The effect of COVID-19 on patients recieving omalizumab treatment.

Background and aim: Although exposure during drug administration and susceptibility to coronavirus disease-19 (COVID-19) infection secondary to immunomodulatory effects constitute potential risks for patients with chronic spontaneous urticaria (CSU) or asthma on omalizumab (OMZ), there is a risk of loss of response following discontinuation of OMZ. There are few studies describing the clinical course of COVID-19 in patients receiving OMZ. Materials and methods: A total of 103 patients on OMZ were included in the study between February 2021 and January 2022. Results: Fourteen (13.6%) of the patients participating in the study had SARS-CoV-2 infection, of whom 3 (21.4%) required hospitalization and 11 (78.6%) were treated in an outpatient clinic. During the pandemic, 17 (16.5%) of the patients interrupted their OMZ treatment. Patients on OMZ for six months or less had a lower rate of interruption (2.5%) than those on OMZ for more than 6 months (25.4%). Patients interrupted treatment for the following reasons: 3 (17.6%) had COVID-19, 10 (58.9%) did not attend the hospital visit due to concern about contamination with SARS-CoV-2, and 4 (23.5%) thought that OMZ treatment would facilitate contamination with SARS-CoV-2. After interrupting OMZ, 3 (25%) female patients and 5 (100%) male patients presented no worsening of their symptoms. Three (13%) of the patients on OMZ for asthma and 11 (13.8%) of those on the drug for urticaria had COVID-19 infection. Patients presenting CSU and severe asthma are completely different, with different potential consequences of OMZ interruption. Nine (52.9%) patients had aggravated symptoms following interruption of OMZ treatment. Three of them described worsening of asthma symptoms and a need to increment their maintenance therapy due to asthma exacerbation after nearly three weeks of interruption, and 6 of them had hives and pruritus as urticaria exacerbation nearly four weeks after interruption of OMZ. The asthma patients did not stop their other treatments, including inhaled corticosteroids. Conclusion: Use of OMZ does not increase the risk of SARS-CoV-2 infection, COVID-19-related pneumonia, or COVID-19-related hospitalization. We advise patients not to interrupt OMZ treatment during the COVID-19 pandemic unless advised to do so by their doctors, and we recommend that they receive instruction concerning self-administration of OMZ to avoid visiting hospitals in the event of a pandemic.

Buts de l'étude: Bien que l'exposition lors de l'administration du médicament et la susceptibilité individuelle à l'infection par le coronavirus-19 (COVID-19) secondaire aux effets immunomodulateurs soient des risques potentiels pour le patient victime d'urticaire chronique idiopathique (UCI) ou d'asthme recevant de l'omalizumab (OMZ), il existe également un risque de perte de réponse au traitement à la suite de l'arrêt de l'OMZ. Matériels et méthodes: Un total de 103 patients recevant de l'OMZ ont été inclus dans l'étude entre février 2021 et janvier 2022. Résultats: Quatorze (13,6 %) patients participant à l'étude ont été victimes d'une infection à coronavirus, 3 d'entre eux (21,4 %) ont été hospitalisés et 11 (78,6 %) ont été traités en ambulatoire. Durant la pandémie, 17 (16,5 %) patients arrêtèrent le traitement par OMZ. Le taux d'arrêt était plus faible (2,5 %) chez les patients recevant l'OMZ depuis 6 mois ou moins par rapport aux patients recevant l'OMZ depuis plus de 6 mois (25,4 %). L'arrêt du traitement était motivé par l'infection COVID-19 dans 3 cas (17,6 %), par une non-fréquentation de l'hôpital par crainte de contagion dans 10 cas (58,9 %), et dans 4 cas (23,5 %) parce qu'ils pensaient que l'OMZ favorisait l'infection COVID-19. Après l'arrêt de l'OMZ, 3 (25 %) femmes et 5 (100 %) hommes n'ont présenté aucune aggravation de leurs symptômes. Trois (13 %) patients recevant de l'OMZ pour asthme et 11 (13,8 %) pour de l'UCI présentèrent une infection par COVID-19. Les patients souffrant d'UCI ou d'asthme sévère étaient totalement différents, avec des conséquences potentielles différentes de l'interruption de l'OMZ. Neuf (52,9 %) patients aggravèrent leurs symptômes à l'arrêt de l'OMZ. Trois d'entre eux décrivirent une accentuation des symptômes d'asthme avec besoin d'augmenter leur traitement de fond pour exacerbation d'asthme après près de 3 semaines d'arrêt, et 6 d'entre eux présentèrent une exacerbation de l'urticaire avec papules et prurit après près de 4 semaines d'arrêt de l'OMZ. Les asthmatiques n'arrêtèrent pas les autres médicaments dont les corticostéroïdes inhalés. Conclusion: L'OMZ n'augmente pas les risques d'infection par COVID-19, ni les pneumopathies liées à l'infection COVID-19, ni les hospitalisations dues au COVID-19. Nous prévenons les patients de ne pas interrompre leur traitement par OMZ pendant la pandémie par COVID-19 sans avis médical, et nous recommandons une éducation thérapeutique pour l'auto-administration d'OMZ pour éviter les séjours hospitaliers en cas de pandémie.

The percentage of hesitation and factors associated with acceptance or refusal for COVID-19 vaccine: Does training about vaccines by allergist affect personal decision?

Background and aim: As the impact of coronavirus disease (COVID)-19 arises worldwide, the effect of vaccines is protecting its importance. The aim of this study was to investigate the vaccination perspectives of patients and learn how many patients were persuaded to get vaccinated with the effect of the education provided by allergists. Materials and methods: A cross-sectional study was carried out among 200 adult patients in the outpatient clinic between February 2021 and January 2022. Patients filled out the anti-vaccination scale form and a questionnaire form developed by allergists. The training about COVID-19 vaccines has been given to the patients who did not consider getting vaccinated. The patients were called by phone and questioned whether they have been vaccinated or not, after 22 weeks. Results: Out of 200 patients participants, 60.5% were considering getting vaccinated. Patients who did not consider getting vaccinated comprised 45.7% of women and 31% of men. While 52.4% of primary school graduates considered getting vaccinated, 75% of high school graduates and 60.8% of higher education graduates were considering getting vaccinated. Major reasons for rejecting vaccination were concerns about side effects and allergy. While the majority of women (47.2%) who did not want to get vaccinated were concerned about vaccine side effects, the majority of men (34.6%) did not want to get vaccinated because they did not trust the efficacy of the vaccine. Vaccination rates have been increased with the training we provided to our patients who did not consider getting the vaccine. 76 patients could be reached by phone and 81.6% of them were vaccinated, and 18.4% were not. Conclusion: The vaccination rates of allergy patients who did not consider getting vaccinated were increased with the information provided by allergists. So, the allergists should give more attention for giving information and increasing the vaccination rates of covid-19.

But de l: 'étude Alors que l'épidémie de maladie à coronavirus (COVID-19) impacte le monde entier, l'effet préventif de la vaccination est de première importance. Le but de cette étude était d'évaluer les souhaits de vaccination des patients et d'apprécier combien d'entre eux étaient persuadés de l'intérêt de celle ci après avoir bénéficié d'un parcours éducatif auprès des allergologues. Matériel et Méthodes: Une étude transversale a été menée parmi 200 patients adultes suivis en ambulatoire entre février 2021 et janvier 2022. Les patients renseignaient une échelle analogique de refus de vaccination et un questionnaire élaboré par des allergologues. Une éducation thérapeutique sur les vaccins pour la COVID-19 était dispensée aux patients refusant la vaccination. Les patients étaient ensuite contactés par téléphone pour savoir s'ils avaient été ou non vaccinés après 22 semaines. Résultats: Parmi les 200 patients, 60,5 % étaient considérés comme vaccinés. Les patients non vaccinés concernaient 45 % des femmes et 31 % des hommes. Alors que 52,4 % des patients ayant suivi une scolarité primaire étaient vaccinés, 75 % des patients de, niveau lycée et 60,8 % de niveau université se déclaraient vaccinés. Les raisons principales de refus de vaccination concernaient la crainte d'effets secondaires et le risque allergique. Alors que la majorité des femmes (47,2 %) refusant la vaccination alléguait le risque d'effets secondaires, la majorité des hommes (34,6 %) ne souhaitait pas être vaccinée pour non confiance dans l'efficacité du vaccin. Les désirs de vaccination étaient augmentés après éducation thérapeutique chez les patients ne souhaitant pas être vaccinés. Ainsi 76 patients ont pu être joints par téléphone et 81,6 % d'entre eux avaient pu être vaccinés et 18,4 % ne l'étaient pas. Conclusion: Les taux de vaccination des patients allergiques qui ne souhaitaient pas être vaccinés ont été augmentés après l'information fournie par les allergologues. Ainsi les allergologues devraient apporter toute leur attention à donner des informations visant à augmenter la vaccination pour la COVID-19.

Allergic Rhinitis and Its Relationship with IL-10, IL-17, TGF-ß, IFN-γ, IL 22, and IL-35.

BACKGROUND: We aimed in our study to research the role of new cytokines such as IL-35, IL-22, and IL-17 that may form a target for novel treatment approaches. METHODS: IL-10, IL-17, TGF-ß, IFN-γ, IL-22, and IL-35 serum levels of allergic rhinitis (AR) patients were measured using ELISA method. Allergic sensitization was demonstrated by the skin prick test. Patients only with olive tree sensitivity were evaluated for seasonal AR (SAR). Patients only with mite sensitivity were included in the study for perennial AR (PAR). AR clinic severity was demonstrated by the nasal symptom scores (NSS). RESULTS: In total, 65 AR patients (patient group), having 31 PAR and 34 SAR patients, and 31 healthy individuals (control group) participated in the study. Cytokine levels between the patient group and the control group were compared; IL-17 (p = 0.038), IL-22 (p = 0.001), and TGF-ß (p = 0.031) were detected as high in the patient group, and IFN-γ (p < 0.001) was detected as low in the patient group. When correlation analysis was made between age, gender, prick test result, NSS, AR duration, and cytokine levels in the patient group, a negative correlation was detected only between IFN-γ (p = 0.032/r = -0.266) level and NSS. CONCLUSIONS: Accompanied by the literature information, these results made us think that T cell subgroups and cytokines have an important role in AR immunopathogenesis. It is thought that future studies to be conducted relating to this subject will form new targets in treatment.

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

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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.

Validity and reliability of Turkish version of rhinitis and mini-rhinitis quality of life questionnaires

Background: The aim of the present study was to develop the Turkish version of Rhinitis Quality of Life Questionnaire (RQLQ) and mini-RQLQ for clinical and research purposes. Methods: Study included 55 patients with Allergic Rhinitis (AR), aged 18–69. Demographic characteristics and symptom score (T4SS) were recorded. All patients filled in the Turkish RQLQ and mini-RQLQ. Reliability analysis included internal consistency and item-total score correlations. Construct validity analysis was performed by Known Group method by correlation of RQLQ and mini-RQLQ scores with T4SS and SF36. Results: Mean age of patients was 36.4 ± 10.6. Mean T4SS was 4.7 ± 4.1. Cronbach's α scores of all RQLQ domains were above 0.90 and those of mini-RQLQ were above 0.80. All items were significantly correlated with their domains. All correlation coefficients for item versus domain score were above 0.75 for RQLQ and above 0.84 for mini-RQLQ. Total RQLQ score was correlated with SF36 domains except physical functioning domain. Total mini-RQLQ score was significantly correlated with all SF36 domains (all r > -0.46). T4SS revealed significant correlation with RQLQ practical score (r=0.38). On the other hand, T4SS was correlated significantly with practical, nose and total scores of mini-RQLQ (r=0.33, 0.48, 0.34 respectively). Conclusions Health is the complete state of well-being and AR has major impact on quality of life (QoL), therefore it seems essential to include QoL measures in clinical evaluation along with traditional parameters. This study has demonstrated that RQLQ and mini-RQLQ are valid measures for use in Turkish patients with AR (AU)

Validity and reliability of Turkish version of rhinitis and mini-rhinitis quality of life questionnaires.

BACKGROUND: The aim of the present study was to develop the Turkish version of Rhinitis Quality of Life Questionnaire (RQLQ) and mini-RQLQ for clinical and research purposes. METHODS: Study included 55 patients with Allergic Rhinitis (AR), aged 18-69. Demographic characteristics and symptom score (T4SS) were recorded. All patients filled in the Turkish RQLQ and mini-RQLQ. Reliability analysis included internal consistency and item-total score correlations. Construct validity analysis was performed by Known Group method by correlation of RQLQ and mini-RQLQ scores with T4SS and SF36. RESULTS: Mean age of patients was 36.4+/-10.6. Mean T4SS was 4.7+/-4.1. Cronbach's alpha scores of all RQLQ domains were above 0.90 and those of mini-RQLQ were above 0.80. All items were significantly correlated with their domains. All correlation coefficients for item versus domain score were above 0.75 for RQLQ and above 0.84 for mini-RQLQ. Total RQLQ score was correlated with SF36 domains except physical functioning domain. Total mini-RQLQ score was significantly correlated with all SF36 domains (all r>-0.46). T4SS revealed significant correlation with RQLQ practical score (r=0.38). On the other hand, T4SS was correlated significantly with practical, nose and total scores of mini-RQLQ (r=0.33, 0.48, 0.34 respectively). CONCLUSIONS: Health is the complete state of well-being and AR has major impact on quality of life (QoL), therefore it seems essential to include QoL measures in clinical evaluation along with traditional parameters. This study has demonstrated that RQLQ and mini-RQLQ are valid measures for use in Turkish patients with AR.

Increased expression of tissue vascular endothelial growth factor and foetal liver kinase-1 receptor in seasonal allergic rhinitis and relevance to asthma component.

BACKGROUND: There is a difference in the extent of remodelling in allergic rhinitis (AR) and asthma. This may be attributed to the difference in local tissue response to these mediators. OBJECTIVES: The aim of this study was to compare vascular endothelial growth factor (VEGF) and its receptor foetal liver kinase (Flk)-1 expression between seasonal AR patients with or without asthma and non-allergic controls as well as that between AR patients with and without asthma. METHODS: Thirteen subjects with seasonal AR and six non-allergic controls were included in the study. Allergic sensitization was demonstrated by a skin prick test. Inferior turbinate thiny biopsies were obtained from both groups. Monoclonal mouse antibodies were used to demonstrate VEGF and Flk-1. Nasal mucosal endothelial cells' staining intensity was graded semi-quantitatively and the histochemical score (HSCORE) was calculated. In all samples, VEGF- and Flk-1-labelled vessels were counted for the assessment of vascular surface density (VSD). RESULTS: The mean HSCORE for VEGF and anti-VEGF-based VSD were significantly higher in the patient group (P=0.001 and 0.002, respectively). The mean HSCORE for Flk-1 and anti-Flk-1-based VSD in the patient group were significantly higher than those in the control group (P=0.016 and 0.028, respectively). Differences between the mean HSCORE for VEGF and anti-VEGF-based VSD in patients with pure AR and AR and asthma were insignificant (P=0.16 and 0.39, respectively). The mean HSCORE for Flk-1 and anti-Flk-1-based VSD in patients with pure AR were significantly lower than those in patients with AR and asthma (P=0.004 and 0.018, respectively). CONCLUSION: Angiogenic factor VEGF and its receptor Flk-1 is increased in AR. A similar increase in VEGF in AR with and without asthma despite a higher Flk-1 in AR patients with asthma may be a possible explanation for the presence of angiogenesis in the airway wall in patients with asthma but not in those with pure AR.

Pulmonary hemosiderosis with normocomplementemic urticarial vasculitis in a child.

Pulmonary hemosiderosis is rarely associated with urticarial vaculitis especially if normocomplementemic. An eigth year old girl presented with relapsing and remitting chronic and persistent urticarial lesions, conjunctival injection, recurrent cough and hemoptysis. Respiratory findings started at seven years of age. Physical examination revealed diffuse skin lesions mainly settled on the extremities, non-purulent conjunctival injection, rare ronchi and fine crackles in bilateral lower zones of the lungs. Biopsy of the urticaria like skin lesions demonstrated leukocytoclastic vasculitis. Rheumatological markers were negative. Levels of complement fractions 3 and 4 were normal. Chest x-ray demonstrated diffuse alveolar infiltrative images. High Resolution Computed Tomography of the chest revealed diffuse ground-glass appearance, increased interstitial density. Diagnostic flexible fiberoptic bronchoscopy was performed and bronchoalveolar lavage fluid revealed hemosiderin laden alveolar macrophages. She was started on systemic corticosteroid treatment. During follow up, pulmonary symptoms disappeared, however skin lesions and conjunctival symptoms persisted and exacerbated four times in two years. CT of lungs after two years of treatment revealed rare patchy areas of ground glass appearance in bilateral lower lobes and right upper lobe as well as a few of millimetric pleural nodules. This patient is still followed up under low dose steroids and pulmonary findings regressed but low grade inflammation due to vasculitis is thought to continue as supported by the persistence of tomographic findings in the lungs despite the absence of any symptoms. This case demonstrates association of urticarial vasculitis and pulmonary hemosiderosis in the setting of normocomplementemia.

Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease.

Gastroesophageal reflux disease (GERD) is commonly associated with asthma; however, frequency in nonatopic children with asthmatic symptoms is unknown. The aim of this study was to determine the frequency of gastroesophageal reflux (GER) in nonatopic children with asthma-like airway disease that recur despite conventional asthma treatment and to evaluate the clinical response to lansoprazole treatment. Twenty-five nonatopic children aged between 1 and 16 years who have asthma-like airway disease and 25 healthy children were included in the study. All cases underwent 24 h pH monitoring with dual sensor catheters. Additionally, acid suppressor treatment was administered to patients diagnosed as having GERD and clinical response was evaluated. Major symptoms encountered in the patient group included wheezing and cough (88%, and 32%, respectively). Reflux episodes were more common in distal esophagus during the prone position (reflux index (RI) of 11.5+/-10.3 vs. 16.2+/-9.4 during supine vs. prone). All distal esophageal parameters were significantly higher in the patient group except number of reflux episodes lasting longer than 5 min (RI of 13.3+/-13.1 vs. 3.9+/-2.9 in the patient vs. control groups, respectively). There was a significant improvement in symptoms and requirement for medication with treatment (number of systems decreased from 2.3+/-0.6 to 0.4+/-0.6, P=0.00). In conclusion, GERD is significantly more common in nonatopic children with asthma-like airway disease compared to the controls and clinical improvement is significant after acid suppressor treatment. Thus, we suggest that children followed-up with the diagnosis of nonatopic asthma with recurrent exacerbations despite adequate asthma treatment have a high frequency of GER and that lansoprazole treatment may be considered early in management.

Calcitonin expression of high endothelial venules during lymphocyte migration in human pharyngeal tonsil.

The migration routes of lymphocytes through high endothelial venules (HEVs) of control and hypertrophic pharyngeal tonsil (HPT) tissue sections were investigated by immunohistochemistry using the expression of a hormone [calcitonin (CT)] and two calcium-dependent endothelial adhesion molecules (E-selectin and P-selectin), as well as electron microscopy. A marked increase in CT-specific staining was observed in the endothelial cells of HEV in the HPT group compared to the control group. Expressions of E-selectin and P-selectin on HEVs of control group were faint, when compared to the strong expression of these selectins on HEVs of HPT. Electron microscopically, we demonstrated that lymphocytes transmigrated through HEV and observed the close membranous contact between endothelial cells and lymphocytes during this process. We speculate that increasing CT during inflammation may be important for lymphocyte migration through the HEVs via controlling the expression of E-selectin and P-selectin.

Symptoms of the olive pollen allergy: do they really occur only in the pollination season?

BACKGROUND: Olive (Olea europaea; O.e.) pollen is a major cause of seasonal respiratory allergy. The O.e. pollination season lasts two months from the beginning of May till the end of June. It was expected that patients with allergic disease from O.e. sensitization were symptomatic only during this period. However, during the last few years, we have observed that the clinical symptoms appear not only during the O.e. pollination season but also during the rest of the year. OBJECTIVE: The aim of this study was to observe and document symptoms of respiratory allergic diseases in the O.e. sensitized patients during the O.e. pollination season and after it. METHODS: One hundred and twenty-seven patients with respiratory allergic disease were enrolled in the study. Allergenic sensitizations were shown by SPT. Finally, patients were split into two groups as monosensitized with O.e. (n=19) and polysensitized (n=108). Patients were assessed by using scores of respiratory allergic disease symptoms and percentage of peak expiratory flow rate values (PEFR %) (only for asthmatic patients) during the O.e. pollination season and after it. RESULTS: Of the patients with O.e. monosensitization, 13 had allergic rhinitis (AR) only while six had allergic asthma (AA) additionally. AR alone and accompanied by AA was present in 84 and 24 polysensitized patients respectively. Eleven patients with O.e. sensitization (57.9 %) and 86 patients with polysensitization (79.6 %) had AR symptoms throughout the year irrespective of the O.e. pollination season. Similarly, three of the O.e. monosensitized and ten of the polysensitized patients with AA had asthmatic symptoms during the O.e. pollination season and also after it. CONCLUSIONS: In the patient group sensitive to O.e. along with other pollen extracts, it was possible to observe symptoms outside the pollination season. However, patients with O.e. monosensitization also had symptoms to a great extent outside the season.

Serum soluble tumor necrosis factor receptor levels in patients with seasonal allergic rhinitis.

It is known that several inflammatory cells and cytokines play a role in allergic inflammation. Furthermore, there are seasonal changes in several mediators responsible for allergic inflammation. The aim of this study was to determine seasonal changes in serum concentrations of soluble tumor necrosis factor receptors (sTNFRs) and the relationship with disease activity and other inflammation markers such as eosinophil cationic protein (ECP) in patients with seasonal allergic rhinitis. Serum levels of sTNFRI and sTNFRII were measured before and during the pollen season in 18 patients with seasonal allergic rhinitis and in 17 healthy controls by using commercially available enzyme-linked immunosorbent assay (ELISA) kits. The serum levels of sTNFRI, sTNFRII, IgE, and ECP were significantly higher in patients than those in controls before and during season. sTNFRI, sTNFRII, and IgE levels were higher before season, whereas ECP levels were higher during season. We suggest that sTNFRs might play regulatory roles even in early stages of allergic rhinitis when patients do not have clinical symptoms yet.

Sensitivity to Parietaria pollen in Izmir, Turkey as determined by skin prick and serum specific IgE values.

As the first study of its kind in the Aegean region of Turkey, we examined the incidence of sensitivity to Parietaria pollen in patients with allergic rhinitis and/or asthma living in the Mediterranean climate of the Aegean coast. On the Mediterranean, there are characteristic climatic conditions (mild winters, dry summers, etc.) which facilitate the growth of a typical vegetation and the production of allergenic pollen, such as that from Parietaria. These pollen types differ greatly from those of central and northern Europe. We skin tested 132 patients with a clinical history of seasonal rhinitis and/or asthma symptoms. Each patient was skin tested with extracts of grass, weed, tree and cereal pollens, and serum samples were collected for specific IgE assays for Parietaria. Sixty-nine of the 132 patients (52%) showed skin reactivity to Parietaria; seven of these (10%) had monosensitization to Parietaria. Fifty-six out of 69 patients (81%) had specific IgE in their serum to Parietaria pollen. Based on skin test reactions, we concluded that Parietaria is important in terms of clinical symptoms and that it is the most common weed pollen in the Aegean region in Turkey.

Superior vena cava syndrome together with multiple venous thrombosis in Behçet's disease.

In this paper, we describe a 25-year-old white man with Behçet's disease who developed superior vena cava syndrome which was followed with the diagnosis of pseudotumour cerebri based on bilateral papilledema for 6 months. Complete superior vena cava obstruction was detected by magnetic resonance imaging (MRI). Secondary reasons for papilledema were all excluded. Treatment of prednisone, pulse cyclophosphamide and heparin was started and clinical symptoms and fundoscopic changes completely disappeared in 2 weeks. In conclusion, we think that Behcet's disease should always be remembered in the differential diagnosis of unidentified neurological signs especially in regions where the disease is relatively common.

Selective IgA deficiency and ankylosing spondylitis.

A man with an ankylosing spondylitis (AS) and selective IgA deficiency is described. There have been several reports in the literature indicating coexistence of AS with selective IgA deficiency. As it is suggested in the literature, we believe that selective IgA deficiency is a poor prognostic factor in AS.