ENDA classification: Three patients experienced anaphylaxis with different NSAIDs, one patient encountered anaphylaxis with one NSAID and urticaria with other NSAIDs, and the last patient had angioedema with different NSAIDs. CONCLUSION: The latest ENDA classification for NSAID hypersensitivity is generally a practical and useful instrument for clinicians. We only point out that anaphylaxis with different NSAIDs can be seen in a small group of patients.

Methotrexate: can it be a choice for nasal polyposis in aspirin exacerbated respiratory disease?

Nasal polyposis (NP) is considered a subgroup of chronic rhinosinusitis and is commonly associated with asthma, bronchiectasis, and cystic fibrosis. A certain subgroup of nasal polyposis is known as Aspirin Exacerbated Respiratory Disease (AERD), previously called Samter's Triad or aspirin triad, comprising polyposis, asthma, and aspirin hypersensitivity and makes up almost 10% of cases of NP. Therapy of NP involves a combination of medical and surgical treatments. However, recurrences are common, particularly in patients with asthma and aspirin hypersensitivity. Both topical and systemic corticosteroids form the mainstay of conservative therapy for NP as well as a primary treatment and prevention for recurrences. They have been shown to improve nasal breathing, rhinitis symptoms, and reduce the size of NP, along with the rate of recurrence. There is great concern about the adverse effects of systemic steroids, especially when long-term usage is necessary to maintain improvement. So far, no knowledge exists about the effects of methotrexate (MTX) on NP of the patients with asthma. We report two patients whose NP dramatically reduced in size after a course of MTX therapy administered as an additional treatment for their steroid- dependent asthma.

Confirmed prevalence of food allergy and non-allergic food hypersensitivity in a Mediterranean population.

BACKGROUND: Until the present, no comprehensive studies evaluating the prevalence of food allergy and non-allergic food hypersensitivity (FA/NAFH) in adults have been done in Turkey or its surrounding countries. OBJECTIVE: This large population-based study was planned to identify the confirmed prevalence of adverse reactions to food in adults in Istanbul. METHODS: A total of 17 064 telephone numbers were randomly selected from both the European and Asian sides of Istanbul, and the 11 816 subjects who agreed to participate in the study were addressed with a questionnaire of eight items. Those who disclosed food-related complaints in this survey were called again and a similar questionnaire was repeated. The respondents who were suspected of having food allergy or food hypersensitivity were invited for a personal clinical investigation that included double-blind, placebo-controlled food challenge tests. RESULTS: The lifetime prevalence of self-reported FA/NAFH was found to be 9.5% [1118/11 816; 95% confidence interval (CI): 8.94-10.00%]. After the clinical investigations, the point prevalence of FA/NAFH, which also included the 'possible FA/NAFH group', was found to be as low as 0.3% (30/11 816; 95% CI: 0.17-0.36%), and the FA/NAFH rates assessed by double-blind, placebo-controlled food challenge tests were 0.1% (12/11 816; 95% CI: 0.05-0.18%) and 0.1% (11/11 816; 95% CI: 0.05-0.17%), respectively. The most significant factor influencing FA/NAFH was familial atopy (adjusted OR 4.3; 95% CI: 3.67-4.99), and the most related atopic disease was itching dermatitis/urticaria (adjusted OR: 3.9; 95% CI: 3.31-4.54). CONCLUSION: We may conclude that FA/NAFH in the Turkish population seems to be low when compared with Northern and Western European countries. This may be due to genetic, cultural or dietary factors, and further studies evaluating the reasons for this low prevalence of FA/NAFH in our population are needed.

Does hospitalization for asthma and allergic diseases occur more frequently in Ramadan fasting: a population based study (2000-2004).

OBJECTIVE: Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is a radical change in life style for the period of a lunar month. Our objective in this study was to investigate whether Ramadan fasting has any effect on the incidence of asthma and to assess whether Ramadan Fasting affected normal lung function values. DESIGN: This is a hospital-based cohort study. SETTING: Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar. PATIENTS: We prospectively reviewed 1590 asthmatic Muslim patients who were hospitalized with asthma over a four year period from January 2000 to December 2004. Patients were divided according to the time of presentation in relation to the month of Ramadan, one month before, during and one month after Ramadan. METHODS: Pulmonary function tests were performed on an electronic spirometer (Compact Vitalograph, Buckingham, U.K.). Performance of the spirometric test and data collection were according to as described by the American Thoracic Society. RESULTS: There were 1590 patients studied. Among them, 901 were males (56.7%) and 689 were females (43.3%). Their mean age was 30 years (15-60). All patients expressed clinical allergy, 454 patients (28.6%) had asthma and rhinitis, 513 patients (32.3%) had allergic rhinitis, 300 patients (18.9%) had asthma alone and 10.6% had other allergic conditions. The ventilatory capacity of lung function parameters mean did not show any statistically significant differences between a period of pre-Ramadan, during Ramadan and after Ramadan concerning FVC, FEV1, FEF(25-75) FEV1/FVC, and PEF values. CONCLUSION: This study demonstrated that no significant difference was found in number of hospitalization and the mean spirometric values for asthma while fasting during the month of Ramadan when compared to the non-fasting months.

The effect of gestational age on sonographic screening of the hip in term infants.

Several authors have suggested that the final five weeks of gestation are a critical period for the development of the hip. In order to test the hypothesis that gestational age at birth may influence the development of the hip joint, we analysed the sonographic findings in 1992 hips (in 996 term newborns) with no risk factor for developmental dysplasia of the hip. The 996 infants were born at a mean gestational age of 39 weeks (37 to 41). The mean bony roof angle (α), cartilage roof angle (ß) and the distribution of the type of hip were compared between the 37th, 38th, 39th, 40th and 41st birth week groups. There was a significant difference in the distribution of type of hip between the different birth week groups (p < 0.001), but no significant difference between the α angles of all groups (p = 0.32). There was no correlation between birth week and roof angle (p = 0.407 and p = 0.291, respectively) and no significant correlation between birth weight and roof angle (p = 0.735 and p = 0.132, respectively). The maturity of the infant hip, as assessed sonographically, does not appear to be affected by gestational age, and the fetal development of the acetabular roof appears to plateau from 37 weeks.

Successful capecitabine desensitization for a delayed-type hypersensitivity reaction

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Successful desensitization to vitamin D in a patient with vitamin D deficiency

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Nodule or pseudonodule? Differentiation in Hashimoto's thyroiditis with sonoelastography.

Fine needle aspiration biopsy (FNAB) is the gold standard for the diagnosis of lymphoma in Hashimoto's thyroiditis and is able to differentiate between benign, inflammatory or malignant nodules, classifying them as either true nodules or pseudonodules. This technique is, however, invasive. The present study aimed to differentiate pseudonodules from true nodules by sonoelastography, a non-invasive technique, in 54 patients with Hashimoto's thyroiditis. The accuracy of sonoelastography to differentiate between true or pseudonodules was compared with the gold standard FNAB and with grey scale ultrasonography. The nodules were categorized into three groups: non-demarcated hypoechogenic, demarcated hyperecho genic, and demarcated hypoechogenic. Sono elastography findings were concordant with the cytopathological results and demonstrated that sono elastography was able to detect true thyroid nodules often misdiagnosed by conventional grey scale ultrasonography. Sonoelastography was found to have increased sensitivity for true nodule diagnosis compared with conventional grey scale ultrasonography and may eliminate unnecessary FNABs being carried out.

Morbilidad psiquiátrica y calidad de vida en pacientes con urticaria crónica idiopática / Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria

Objetivos. Determinar la prevalencia de la morbilidad psiquiátrica en los pacientes con urticaria crónica idiopática (UCI); determinar la calidad de vida relacionada con la salud (HRQL) en los pacientes con UCI en comparación con controles sanos. Métodos. Se seleccionaron 350 pacientes con urticaria crónica, entre el 1/01/2005 y 31/04/2005 en el Departamento de Alergia de la Universidad de Estambul, que cumplieran con los criterios de inclusión: pacientes con diagnóstico de UCI, con edad de entre 18 y 65 años, sin síntomas psicóticos ni retardo mental, con capacidad cognitiva normal y ausencia de enfermedad comórbida. Como control se eligió un grupo de individuos sanos con características demográficas comunes. Todos los participantes recibieron información sobre el estudio mediante consentimiento informado. Se realizó el diagnóstico de UCI descartando, para ello, todas las causas posibles (drogas, químicos, alimentos) mediante dietas de eliminación y con prick tests negativos. Además, se realizaron exámenes de laboratorio: hematología, enzimas hepáticas, hormonas tiroideas, anticuerpos antinucleares y test del suero autólogo. Se utilizó una escala visual analógica, además de entrevistas clínicas para medir la severidad de la enfermedad. Por otra parte, la evaluación psiquiátrica consistió en: entrevistas de forma semiestructurada en donde los participantes completaron un cuestionario de HRQL (resultado de la encuesta de salud) de 36 ítems de forma corta (SF-36) y además una entrevista clínica estructurada por el eje DSM-IV para diagnóstico de enfermedad psiquiátrica en los pacientes con UCI. Resultados. En este estudio se incluyó a 84 pacientes con UCI y 75 controles sanos. La media de edad ± desvío estándar fue 36,83 ± 10,26. El 84% de los pacientes eran mujeres; la duración media (±DE) de la enfermedad fue 6,34 ± 7,2 años y los síntomas fueron intermitentes en el 51% de los pacientes.