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.

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.

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.

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.

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.

Allergy symptoms and IgE immune response to rose: an occupational and an environmental disease.

BACKGROUND: Turkey is one of the four major producers of rose. Cultivation of rose is the main economic activity of many villagers in the Lakes region. Rose allergy has not been reported before. We investigated the prevalence of allergy symptoms and specific-IgE immune response due to rose in villagers who had been cultivating rose in Güneykent village in the Lakes region. METHODS: A screening questionnaire including respiratory and allergic symptoms was administered to 290 villagers. The investigation team visited and studied 75 randomly selected villagers with an interviewer-administered questionnaire, pulmonary function testing, skin prick testing and serum total IgE. Specific IgE against Rosa rugosa was measured in 41 villagers. RESULTS: Villagers reported asthma/allergy symptoms outside the rose season (17.6%), during the rose season (6.2%), and both during the rose season and outside the rose season (whole the year) (17.6%). Atopy and specific IgE against Rosa rugosa were detected in 12 (19%), and 8 (19.5%) of the villagers tested. Villagers who had symptoms whole the year reported wheeze more frequently than those who reported symptoms only outside the rose season (41.2% vs 11.1%). CONCLUSIONS: IgE-mediated allergy could occur due to rose and/or its pollen. Symptoms mainly affect the upper airways. Further studies in the rose handlers, florists and workers of the rose industry would help elucidate the occurrence of rose allergy.

Survey of the allergic status of patients with bronchial asthma in Turkey: a multicenter study.

Patients diagnosed with bronchial asthma (BA) were prospectively enrolled to assess their allergen spectra and atopic status. The patients came from five major cities (Ankara, Izmir, Samsun, Elazig, and Adana) in different regions of Turkey. Atopic status, total IgE levels, and allergen spectra were determined in 1149 patients and 210 controls who were spouses of the patients sharing the same environment but not consanguinity with the patients. Total IgE levels were significantly higher in the asthmatic patients. For both groups, total IgE levels were higher in both atopic and male subjects. Atopy rates were 42% in asthmatics and 26.1% in controls, declining notably by age in both groups. The most common allergen in both groups was house-dust mite (HDM), which was more frequently detected in coastal regions (Samsun, Izmir, and Adana). Allergen spectra of the patients included HDM, pollens, cockroach, pet animals, and molds in decreasing order of frequency. Phleum pratense and Artemisia vulgaris were the most common pollens in all regions, whereas Olea europaea was the most common in Izmir. Pollen sensitivity was least frequent in Elazig. For all of the regions, pet sensitivity was less common than, and mold sensitivity was comparable to, that of Western countries. In conclusion, BA patients in Turkey displayed significant differences in their allergen spectra and total IgE levels from control subjects and BA patients in Western countries.

Birch pollen related food hypersensitivity: as a para-occupational syndrome.

Two patients presented with allergy to birch pollen and hypersensitivity to hazelnut and apple. Since both of these patients developed pollen sensitivity when they were abroad for occupational purpose, we want to mention this situation as "a para-occupational syndrome".

Survey on the allergic status in a Turkish population in Sweden.

A limited survey on the allergic status and total IgE was performed on 205 persons of Turkish origin aged between 16 and 76 years living in Stockholm, Uppsala, Sweden in 1990. A questionnaire was mailed to 205 persons and was returned by 92%. 71 persons were randomly selected among those who returned the questionnaire, and were examined after an interview, skin-prick test (SPT) and total IgE levels were also measured. The atopy prevalence of the randomly selected group of Turks was found 32.4%. Clinical symptoms were significantly associated with positive SPT reactivity. IgE levels in the atopic group were significantly higher than those of non atopic group (78.2 ku/l vs 28.4 ku/l respectively). However, the difference in IgE levels were significant between non atopic and atopic groups residing in Sweden longer than 10.5 years, but not significant between those who resided less than 4.5 years. The allergic spectrum changed with residence time spent in Sweden in Turks. Skin test positivity to birch, cat, and dog increased with time. This increase may be related to the change in life styles and habits, such as indoor contact with pets, and intensive environmental birch pollen exposure. In conclusion, our data indicate that immunologic status of persons is influenced by a new millieu. Within a few years the allergic status of Turkish immigrants adapted to the new environment.