Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study.

BACKGROUND: Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach. OBJECTIVE: To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach. METHODS: Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed. RESULTS: Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers. CONCLUSIONS: In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.

Hypersensitivity reactions to COVID-19 vaccines: a case of Eosinophilic pneumonia following Sinovac/CoronaVac vaccination.

Summary: Hypersensitivity reactions has been reported with COVID-19 vaccines. Acute eosinophilic pneumonia has not been reported yet after Sinovac/CoronaVac vaccine. A 73-year-old woman presented with maculopapular rash, cough and dyspnea following Sinovac/CoronaVac injection. The complete blood count (CBC) indicated eosinophilia and further evaluation of the eosinophilia with CT and bronchoscopy confirmed a diagnosis of acute eosinophilic pneumonia. After methylprednisolone therapy, her rash resolved with marked improvement of the dyspnea. She is still on treatment and on the follow up period, we plan to continue steroid treatment at least 3 months.

Evaluation of Brain Volume Changes by Magnetic Resonance Imaging in Obstructive Sleep Apnea Syndrome.

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate potential morphological changes in the brain tissue of patients with severe obstructive sleep apnea syndrome (OSAS) in comparison with normal subjects by using T1-weighted magnetic resonance imaging (MRI) technique. MATERIAL AND METHODS: This study comprised subjects with severe OSAS with an apnea-hypopnea index (AHI) more than 30 and normal subjects with AHI less than 5 according to polysomnography findings. The study subjects were evaluated using Three Dimensional Magnetization Prepared Rapid Acquisition Gradient Echo sequence on T1-weighted MRI. FreeSurfer morphometric procedure was used as the automated segmentation method and in both cerebral and cerebellar hemsipheres and segmental volumes of brain were analyzed. RESULTS: Of the 22 patients with severe OSAS, 19 were male, three were female and their ages ranged between 40 and 60 years (mean age 50.27 ± 5.3 years). Of the 22 control subjects 19 were male, three were female and their ages ranged between 40 and 60 years (mean age 49.36 ± 6.95 years). There were no statistically significant differences in terms of age and sex properties between the groups. There was a statistically significant difference in BMI between the OSAS patients and the control group. There were statistically significant differences in polysomnographic features (time elapsed below 90% SaO2 (min), Epworth Sleepiness Scale, AHI, mean minimum SaO2 (%), mean O2 desaturation (%), and arousal index values) between the OSAS patients and the control group. CONCLUSIONS: The findings of our study indicated that even if severe, no structural changes occur in the course of mild, moderate, and severe OSAS.

Comparison of inflammatory cytokine release from nasal epithelial cells of non-atopic non-rhinitic, allergic rhinitic and polyp subjects and effects of diesel exhaust particles in vitro.

BACKGROUND: Although studies have reported an association between air pollutants and increased allergic airway diseases, such as allergic rhinitis and nasal polyposis, the underlying mechanisms are not fully understood. A limited number of studies have suggested that diesel exhaust particles (DEP) play a role in atopy and the pathogenesis of allergic upper airway diseases. The aim of this study was to investigate the effect of DEP on inflammatory cytokine release, and mRNA expression of transcription factors such as JNK and NF-ß in primary nasal epithelial cells (NECs), in vitro. METHODS: NECs from non-atopic, non-rhinitic subjects (controls) and patients with allergic rhinitis and nasal polyps were cultured and incubated with 0-100µg/ml DEP for 24h. ELISA and RT-PCR were used to assess the release of IL-8, GM-CSF, and RANTES, and mRNA expression for JNK and NF-κB, respectively. RESULTS: Compared to control cells, NECs from subjects with atopic polyps released significantly greater amounts of IL-8 (median=887 vs. 176.6pg/µg cellular protein; p<0.0001) and RANTES (median=0.191 vs. 0.02pg/µg cellular protein; p<0.001). While 50µg/ml DEP induced release of RANTES in NECs from patients with allergic rhinitis, 100µg/ml DEP decreased IL-8 levels in NECs from both control and allergic rhinitic subjects. DEP did not affect mRNA expression for JNK and NF-κB from NECs of subjects with polyps. CONCLUSIONS: NECs from subjects with various pathologies may respond differently to DEP.

Association between asthma self-management knowledge and asthma control in the elderly.

BACKGROUND: Considerable evidence points to the importance of patient education in achieving better asthma control. However, little is known about the effect of older adults' asthma knowledge on asthma control. OBJECTIVE: To identify the relation between asthma self-management knowledge and short-term asthma control in older adults. METHODS: The study included 82 patients with asthma undergoing usual asthma care who were interviewed by the same trained allergist. At the same time, the authors conducted an asthma knowledge questionnaire, an Asthma Control Test, skin prick testing, spirometry, and evaluation of inhaler device technique. The Turkish version of the asthma knowledge questionnaire was administered to all participants in face-to-face interviews. The relation between asthma knowledge and asthma control was tested by regression analysis. RESULTS: The education level was below the secondary level in 79% of patients; 59% of patients were obese; and 44% of patients had mild, 41% had moderate, and 5% had severe persistent asthma. The atopy rate was 21%. The most common sensitization was to Dermatophagoides pteronyssinus. Fifty-two percent of patients had uncontrolled asthma; 22 patients showed proper use of the inhaler device. Forty patients (48%) had limited asthma knowledge. The main source of asthma knowledge was from physicians for 81% of patients. There was no significant association between patients' asthma knowledge and asthma control level (P = .991). CONCLUSION: Knowledge of asthma was very low in elderly patients and usual asthma care was largely insufficient. These findings suggest that asthma education programs should be developed for older adults based on their education level and clinical asthma characteristics.

Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey.

BACKGROUND: No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. METHODS: This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. RESULTS: Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. CONCLUSION: Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.

Storage mite sensitisation is associated with early life village residence in Turkey.

BACKGROUND: Storage mites (SMs) occur in house-dust and the rate of sensitisation to them is high. We aimed to investigate if past and current living conditions are associated with the risk of SM sensitisation. METHODS: In total, 321 patients (70% females) aged 33.6 ± 11.9 years (range: 14-68 years) were studied at our allergy unit between September 2009 and December 2010. Patients with persistent or intermittent rhinitis and/or asthma were included in the study. Skin prick tests (SPTs) for SMs (Lepidoglyphus destructor, Tyrophagus putrescentiae, and Acarus siro) and other common aeroallergens were performed. Demographic data and characteristics of the patients' homes were assessed via a questionnaire. RESULTS: In all, 102 (31.8%) patients were sensitised to ≥ 1 SM, of whom 43.1% were also sensitised to Dermatophagoides pteronyssinus. Comparison between the SPT-negative group (n = 129) and the SM-positive only group (n = 33) showed that having lived in a village during the first years of life was associated with SM sensitisation. Current place of residence was not significantly associated with any of the study variables. CONCLUSIONS: Living conditions have been changing and SM sensitisation may be associated with a history of village residence. The high rate of SM sensitisation observed in the study population might indicate the necessity of including those mite species in SPT panels, but the clinical relevance of sensitisation remains unclear. The clinical importance of SM sensitisation in urban areas should be investigated further.

Determining safe alternatives for multidrug hypersensitive patients with the alternative triple antibiotic-analgesic test.

BACKGROUND: Drug provocation tests (DPTs) need technical equipment, staff and time. There are very few allergy centres performing DPTs in Turkey. Therefore many patients are referred to these centres. One day triple-double antibiotic or non-steroidal anti-inflammatory drug (NSAID) oral DPT for determining safe alternatives is safe, cost-effective and time saving compared to conventional one day one drug oral DPT. Our aim was to investigate the safety of antibiotic-NSAID oral DPT performed on the same day to find safe alternatives in multidrug hypersensitive patients. METHODS: Forty-two patients who had been diagnosed as having both antibiotic and NSAID hypersensitivity were enrolled to the study between 15 November and 15 July 2010. The reactions were urticaria and/or angio-oedema not including laryngeal oedema for all patients. Two antibiotics-one NSAID or two NSAIDs-one antibiotic triple test have been performed on the same day to study patients (n=22), while the control group (n=20) had taken drugs on three separate days. RESULTS: Only two patients had positive reactions during triple test and two patients had adverse reactions; one had gastric pain, one had nausea. Three patients in the control group had positive reactions. There were no significant differences between the two groups in frequency of adverse and allergic drug reactions (p>0.05). Sixty days were spent for the tests of the control group with only 28 days for the study population. CONCLUSION: Triple test performed with antibiotic and NSAID on the same day for determining safe alternatives for multidrug hypersensitive patients reporting non-life-threatening allergic reactions seems to be safe and time-saving.

Prediction of atopy by skin prick tests in patients with asthma and/or persistent rhinitis.

BACKGROUND: Patient history gives important clues about the likelihood of atopy. However, the accuracy of assessment of atopy based on detailed allergy history is low. The objective of this survey was to determine the successful prediction rate of atopy by a questionnaire and the effect of various factors on the successful prediction. METHODS: A standard questionnaire including detailed allergy history was filled in by two experienced allergists for 169 patients having bronchial asthma and/or persistent rhinitis symptoms. Skin prick test (SPT) results were predicted based on the clinical data obtained by a questionnaire. Final diagnosis was made after SPT. Sensitivity and specificity analysis of SPT results prediction was investigated using two different cut-off values (3mm and 5mm) for positive tests, and factors associated with successful atopy prediction were analysed. RESULTS: SPT was predicted to be positive in 42.6% and was positive in 36.1%. Depending on SPT results with the cut-off value 3mm, prediction sensitivity was 77%, specificity was 65.3%, positive predictive value was 65%, and negative predictive value was 86%. Successful positive atopy prediction was associated with age; true negative prediction was also associated with age and high education. With the threshold of 5mm for a positive test, sensitivity, specificity, positive and negative predicted values were 91%, 61%, 14% and 99%, respectively. CONCLUSION: It seems that the success rate of detailed history is high for negative prediction. However, detailed history alone does not seem to be efficient for atopy prediction.

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.