BACKGROUND: Respiratory allergies mostly allergic rhinitis and asthma represent an important and increasing public health problem and one of the priorities for the European health systems. There is an increasing public concern regarding the persistence and severity of allergic diseases and many difficulties of health systems in providing prompt specialized medical assistance. Our study aims to highlight the main results of the Alliance 4Life project focused on the evaluation of the burden and management of respiratory allergies in primary care from Romania and comparative health-related data from four Central and Eastern European countries. METHOD: We developed a questionnaire focused on patients with allergic rhinitis and asthma directly addressed to general practitioner (GP) specialists from Romania who attended the annual national conference in Bucharest. RESULTS: The main results showed that patients with respiratory allergies are frequently encountered in primary care practice, only a few patients are evaluated by allergists and there is a clear need for education in this field. CONCLUSIONS: This preliminary study confirms that respiratory allergies represent a considerable burden in primary care and the questionnaire may be a useful tool in further studies considering the experience of other healthcare systems. More advanced studies integrating epidemiology with data on air pollution and environmental conditions should be envisaged.
AIM: This review aimed to assess the impact of coronavirus disease 2019 (COVID-19) on skin health to establish a classification of the skin lesions that occur most frequently during the disease and whether a particular category of skin damage is more likely to occur both in the short term and in the long term. METHODS: We conducted a literature search of the PubMed database. Ultimately, 109 articles were included in this review. The exact phrases∕syntax and connectors used for the database search∕query were as follows: "Coronavirus and skin", "COVID-19 and skin", "SARS-CoV-2 and skin", "Coronavirus cutaneous manifestations", "COVID-19 cutaneous manifestations", "SARS-CoV-2 cutaneous manifestations", "Coronavirus dermatology", "SARS-CoV-2 and dermatology", "COVID-19 and dermatology", "COVID-19 and skin eruption", "Coronavirus and skin rash", "COVID-19 and hair", "Coronavirus and hair", "Coronavirus and nails", "SARS-CoV-2 and hair", and "SARS-CoV-2 and nails". Only articles with abstracts referring strictly to cutaneous manifestations of COVID-19 were chosen. Articles without abstracts were not considered. RESULTS: We established six of the most frequently reported clinical patterns associated with COVID-19 and their probability of occurring during COVID-19 disease evolution based on the current literature reports. We did not identify the particular types of skin lesions that are most prone to long-term persistence; most such cases are rare, and no conclusion can be drawn based on them. CONCLUSIONS: Apart from classified COVID-19-related skin disorders, this pandemic has been a challenge for dermatologists and a wide range of cutaneous side effects related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treatments have been reported. We are aware of other polymorphic clinical presentations, with novel data being reported periodically, but the pathophysiological mechanisms and evolution are largely unknown.
COVID-19 , Skin Diseases , Humans , COVID-19/pathology , SARS-CoV-2 , Pandemics , Skin Diseases/complications , Skin Diseases/pathology , Skin/pathology
BACKGROUND: During the Covid-19 pandemic patients suffering from asthma raised many concerns regarding the outcome ofthe impact of COVID-19 disease on their preexisting condition. The 2021 GINA report indicates that people with asthma do not appear to be at increased risk of a severe form of COVID-19. METHOD: This study is a retrospective study of patients (n = 163) median age = 27.8 years, M:F = 1:1.26, with asthma evaluated using ACT (asthma control test) and VAS (visual analog scale) before and after COVID-19 disease. An ACT score over 20 points placed patients in the controlled asthma group. RESULTS: The overall evaluation for COVID-19 in our asthma patients revealed that 22.7% of the studied group had the COVID-19 disease (21.5% in the controlled asthma group and 24.5% in uncontrolled asthma group). Asthma disease history was longer in the uncontroled asthma group (128 ± 96.8 months vs. 296 ± 59.7 months, p = 0.05). Asthma treatment was conducted according to the GINA guideline, and 18.4% (30 pts) of the patients were on allergen immunotherapy treatment. Significantly more uncontrolled patients were significantly more in Step 1 and 5 of treatment (p = 0.05 and p = 0.03). During the COVID-19 pandemic, patients in the GINA step 5 of treatment experienced a worsening of asthma, often twice as severe as compared to patients with asthma in GINA step 1-4. In these patients, even mild COVID-19 disease led to worsened asthma symptoms, while severe COVID-19 led to a severe asthma impairment measured by ACT score (p = 0.03) and VAS scale (p = 0.02), with increased oral corticosteroids consumption. CONCLUSION: Maintaining optimal asthma control should be able to reduce risk of severe outcomes after COVID-19 disease. Communication via phone with the specialist involved in their asthma care was very comforting for patients, thus confirming the necessity to include phone calls, smart phone's application or online evaluations and counseling in long-term care of chronic diseases.
Asthma , COVID-19 , Humans , Adult , Retrospective Studies , Pandemics , Asthma/diagnosis , Adrenal Cortex Hormones/therapeutic use
Ragweed pollen is an important component of biological pollution in the urban environment, responsible for increasing respiratory allergies and significant contribution to the health impact of air pollution in the Bucharest area. The aim of this paper is to present the eight-year ragweed pollen monitoring data from Bucharest, to place them in the context of local air pollution, public health regulations and available data on the health impact of ragweed pollen in the urban environment. Our pollen data were correlated with major air pollutant concentrations and with meteorological factors in a recently published local paper and the clinical data of patients with ragweed-induced respiratory symptoms were collected and published in 2019. The ragweed pollen monitoring data, correlated with field data reported by patients and plant specialists confirm the rapid spread of Ambrosia in the Bucharest city area, in addition to some stringent environmental local problems due to air pollution. The number of patients addressed to allergists almost doubled from one year to another, confirming the real alarming health impact of this environmental hazard. Our study confirms the need for more coherent strategies to control ragweed spread, based on application of existing local and international regulations, air pollution control and evaluation of consequences on human health.
Air Pollutants , Air Pollution , Air Pollutants/analysis , Air Pollution/adverse effects , Allergens/analysis , Ambrosia , Humans , Pollen
Eosinophilic gastroenteritis (EGE) is a subgroup of the eosinophilic gastro-intestinal disorders (EGIDs), characterized by eosinophilic infiltration and chronic inflammation of the gastrointestinal tract. These are rare diseases with still incompletely elucidated causes and mechanisms, with frequently delayed diagnosis and variable outcome. Despite increased interest in eosinophilic diseases in recent years, fewer data have been published on EGE and no standardized diagnostic and therapeutic approach exists. This paper reports the case of a young male patient diagnosed with EGE in 2017 based on clinical and histopathological criteria and constantly monitored during five years. Besides gastrointestinal eosinophilic infiltration, biopsies also revealed eosinophilic infiltration of the oesophagus, despite no declared characteristic oesophageal symptoms. We found increased specific IgE to multiple foods and progressive blood hypereosinophilia which preceded EGE diagnosis by three years. The EGE management included selective dietary restrictions and pharmacologic therapy based on daily budesonide non-enteric coated tablets, proton pumps inhibitors, antihistamines, cromoglycate, correction of iron, calcium and vitamin D deficiencies. The clinical outcome was good, while blood eosinophilia and endoscopic appearance remained almost unchanged. After one year the patient complained of respiratory symptoms suggesting asthma, needing continuous combined inhaled therapy. The reported case is illustrative for complex presentation, diagnosis and outcome of a rare case of mucosal chronic EGE associated with oesophageal involvement, peripheral eosinophilia, multiple food allergies and asthma.
Introduction Vaccination is the most important confirmed tool that can stop the ongoing coronavirus disease 2019 (COVID-19) pandemic, but the vaccination rate remains low in some countries, including Romania, despite consistent and undoubtedly scientific proof of this disease-prevention method. The risk of allergic reactions after COVID-19 vaccines may be a reasonable cause for the antivaccination attitude of people with a history of allergies or who consider themselves at risk for having severe allergic reactions after vaccination. Objective Our paper aims to analyze the role of allergist advice in getting people with a history of allergies to trust and accept COVID-19 vaccines and to evaluate the real risk of allergic reactions to these vaccines in this population. Method We performed a retrospective study of patients who asked for allergist advice from our hospital before getting one of the COVID-19 vaccines and who received a consultation either through phone call or online or have been admitted for hospital evaluation in 2021. Results More than 300 calls and 100 online consultations for COVID-19 vaccination-related allergist advice were done in our center within one year. From the total number of 210 people who were evaluated based on a one-day hospital stay in the Allergology department, 64 patients (30.47%) have been scheduled for evaluation before vaccination because of their past or recent medical history of allergies. Nine patients had documented post-vaccination adverse events, which occurred after the first dose in seven cases, after the second dose in one case, and after the booster in one case. The reactions were mild but one was moderate. No patient was considered to have a contraindication or special precaution for COVID-19 vaccination, and all patients with reactions after the first dose could safely complete the vaccination scheme. Conclusion In conclusion, allergist advice and evaluation can significantly influence the decision to vaccinate in patients with a history of allergies.
Mast cells are granulocytic immunomodulatory cells with an important role in physiologic and pathogenic processes due to their location at the junction between the internal and external environment and to their capacity to release a broad range of active mediators. Mast cells mediators have both pro-inflammatory and anti-inflammatory activities and are implicated in various and complex pathology. Mast cells disorders (MCDs) represent a heterogeneous pathology, with frequently difficult and challenging evaluation and diagnostic workup. MCDs can be primary, secondary to other diseases, or idiopathic. Increased research interest in this field was noted during the last decade and various classification criteria, as well as diagnostic and treatment recommendations, were proposed. The aim of this paper is to review the most recent published data on the classification and evaluation of mast cells disorders and to point out the main difficulties in diagnosing and managing these complex diseases in medical practice.
Biologic therapy is recommended by Global Initiative for Asthma (GINA) guidelines in asthma patients not controlled with maximal inhaled therapy corresponding to GINA step 4. Omalizumab is an anti- immunoglobulin E (IgE) monoclonal antibody and the first biological available for the add-on treatment of severe allergic asthma, approved by Food and Drug Administration (FDA) in 2003. Diagnosing and managing asthma patients during coronavirus disease 2019 (COVID-19) pandemic since early 2020 has been challenging, mainly due to the risk of contracting COVID-19 disease and to the limited access to hospital care and pulmonary function tests. We report a case of a 52-year-old female patient, diagnosed with adult-onset asthma in 2018, who was first referred to the Allergy Department of our hospital in January 2019 for dyspnea, wheezing, and worsening cough. Despite continuous inhaled therapy and good inhalation technique, she had frequent asthma symptoms, requiring short courses of oral corticosteroids (CS). Physical examination and pulmonary function tests on admission revealed broncho-obstructive syndrome and laboratory tests showed mild inflammation and high total serum IgE. She continued to have two moderate-severe exacerbations after stepping up to maximal inhaled therapy plus oral montelukast and theophylline, according to GINA step 4. By the end of 2019, we additionally started omalizumab, which resulted in prompt clinical benefits and resolution of asthma symptoms. Given the ongoing COVID-19 pandemic limiting in-person visits, virtual follow-ups indicated adequate control of his symptoms, as proved by asthma control test and no need for hospital presentation.
Introduction Respiratory allergies represent an important public health problem, with increasing prevalence and severity in Europe during the last decades. The rise of pollen allergies is an issue that continues to negatively impact people's daily lives across the globe and has become more important in the light of global warming and increasing air pollution. The aim of our paper is to evaluate the prevalence of declared atopy and the influence of lifestyle on allergic diseases, particularly on pollen allergies, in the urban environment from Romania. Methods The study is based on the cooperation Interactive Qualifying Project (IQP) called "Pollen Allergies in Romania: Optimizing Data Analysis in Raising Awareness", agreed and carried on between a group of North-American students and teachers from Worcester Polytechnic Institute and a hospital-based allergy team from Carol Davila University of Medicine and Pharmacy and Colentina Clinical Hospital from Bucharest. The project aimed to evaluate the prevalence of atopy and lifestyle practices of allergic patients and to develop a data analysis tool to determine correlations between pollen counts and other environmental factors in the city of Bucharest. Results The lifestyle survey revealed that about one-third of allergic patients declared history of atopy. Some of the declared lifestyle practices can be considered environmental risk factors for allergies. This IQP can be considered a model of international, interdisciplinary and intercultural collaboration. Conclusion We concluded that Romania is facing an increasing pollen allergies trend and some actual lifestyle aspects can significantly influence the risk of pollen allergies in the big city environment.
Colorectal carcinoma represents a major cause of mortality and 0.2-12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.
Adenoma , Colonic Polyps , Colorectal Neoplasms , Adenoma/pathology , Colonic Polyps/pathology , Colonic Polyps/surgery , Colonoscopy , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Humans , Intestinal Polyps/surgery , Retrospective Studies
Mast cell activation syndromes (MCAS) represent a heterogeneous clinical entity caused by episodic and severe mast cell activation, including primary and secondary mast cell disorders (MCDs). The group of primary or clonal MCDs refers to systemic mastocytosis, other clonal MCAS and hereditary hypertryptasemia, while the secondary MCAS is characterized by normal mast cells (MCs) which are activated by external triggers, such as allergens or physical stimuli. Another category of MCAS is the idiopathic form, when no trigger or genetic mutation can be identified. Symptoms of mast cell activation are due to release of specific mediators and can be seen in many diseases, such as allergies, with localized or systemic clinical manifestations. Confirmation of MCAS is based on diagnostic criteria proposed by an international group of experts and the best available evidence in this field. It is generally accepted that the clinical picture of MCAS is non-specific and there are few available laboratory tools, making it difficult for clinicians to identify and confirm this entity. The diagnosis is established after exclusion of other possible clinical entities in most of the cases. Therefore, the actual diagnostic criteria of MCASs, some relevant clinical aspects and laboratory tools used in clinical practice were reviewed.
According to recent data, psoriatic patients have an increased prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome, compared with the general population. In some published studies, the severity and presence of psoriasis disease were correlated with the severity of NAFLD. In the current study, we aimed to compare the sensibility and specificity of the non-invasive scores and liver biopsy in determining fibrosis in patients with NAFLD and moderate to severe psoriasis. We performed the scientific research from June 2014-December 2017 and we included 71 patients: 40 patients with NAFLD and 31 patients with moderate to severe psoriasis according to Psoriasis Area and Severity Index (PASI) score and NAFLD, who received Etanercept treatment for at least one year. Based on the clinical and laboratory data, we calculated the following scores for fibrosis: body mass index (BMI), aspartate aminotransferase (AST)∕alanine aminotransferase (ALT) ratio, diabetes (BARD) score, Fibrosis-4 (FIB-4) score, and NAFLD fibrosis score (NFS). For liver biopsy, we used the Menghini technique. By calculating Kendall's test, we also observed a strong direct correlation between the degree of fibrosis and FIB-4 (tau=0.558) and NFS (tau=0.490) scores, with a critical statistical impact, and the lack of a correlation with the BARD score (tau=0.095; p=0.332). The hepatic biopsy allowed the more accurate establishment of the role of the non-invasive tests in the diagnosis of the lesions of steatosis, steatohepatitis, and hepatic fibrosis. The non-invasive tests are most useful for the exclusion of the evolution lesions and for the confirmation of the advanced stages of the disease. Among these, the NFS score proved a high statistically significant correlation (p<0.0001) with the fibrosis histological lesions.
Liver Cirrhosis/etiology , Liver Cirrhosis/physiopathology , Non-alcoholic Fatty Liver Disease/physiopathology , Psoriasis/physiopathology , Female , Humans , Male , Middle Aged
Eosinophilic disorders represent a group of pathologic conditions with highly heterogeneous pathophysiology and clinical presentation and variable prognosis, ranging from asymptomatic or mild, to severe and complex cases, with fatal outcome. Interest in this group of disorders has increased during the last two decades, with consistent progress made regarding understanding of molecular mechanisms, refining of diagnostic criteria, classification and evaluation of therapeutic options. There are still many gaps and difficulties in evaluating eosinophilic syndromes and diseases in medical practice. The disease prognosis depends mainly on the cause and mechanism of eosinophilia, on severity of organ dysfunction and on accurate diagnosis and response to treatment. Besides primary hypereosinophilic syndromes and secondary (reactive) eosinophilias, many associated or idiopathic forms have been described, making this topic a complex and difficult medical entity. An important aim of the experts in the field is to agree upon a more clear and practically useful classification, a better characterization of various phenotypes and endotypes of eosinophilic diseases and to identify novel biomarkers and more effective therapies. The aim of this paper is to review recent data from the literature regarding definition, classification and diagnosis criteria of eosinophilic diseases and to propose a revised and updated diagnostic algorithm useful in clinical practice.
Background and objectives: Respiratory allergies induced by allergenic pollen represent an important public health problem with increasing prevalence and severity in Europe. Romania has no aerobiology network and pollen measurements have been done for about ten years in the west region only. Materials and Methods: We established the first pollen monitoring center in the capital of Bucharest in 2013, based on collaboration with the Réseau National de Surveillance Aérobiologique (RNSA) from France. The aim of our paper is to present results from five years of pollen monitoring in the city center of Bucharest and preliminary data on distribution and health impact of some allergenic plants, mainly Ambrosia artemisiifolia, which is considered a real danger for the public health. Results: Our data show a significant atmospheric amount and a longer season than previously considered of grass (Gramineae) pollen and short period with a high level of Ambrosia pollen, while tree pollen looks less important in this area. The plant distribution data provided by specialists and information from affected persons showed the wide and increasing spread of Ambrosia in Bucharest and other cities from the south region. Preliminary health data from allergists confirmed that the number of patients with allergies to Ambrosia pollen is increasing from one year to another and almost all patients describe a high urban exposure from their living or working place. Conclusions: We consider that the recently implemented Law 62/2018 against Ambrosia may help reduce weed distribution and the atmospheric pollen load, but a more complex and coordinated strategy for controlling urban vegetation and reducing biologic pollution is needed.
Health Impact Assessment/methods , Pollen/microbiology , Allergens , Data Analysis , Humans , Romania , Seasons
BACKGROUND: Angioedema due to acquired deficiency of C1-inhibitor (C1-INH-AAE) is a rare disease sharing some clinical and laboratory similarities with hereditary angioedema, but with late onset and no positive family history. The underlining cause may be malignant or due to autoimmune diseases, but some cases remain idiopathic. CASE PRESENTATION: We report a case of a 75 year old woman suffering from recurrent episodes of angioedema since the age of 66, considered first induced by treatment with angiotensin-converting-enzyme inhibitors (ACEI). She continued to have angioedema attacks during 6 years after discontinuation of ACEI, until evaluation in our clinic in 2014, when C1 inhibitor esterase (C1-INH) deficiency was confirmed. The extended medical evaluation for inflammatory, allergic, autoimmune and neoplasic diseases was negative. C1-INH and complement fraction C4 plasma levels were significantly decreased at all measurements, but no diagnostic criteria for diseases known to induce C1-INH deficiency could be found. We first initiated daily prophylactic treatment with tranexamic acid, with no amelioration after 3 months. During the last and most severe attack, with the first facial and laryngeal edema, we have switched to attenuated androgen danazol. The evolution was very good, with prompt remission of angioedema and significant increase of C1-INH and C4 plasma levels after 2 weeks of daily danazol use. She completed 3 years of continuous treatment with low daily maintenance dose of danazol (ongoing), with no angioedema attack. We closely monitored C1-INH and C4 plasma levels, possible danazol side effects and any signs suggesting late onset of C1-INH deficiency causal disease. CONCLUSION: We reported a particular case of rare angioedema due to acquired deficiency of C1-inhibitor, which has no clear cause after long follow-up, but good response to attenuated androgen. We concluded that the awareness of angioedema due to C1-INH deficiency should be increased within medical community and therapeutic options should be more clearly indicated and available for all diagnosed cases.
INTRODUCTION: Respiratory allergies induced by allergenic plants pollen represent an important public health problem with increasing prevalence and severity. Aerobiologic study of allergenic pollens is performed in many countries on regular basis and correlated with health data from allergists in the frame of national aerobiology networks. Romania has no aerobiology network and pollen measurements have been done between 1999-2012 in West region only. In the frame of COST Action called Sustainable management of Ambrosia artemisiifolia in Europe (SMARTER FA 1203), three years collaboration with Reseau National de Surveillance Aerobiologique (RNSA) from France and the first pollen monitoring center in Bucharest were established.The aim of this paper is to present results of first pollen monitoring in Bucharest, activities of Romanian SMARTER group and collaboration with European aerobiology specialists. MATERIAL AND METHOD: We used a Hirst-type pollen trap placed on the roof of the Research Center from "Colentina" Clinical Hospital and the pollen monitoring method based on European Aeroallergen Network (EAN) standardized requirements. Monthly results during the pollen seasons 2014-2016 were sent to RNSA and EAN and posted on the European pollen information site. RESULTS: We found high amounts of allergenic pollen, mainly grasses from May to September and Ambrosia artemisiifolia during September. Conlcusions. We concluded that SMARTER offered access to aerobiology training, improved multidisciplinary collaboration and perspectives to further develop national and international projects. More coordinated efforts to develop national aerobiology network and to recuperate the gap comparing to other European countries in the field of aerobiology and respiratory allergology are needed.
Allergens/analysis , Environmental Monitoring/methods , Pollen , Ambrosia/immunology , Antigens, Plant/analysis , Antigens, Plant/immunology , Artemisia/immunology , Europe , Humans , Plant Extracts/analysis , Plant Extracts/immunology , Poaceae/immunology , Romania , Seasons , Trees/immunology
Allergic diseases represent an important health problem in the most of developed countries, due to continuous increasing prevalence, with significant individual and social consequences. Allergic diseases may raise serious problems in clinical practice, derived from complexity of clinical forms and mechanisms and from rising incidence of severe cases, with high fatality risk. Taking into consideration the dramatic increase of all allergies forms during the last decades, they are considered a real "epidemic" of the XXIst century, being classified by the World Health Organization as the fourth most frequent chronic diseases. The European authorities pay more attention to allergic diseases in last years and discuss the actual situation of the allergology specialty in different countries, with the aim of harmonization and improvement of medical assistance in this field. The aim of this paper is presentation of some relevant aspects of allergology specialty and practice in our country in the actual European context, mainly unmet needs and difficulties, taking into consideration recommendations and priorities recently issued by European authorities. We hope for a better recognition of the specialty and improved interdisciplinary collaboration.
Allergy and Immunology/organization & administration , Hypersensitivity/therapy , Allergy and Immunology/education , Europe , Humans , Societies, Medical
Eosinophils are innate immune leukocytes recruited in large numbers to sites of allergic inflammation and parasitic infections. Recent studies show additional pleiotropic effects of recruited eosinophils impacting immunomodulation, tissue homeostasis and repair. Pathologic conditions accompanied by blood eosinophilia are quite frequent in medical practice and may raise serious differential diagnosis problems in severe cases, that require a multidisciplinary approach. Hypereosinophilia may be reactive to other diseases or primary, representing hypereosinophilic syndromes, that are diagnosed based on clinical and laboratory criteria, according to actual international guidelines. The etiopathogenic diagnosis is difficult and delayed in many cases and clinical evolution may be- severe, with multiorgan involvement and poor prognosis. Some cases remain idiopathic, despite exhaustive investigation.This paper aims to review the most recent data in the literature referring to the role of eosinophils in human pathology, diagnostic criteria and treatment strategies of hypereosinophilic syndromes, actual classification and to draw some useful recommendations in clinical practice.
Hypereosinophilic Syndrome/etiology , Hypersensitivity/immunology , Humans , Hypereosinophilic Syndrome/diagnosis , Hypereosinophilic Syndrome/therapy , Parasitic Diseases/immunology , Prognosis
INTRODUCTION: Recent data from literature have shown many difficulties in managing allergic diseases in primary care in most countries and a consequently clear need for standardized educational programmes. Drug allergies represent an important medical issue for general practitioners (GPs) in Romania, though no national data about incidence, severity and management exist.The aim of our study was to evaluate epidemiological aspects of drug allergies in primary care practice in Bucharest, especially the diagnostic and therapeutic attitudes of family doctors and their need for education and training in this field of pathology. FINDINGS: A questionnaire with 21specific questions was addressed to 800 family doctors from Bucharest, either directly or via internet, with a response rate of 31,87%.The answers showed a significant interest of GPs in drug allergies, which are considered an increasing pathology. Almost half of the responders had never attended any form of education in allergology and 96% expressed a clear interest to participate in specialized educational programmes. We have noticed an underestimation of the severity of drug allergy, a surprisingly high percentage of allergy skin tests or blood tests recommended by GPs without specialist advice, and persistant confidence in alternative medicine. CONCLUSIONS: We concluded that the attitude towards and the competence regarding drug allergies of GPs in this study, as well as their collaboration with allergists, are not standardized and updated according to current guidelines. Further educational programs for GPs in drug allergies, based on standardized guidelines and national epidemiological studies for evaluation of drug allergy-related morbidity and mortality are needed.
