A new classification option for NSAID hypersensitivity: Kalyoncu classification

Background The European Network for Drug Allergy (ENDA) proposed a consensus document for hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) in 2011. A subgroup of patients with NSAIDs-exacerbated respiratory disease (NERD) develop urticaria/angioedema type reactions in response to NSAIDs. The Kalyoncu classification might be a novel option to classify patients with NSAID hypersensitivity (NH). In this study, we compare the ENDA and the Kalyoncu classifications. Methods This study enrolled a total of 196 patients. NH reaction types were categorized as asthma, rhinitis, urticaria/angioedema and anaphylaxis. Based on the reaction history and oral provocation test findings, patients were grouped according to ENDA and Kalyoncu classifications. Results The mean age of the 196 patients was 40.32±13.28 years, and 130 (66.3%) of them were female. Under the ENDA and Kalyoncu classifications, the most common NH subgroups were NERD (32%), and isolated NH (34.2%), the least prevalent NH subgroups were single NSAID-induced delayed reactions (SNIDR) (1.5%), and pseudo Samter’s syndrome (11.7%). Conclusions Our research revealed that the Kalyoncu classification is more descriptive of patients with NERD exhibiting urticaria/angioedema-type reactions. It also provides future risk assessment for development of NERD. For controversial cases, the Kalyoncu classification can be utilized as a new complimentary option alone or in conjunction with ENDA classification (AU)

The Hacettepe Method is an efficient, safe and cost effective method of drug allergy work-up

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Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults.

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.2-11.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.3-15.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 12.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.3-11.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

Childhood onset analgesic intolerance: a marker for bronchial asthma in adulthood?

Analgesic intolerance (AI) which is classically known as a disease of the middle-aged adults, not uncommonly starts in childhood. In this study we sought to identify the characteristics of childhood onset AI and evaluated its association with the development of asthma. Among 729 analgesic intolerant patients followed in our institution between January 1991 and July 2004, 50 (16 male, 34 female, 6.8% of the total AI population) had history of AI starting before the age of 18. The prevalence of asthma was 24% in childhood and increased to 40% during adulthood. Atopy was more common in patients with bronchial asthma (p<0.05). The mean (+/-SD) age of onset for asthma (18.6+/-9.7years) was significantly greater than the onset of both rhinitis and AI (13.0+/-6.5 and 13.2+/-4.0 years, respectively). This finding is different than the chronology of events reported in the literature for adult onset AI patients, in which rhinitis and asthma usually precede the development of AI. The presence of such a difference in the sequence of disease patterns may be a clue for the pathophysiologic differences underlying childhood and adult onset AI. The role of childhood onset AI as a risk factor for developing for asthma in adulthood should be further assessed in prospective patient cohorts.

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children.

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.

Sarcoidosis following specific immunotherapy: more than just coincidence?

Although not yet clear, the etiology of sarcoidosis may be linked to seasonal, environmental and genetic factors; mycobacterial or other infections. To the best of our knowledge there is no data suggesting any connection between the onset of sarcoidosis and specific allergen immunotherapy in the medical literature. During the 11-year period between 1993 and 2005, a total of 91 sarcoidosis cases have been diagnosed at our institution. Out of these, here we present 3 cases of de novo sarcoidosis occurring after receiving specific immunotherapy (SIT) at the same institution (two of which had acquired the disease in Sweden where they had resided for a short time). We suggest that sarcoidosis may occur in patients following (SIT) probably via an abnormal immunological host response to an unknown antigenic trigger.

Sarcoidosis following specific immunotherapy: more than just coincidence? / Sarcoidosis tras la inmunoterapia específica: ¿más que una simple coincidencia?

Although not yet clear, the etiology of sarcoidosis may be linked to seasonal, environmental and genetic factors; mycobacterial or other infections. To the best of our knowledge there is no data suggesting any connection between the onset of sarcoidosis and specific allergen immunotherapy in the medical literature. During the 11-year period between 1993 and 2005, a total of 91 sarcoidosis cases have been diagnosed at our institution. Out of these, here we present 3 cases of de novo sarcoidosis occurring after receiving specific immunotherapy (SIT) at the same institution (two of which had acquired the disease in Sweden where they had resided for a short time). We suggest that sarcoidosis may occur in patients following (SIT) probably via an abnormal immunological host response to an unknown antigenic trigger

Aunque no esta claro, la etiología de la sarcoidosis puede estar liga a la estacionalidad, ambiente, factores genéticos, micobacterias u otras infecciones. No conocemos publicaciones que sugieran una conexión entre el inicio de la sarcoidosis y la inmunoterapia específica con alergenos. Durante un período de 11 años, entre 1993 y 2005, se ha diagnosticado en nuestra institución un total de 91 casos de sarcoidosis. Aparte de estos, presentamos aquí 3 nuevos casos iniciados tras recibir inmunoterapia específica en la misma institución, dos de los cuales iniciaron el proceso en Suecia, donde habían residido por un breve periodo de tiempo. Sugerimos que la sarcoidosis puede tener lugar en pacientes tratados con inmunoterapia específica con alergenos, probablemente por un mecanismo inmunitario anormal por el desencadenamiento de una respuesta antigénica desconocida

Lung health in workers exposed to reed dust.

We conducted a cross-sectional survey in a cellulose plant among 109 reed workers, exposed to reed dust and 78 unexposed office workers, to investigate respiratory health effects of reed dust exposure. Investigations included dust measurements, serum total IgE, skin prick test, pulmonary function testing and questionnaire on respiratory symptoms. Total dust level in the reed processing unit was higher than the office (9.7 and 0.02 mg/m3, respectively). Reed workers had a higher rate of current smoking (67% and 46%, respectively). After the adjustment for smoking status and age, reed dust exposure was significantly associated with wheezing, chronic cough, dyspnea, itching eyes and itching nose. Chest tightness and ODTS symptoms were only reported by reed workers (27.5% and 23.9%, respectively). After the adjustment for pack-years of smoking, percentage of predicted FEV1, FVC, FEV1/FVC and FEF25-75 in reed workers were significantly lower than office workers. Among reed workers, wheezing was associated with older age (>40 years) and ever smoking, and cross-shift decline in FVC and FEV1 with shorter duration of work. Reed dust exposure in the workplace could provoke respiratory symptoms, possibly due to an irritating effect. Health selection bias is likely, and could have underestimated the health effects of reed dust exposure.

Erythema multiforme: as a complication of allergen-specific immunotherapy

Here we present a 25-year-old female patient admitted with a complaint of blistering lesions on her face, neck, chest and extremities appearing after the first dosis of specific immunotherapy and diagnosed as erythema multiforme. To our knowledge, there are no papers in the literature reporting erythema multiforme due to specific immunotherapy (AU)

Presentamos el caso de una mujer de 25 años de edad ingresada con lesiones ampollosas en la cara, cuello, pecho y extremidades que aparecieron después de la primera dosis de inmunoterapia específica y para las que se estableció el diagnóstico de eritema multiforme. Hasta lo que sabemos, no se han publicado estudios sobre la aparición de un eritema multiforme debido a inmunoterapia específica. (AU)

Erythema multiforme: As a complication of allergen-specific immunotherapy.

Here we present a 25-year-old female patient admitted with a complaint of blistering lesions on her face, neck, chest and extremities appearing after the first dosis of specific immunotherapy and diagnosed as erythema multiforme. To our knowledge, there are no papers in the literature reporting erythema multiforme due to specific immunotherapy.

Aspirin-induced asthma needs a classification

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Honey allergy in adult allergy practice.

Honey allergy is a very rare condition which shows a clinical picture ranging from cough to anaphylaxis after ingestion of honey. Here we report 5 cases of honey allergy.