Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled?

OBJECTIVE: The older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey. METHODS: The data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire. RESULTS: Of the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma. CONCLUSIONS: Herein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors.

Stepwise Approach in Asthma Revisited 2023: Expert Panel Opinion of Turkish Guideline of Asthma Diagnosis and Management Group.

Introduction of inhaled corticosteroids (ICS) has been the cornerstone of the long-term management of asthma. ICSs either alone or in combination with long-acting beta-2 agonists have been shown to be associated with favorable asthma outcomes. However, asthma control is still reported to be below expectations all around the world. Research in the last decades focusing on the use of ICS/formoterol both as maintenance and as needed (maintenance and reliever therapy approach) showed improved asthma outcomes. As a result of recent developments, Turkish Asthma Guidelines group aimed to revise asthma treatment recommendations. In general, we recommend physicians to consider the risk factors for poor asthma outcomes, patients' compliance and expectations and then to determine "a personalized treatment plan." Importantly, the use of short-acting beta-2 agonists alone as a symptom reliever in asthma patients not using regular ICS is no longer recommended. In stepwise treatment approach, we primarily recommend to use ICS-based controllers and initiate ICS as soon as possible. We define 2 different treatment tracks in stepwise approaches as maintenance and reliever therapy or fixed-dose therapy and equally recommend each track depending on the patient's risks as well as decision of physicians in a personalized manner. For both tracks, a strong recommendation was made in favor of using add-on treatments before initiating phenotype-specific treatment in step 5. A strong recommendation was also made in favor of using biologic agents and/or aspirin treatment after desensitization in severe asthma when indicated.

Adverse effect of VEGFR-2 (rs1870377) polymorphism on the clinical course of COVID-19 in females and males in an age-dependent manner.

The COVID-19 pandemic has affected people worldwide with varying clinical presentations ranging from mild to severe or fatal, and studies have found that age, gender, and some comorbidities can influence the severity of the disease. It would be valuable to have genetic markers that might help predict the likely outcome of infection. For this objective, genes encoding VEGFR-2 (rs1870377), CCR5Δ32 (rs333), and TLR3 (rs5743313) were analyzed for polymorphisms in the peripheral blood of 160 COVID-19 patients before COVID-19 vaccine was available in Türkiye. We observed that possession of the VEGFR-2 rs1870377 mutant allele increased the risk of severe/moderate disease in females and subjects ≥65 years of age, but was protective in males <65 years of age. Other significant results were that the CCR5Δ32 allele was protective against severe disease in subjects ≥65 years of age, while TLR3 rs5743313 polymorphism was found to be protective against severe/moderate illness in males <65 years of age. The VEGFR-2 rs1870377 mutant allele was a risk factor for severe/moderate disease, particularly in females over the age of 65. These findings suggest that genetic polymorphisms have an age- and sex-dependent influence on the severity of COVID-19, and the VEGFR-2 rs1870377 mutant allele could be a potential predictor of disease severity.

Picturing asthma in Turkey: results from the Turkish adult asthma registry.

INTRODUCTION: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Amoxicillin/Clavulanic Acid-Induced Symmetric Drug-Related Intertrigious and Flexural Exanthema.

ß-Lactams, particularly penicillins, may cause several allergic reactions. We described symmetric drug-related intertriginous and flexural exanthema (SDRIFE) illness in this case, a rare instance of systemic contact dermatitis caused by amoxicillin/clavulanic acid that needs to be considered in the differential diagnosis. A 65-year-old male patient was admitted to our Allergy Outpatient Clinic because of increased blue-purple pigmentation on the flexural surfaces of the hip, forearm, axilla, and posterior face of the neck. The patient was receiving a combination of angiotensin receptor blocker (ARB) and hydrochlorothiazide diuretic medication for hypertension. The patient used an antibiotic containing amoxicillin three months ago; As a result, there was localized redness, itching, and black spotting without any systemic symptoms. Similarly, the patient reported that when he used amoxicillin for an upper respiratory tract infection eight months ago, he experienced similar side effects within 20 days and recovered when he applied corticosteroid ointment. Due to the symmetrical site involvement following the consumption of penicillin group antibiotics with a five-month gap and subsequent comparable reactions in our patient, SDRIFE was taken into consideration. The results of the skin punch biopsy identified Baboon Syndrome (SDRIFE). Treatment with topical corticosteroids and antihistamines began. Clinically speaking, SDRIFE is distinguished by significant erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area, symmetric involvement of at least one other intertriginous or flexural area, and the absence of systemic signs or symptoms. The possibility that the medication may have contributed to the patient's erythematous eruption in the flexural regions should be taken into account, and the patient should be advised to stop taking the medication and not use it again.

Anaphylaxis After Consumption of Guar Gum-Containing Food: A Report of Two Cases.

Guar gum is a food additive that acts as a thickening agent. Although the relationship between guar gum and occupational rhinitis/asthma has already been established, only very few cases of anaphylaxis were associated with guar gum ingestion. We present two examples of anaphylaxis induced by guar gum. Both cases were successfully treated with adrenaline. Moreover, serum-specific immunoglobulin E (IgE) with the culprit agent was detected in blood samples. To the best of our knowledge, here we present the first case of class 6 guar gum-specific IgE-positive anaphylaxis. This report aims to raise awareness of rare food additive allergies such as guar gum.

Does serum leptin levels differ between patients with rhinitis of allergic versus nonallergic aetiology?

BACKGROUND: Leptin may play a critical role in airway inflammation. However, it has rarely been evaluated in rhinitis with different aetiology. This study aimed to compare the serum leptin levels between allergic rhinitis (AR) and nonallergic rhinitis (NAR). METHODS: Patients with chronic rhinitis were classified due to skin prick (ALK-Abello/Madrid) and/or serum-specific immunoglobulin E tests (UniCAP 100-Pharmacia), against to aeroallergens if concordant with symptoms. RESULTS: A total of 398 patients with a mean age of 29.03 years were recruited and grouped as AR and NAR. Mean serum leptin levels were similar in patients with NAR and AR, as well as in patients with and without asthma, but were significantly higher in females than males in both groups. Also, leptin levels were significantly higher in obese than nonobese patients in AR. In correlation analysis, leptin levels were found to be correlated with female gender, older age, and high body mass index (BMI) in the whole group. Despite the higher total nasal symptom score (TNSS) in patients with AR compared with NAR, there was no association of leptin levels with TNSS, severity and seasonality of symptoms, and allergen sensitization. In logistic regression analysis, younger age and high serum leptin levels were found to be independent predictors for the diagnosis of AR. CONCLUSIONS: We conclude that female patients with high BMI are more prone to AR probably due to immunological effects of adipose tissue, in addition to hormonal factors. This study showed that leptin measurement has limited value as a sole diagnostic tool to differentiate AR and NAR.

Change in Allergy Practice during the COVID-19 Pandemic.

BACKGROUND: International guidelines in asthma and allergy has been updated for COVID-19 pandemic and pandemic has caused dramatic changes in allergy and immunology services. However, it is not known whether specialty-specific recommendations for COVID-19 are followed by allergists. OBJECTIVES: By conducting this study, we aimed to determine the attitudes and experiences of adult/pediatric allergists on allergy management during COVID-19. METHOD: We used a 20-question survey to elicit data from allergists (residents and pediatric and adult allergists registered to the Turkish National Society of Allergy and Clinical Immunology) across Turkey via e-mail. We analyzed the data statistically for frequency distributions and descriptive analysis. RESULTS: A total of 183 allergists participated in the survey. Telemedicine was used for management of asthma (73%), allergic rhinitis (53%), atopic dermatitis (51%), chronic urticaria/angioedema (59%), drug hypersensitivity (45%), food allergy (48%), venom allergy (30%), anaphylaxis (22%), and hereditary angioedema (28%). Thirty-one percent of the respondents discontinued subcutaneous immunotherapy (SCIT) during the COVID-19 pandemic. Thirty-four percent of the physicians reported interruption of systemic steroid use in asthma patients, and 25% of the respondents discontinued biological therapy. CONCLUSIONS: Allergists in Turkey have been using telemedicine at a high rate during the COVID-19 pandemic for asthma and rhinitis. The continuation rate of SCIT was low while the discontinuation rate of biologicals and systemic steroid use in asthma was high in Turkey.Our study results and learning from the experiences of other countries and specialties may help to optimize allergy practice and compatibility with international guidelines.

Rationale for the autologous serum skin test in acute versus chronic urticaria.

INTRODUCTION: Autologous serum skin test (ASST) is a rapid, in-vivo clinical test to detect functional autoantibodies in patients with chronic spontaneous urticaria (CSU), but the rationale for its use in acute urticaria (AU) is unknown. AIM: To evaluate the efficacy of ASST among patients with AU or CSU. MATERIAL AND METHODS: Treatment-naïve adult (age ≥ 18 years) patients with a diagnosis of AU (< 6 weeks' duration) and CSU were enrolled prospectively in a cross-sectional study. Healthy age- and sex-matched subjects served as controls. Besides a detailed history and physical examination, ASST, total immunoglobulin E (IgE), freeT3 (fT3), freeT4 (fT4), anti-thyroglobulin, and anti-TPO levels were assessed in all subjects. RESULTS: Of 101 subjects, mean age was 34.35 ±12.68 years and the study comprised 58.4% of females with no difference between AU (n = 27), CSU (n = 46), and control groups (n = 28). The ratio of positivity in ASST was similar between AU (25.9%) and CSU groups (21.7%), but higher than in controls (10.7%, p = 0.33 for all). The ratio of patients with high total IgE levels (> 100 IU/ml) in AU (85.2%) and CSU (65.2%) groups was similar (p = 0.06), but significantly higher than in the control group (10.7%) (p< 0.001 and p< 0.001). The CSU group had significantly higher abnormal thyroid test results (45.7%) than AU (14.8%) and control groups (3.6%) (p = 0.01 and p< 0.001), whereas patients with clinically diagnosed thyroiditis were only in the CSU group (6.5%). In logistic regression analysis, there was no relation found among the possible risk factors for ASST, even if analysed separately as AU, CSU and control groups. CONCLUSIONS: Even though thyroid function test levels were found to be related with CSU, and total IgE was associated with urticaria, ASST was found to be of importance. This study confirms that ASST was insufficient to demonstrate autoimmunity and acute-chronic urticaria nature. Further tests indicating auto-antibodies in AU and CSU are needed.

Physicians' preference for controller medication in mild persistent asthma.

BACKGROUND: Although the asthma guidelines recommend inhaled corticosteroids(ICS) or leukotriene receptor antagonists-(LTRAs) for the treatment of mild persistent asthma, factors governing the physicians' preference are unknown. We aimed to investigate the preference of physicians for the controller medication and the factors governing their choice. METHODS: A self-administered questionnaire composed of 16 questions that aimed to determine the preference of the physicians for the first choice controller medication in mild persistent asthma and physician and patient related factors that may be associated with this selection was e-mailed to the members of the Turkish National Society of Allergy and Clinical Immunology and distributed to participants in the 21st congress. RESULTS: Of the 670 questionnaires, there were 51% participants and 336 of them were complete enough to be included in the analysis. Low dose ICS was preferred as the first choice controller medication for mild persistent asthma by 84.5% of the physicians. The reasons for physicians' preference were different for ICS and LTRA. In the logistic regression analysis, use of asthma guidelines (OR:3.5, 95%CI:1.3-9.3, p = 0.01), alignment in guidelines (OR:2.9, 95%CI:1.4-5.8, p = 0.002) and the opinion that it is a more effective (OR:2.3, 95%CI:1.1-4.8, p = 0.02) were independently associated with ICS preference. Being a pediatrician (OR:5.4, 95%CI: 2.7-10.5, p < 0.001) and the opinion that it has better patient compliance (OR:4.4, 95%CI: 1.6-12.0, p = 0.004) were independently associated with LTRA preference. CONCLUSION: Surveyed Turkish physicians, the majority of whom were specialists, preferred ICS over LTRA as controller medication in mild persistent asthma. Asthma guidelines, training background (pediatrician versus not) and perceived efficacy and patient compliance appeared to influence their preferences.

Survey of physicians' attitudes toward the use of magnesium sulfate for acute asthma exacerbations in Turkey.

BACKGROUND: Magnesium sulfate (MgSO4) is considered to be a well-tolerated, inexpensive, and effective medication for severe asthma exacerbations. We surveyed physicians who treat patients with asthma to evaluate the current knowledge and usage of MgSO4. METHODS: A self-administered questionnaire was e-mailed to members of the Turkish National Society of Allergy and Clinical Immunology and was distributed to participants of its annual congress. RESULTS: Of the 456 respondents (mean age: 36.53 ± 9.11 years), 42.3% reported to use MgSO4 in asthma exacerbations in their practice, and 48.7% agreed that MgSO4 was included in asthma guidelines. The best known indication was that it was useful only in patients refractory to bronchodilators and systemic corticosteroids (67.7%). The two most common reasons to use MgSO4 were to shorten hospital stay (94.7%), and prevent admission to intensive care unit (80.3%). The respondents mostly used MgSO4 in the treatment of severe or life-threatening exacerbations. Thirty-nine percent believed that MgSO4 had no effect on discharge period, and 29% of them marked minor side effects. The most common reason for not using MgSO4 was inexperience (36.5%). Having an academic affiliation (OR = 3.20, p < 0.001), the number of asthmatic outpatients seen per month (OR = 1.82, p = 0.007), and more recent graduation from medical school (≤1991) (OR = 0.23, p < 0.001) were associated with the use of MgSO4 in the multivariate analysis. CONCLUSION: Even though the effect of MgSO4 in acute severe asthma is well known, only half of the physicians dealing with asthma patients have used it in their practice. Education and encouragement in this regard are necessary.

The Prevalence of Allergic Diseases and Associated Risk Factors in School-Age Children and Adults in Erzurum, Turkey.

OBJECTIVES: Allergic diseases are a major public health problem, owing to their socioeconomic burden and high frequency. The aim of this study was to assess the prevalence and risk factors of allergic diseases in adults and children in the province of Erzurum. MATERIAL AND METHODS: Primary school students aged 11-12 years old filled out the International Study of Asthma and Allergies in Childhood (ISAAC) phase II questionnaire, and their parents filled out the European Community Respiratory Health Survey (ECRHS) questionnaire by themselves. We enrolled 494 questionnaires for ISAAC and 946 for ECRHS. RESULTS: The survey response rates were 91.8% for ISAAC and 87% for ECRHS. The frequencies of doctor-diagnosed asthma, allergic rhinitis, conjunctivitis, atopic dermatitis, and food allergy in children were 11.9%, 8.9%, 27.3%, 3.6%, and 6.5%, respectively. In adults, the rates of wheezing in the chest, accompanying shortness of breath, and wheezing in the absence of flu within the last 12 months were 8%, 8%, and 5.5%, respectively, whereas the rate of asthma attack in the last 12 months was 2.9%, the rate of asthma medication usage was 2.6%, and the frequency of allergic rhinitis was 1.6%. The determined risk factors for childhood were "duration of attending a nursery" for asthma (p=0.02, OR=2.51, 95% CI=1.14-5.53), "having ever been to a nursery" for atopic dermatitis (p=0.02, OR=3.83, 95% CI=1.24-11.8), and "a family history of rhinitis" for food allergy (p=0.01, OR=2.94, 95% CI=1.13-6-57). CONCLUSION: The prevalence of allergic diseases in children and adults in Erzurum was found to be lower than in studies conducted throughout Turkey and in western regions of the Country. Going to a nursery, the length of nursery education, and a family history of rhinitis were identified as the risk factors for allergic diseases in children. The identification of regional risk factors and taking preventive measures in this regard may provide a reduction in the incidence of allergic diseases.

Body composition in patients with stable chronic obstructive pulmonary disease: comparison with malnutrition in healthy smokers.

OBJECTIVE: Although malnutrition (body mass index (BMI)<18.5kg/ m(2)) has been associated with impaired health status in patients with chronic obstructive pulmonary disease (COPD), the effects of body composition (body fat and protein percentage) in patients with COPD have not been clearly demonstrated. MATERIALS AND METHODS: A total of 180 stable patients with COPD at the stages of moderate, severe, very severe, and 50 healthy subjects were included in this prospective study. All subjects underwent a clinical evaluation, spirometry tests, anthropometric measurements and blood analysis. RESULTS: Frequency of underweight was higher in COPD (11.7%) patients than the control group (8%). The frequency of underweight increased as the severity of COPD worsens. There was body decomposition (protein or fat depletion) in not only all underweight patients but also some normal/overweight COPD patients, as well as in the healthy subjects. Deterioration in FEV1 (L), and FEV1/FVC was more evident in underweight patients with protein and fat depletion compared to normal/overweight patients (p=0.004, and p=0.005). Inspiratory and expiratory respiratory muscle power was lower in under-weight patients with depletion than in normal/overweight patients (p=0.02, and p=0.01). DLCO and DLCO/VA were significantly lower in underweight patients than in normal/overweight patients (p=0.003, and p=0.004), they were also lower in normal/overweight patients with depletion than in normal/overweight patients with no depletion (p=0.01, and p=0.07). Normal/overweight patients with protein depletion had the most frequent number of exacerbations than others (p=0.04). CONCLUSION: These results show that the body decomposition is important in patients with COPD. Assessment of body composition should be a part of nutritional assessment besides BMI in patients with COPD.

Level of knowledge about anaphylaxis among health care providers.

INTRODUCTION: Level of knowledge about anaphylaxis was evaluated in health care providers by using a self-administered questionnaire. MATERIALS AND METHODS: A total of 1172 participants responded to the survey, and previously half of them had met a case with anaphylaxis with a highest rate in primary and a lowest rate in tertiary care (p= 0.005). RESULTS: 84.7% of participants answered the questions about the symptoms of anaphylaxis correctly. Although 62.6% of the group knew correctly anaphylaxis treatment steps, 44.7% of them agreed to administer epinephrine if they suspected of a subject with anaphylaxis. One third of the group indicated appropriate route of epinephrine administration. 85.2% of participants agreed to refer the patient to allergy clinic despite 33.7% of the group were unaware of where the nearest allergy clinic was. Only 20.3% of the respondents have heard about epinephrine auto-injector. CONCLUSION: Anaphylaxis was often diagnosed and managed inadequately, regardless of practice location, employment status and speciality in north-eastern Turkey.

Desmoplastic malignant mesothelioma.

Desmoplastic mesothelioma is a rare subtype of diffuse malignant mesothelioma. A 72-year-old woman from East Anatolia presented with chest pain. The images of body positron emission tomography revealed irregular, left pleural thickening involving mediastinal and diaphragmatic surfaces with hypermetabolic characterization. The diagnosis of desmoplastic malignant mesothelioma was confirmed by minithoracotomy and immunohistochemical staining with pan-cytokeratin, cytokeratin 5/6, calretinin, carcinoembryonic antigen, thyroid transcription factor-1, CD15, and HMB-45 on the biopsy specimen. This case is unique in terms of the reporting patient being from a nonendemic area for asbestos-related diseases and in terms of its rare histopathology.

Efficacy and safety of H1-antihistamines: an update.

H1-antihistamines are inverse agonists that combine with and stabilize inactive conformation of H1-receptors. Thus they interfere with actions of histamine at H1-receptors. They are widely used for treatment of allergic rhinitis, allergic conjunctivitis, urticaria, coughs, colds and insomnia. H1-antihistamines are classified as older 'first generation' and newer 'second generation'. First generation H1-antihistamines have poor receptor H1-receptor selectivity, and cross blood-brain-barrier. They have a lot of adverse events such as anti-muscarinic, anti-α-adrenergic, anti-serotonin, and sedative effects. In contrast, second generation H1-antihistamines were highly selective for the histamine H1-receptor, do not cross the blood brain barrier, and have minimal adverse events. The risks of first-generation H1-antihistamines have been clearly underestimated, particularly when purchased as nonprescribed over the counter medications by public. This review summarizes current literature to evaluate antihistamines including their mechanism, indications and side-effects.

Health-related quality of life in patients with sleep-related breathing disorders: relationship with nocturnal parameters, daytime symptoms and comorbid diseases.

BACKGROUND: Sleep-related breathing disorders (SRBD) are frequently encountered health problems in the general population. Habitual snoring and obstructive sleep apnea/hypopnea syndrome (OSAHS) constitute most SRBD diagnoses. Although the decrease in quality of life is a well-known entity in SRBD patients, there is not enough data regarding the underlying pathophysiological mechanisms to explain this deterioration. OBJECTIVES: The aim of this study was to investigate which parameters were affecting the quality of life in patients with SRBD. METHODS: Medical Outcome Survey - Short Form 36 (SF-36) and Epworth Sleepiness Scale were used in 135 patients with SRBD (69 patients with OSAHS and 66 patients with habitual snoring), and Charlson comorbidity index was calculated. Acquired data were compared with leading symptoms and polysomnographic findings in these patients. RESULTS: All SF-36 scores were significantly decreased in SRBD patients. However, there were no significant differences in the SF-36 scores of these patients. Also, no significant correlation was found between the severity of OSAHS and the SF-36 scores. Similarly, none of the polysomnographic parameters was found significantly correlated with SF-36 scores. In contrast, all SF-36 scores were influenced by body mass index, Epworth Sleepiness Scale score, mean nocturnal saturation and the presence of coexisting diseases. CONCLUSIONS: According to the results of multiple variance analysis, we concluded that the quality of life depends on a number of collaborative factors such as obesity, mean nocturnal saturation, symptoms related to SRBD and the presence of comorbid diseases, rather than only on one independent parameter in the patients with SRBD.

An unusual form of formaldehyde-induced lung disease.

A case report of an unusual formaldehyde exposure that had happened accidentally is described. A 54-year-old male ingested 10% formaldehyde and inhaled while vomiting and he developed cough, dyspnea and wheezing with prevalent ronci and bilateral infiltrates on chest x-ray (cxr). His pulmonary symptoms and FEV1 responded well to systemic corticosteroids and nebulised salbutamol given for the possible diagnosis of hypersensitivity and/or chemical pneumonitis, and infiltrates were cleared. Two weeks after the incident, he had massive haemoptysis, fever, leucocytes, prevalent crackles, bronchospasm, and new infiltrates on CXR. After an antibiotic and steroid therapy, his symptoms and crackles relieved, radiographic infiltrates were regressed. Delayed type hypersensitivity to formaldehyde patch test was appropriate with late-onset symptoms. This is a first case of pneumonitis as well as asthma different from the occupational exposure to formaldehyde. This data suggests direct and indirect effects of formaldehyde in healthy human airways.

An unusual form of formaldehyde induced lung disease / Una forma inusual de enfermedad pulmonar inducida por formaldehido

A case report of an unusual formaldehyde exposure that had happened accidentally is described. A 54-year-old male ingested 10 % formaldehyde and inhaled while vomiting and he developed cough, dyspnea and wheezing with prevalent ronci and bilateral infiltrates on chest x-ray (cxr). His pulmonary symptoms and FEV1 responded well to systemic corticosteroids and nebulised salbutamol given for the possible diagnosis of hypersensitivity and/or chemical pneumonitis, and infiltrates were cleared. Two weeks after the incident, he had massive haemoptysis, fever, leucocytes, prevalent crackles, bronchospasm, and new infiltrates on CXR. After an antibiotic and steroid therapy, his symptoms and crackles relieved, radiographic infiltrates were regressed. Delayed type hypersensitivity to formaldehyde patch test was appropriate with late-onset symptoms. This is a first case of pneumonitis as well as asthma different from the occupational exposure to formaldehyde. This data suggests direct and indirect effects of formaldehyde in healthy human airways

Se presenta un caso inusual de exposición a formaldehído que ocurrió accidentalmente. Varón de 54 años que ingirió accidentalmente unos 200 cc de formaldehído al 10%, que también inhaló, siguiéndose de vómitos, tos, disnea, con prevalencia de roncus y la radiografía mostró infiltrados en ambos pulmones. Los síntomas pulmonares y el FEV1 respondieron bien con corticosteroides sistémicos y salbutamol nebulizado, por el posible diagnóstico de hipersensibilidad y neumonitis química. También los infiltrados pulmonares se aclararon. Dos semanas después del incidente, el paciente tuvo una hemoptisis masiva, fiebre, crepitantes, broncoespasmo y nuevos infiltrados (RX), leucocitosis. Después de ser tratado con antibióticos y corticoides, los síntomas y los infiltrados regresaron. Se comprobó la existencia de hipersensibilidad retardada mediante prueba del parche con formaldehído, lo que correlacionó con la aparición tardía de los síntomas. Este es el primer caso de neumonitis así como de asma, diferente de la exposición ocupacional a formaldehído. Estos datos sugieren los efectos directos e indirectos del formaldehído en las vías aéreas de individuos sanos