High adherence to subcutaneous immunotherapy in a real-life study from a large tertiary medical center.

BACKGROUND: Studies on real-life adherence to subcutaneous allergen immunotherapy (SCIT) for respiratory allergy are scarce. The aim of this study was to evaluate adherence to SCIT. METHODS: The patients prescribed SCIT for allergic rhinitis and/or asthma in 2009-2011 were contacted in 2014 and asked whether they completed at least the 3 years of SCIT and/or whether they suspended the treatment for at least 2 months. The Total Symptom Score-6, visual analog scale (VAS), asthma control test (ACT), medication scores, quality of life (QoL) scores, and immunotherapy satisfaction scores with VAS obtained before the initiation of SCIT in the first year and at the end of SCIT were compared. RESULTS: A total of 204 patients (136 female [66.7%]; mean age, 38.83 ± 12.02 years) were included; 73% (149/204) were both compliant and persistent; 14% (29/204) were only persistent; and, overall, 87.3% (178/204) were considered adherent. Adherence was more frequent in female patients (95% CI, 62.3-76.3%; p = 0.018). Medication, symptom, ACT, and QoL scores in the first year and at the end of the treatment were significantly lower than the initial scores, and the immunotherapy satisfaction scores at the end of treatment were higher than the scores in the first year in the patients who were adherent (p < 0.001 for each score). CONCLUSION: The adherence rate to SCIT in our study was relatively high, in contrast to previous real-life data. Results of our study indicated that a close relationship between allergists and their patients during SCIT and the follow-up period in the same center improved the outcome of SCIT.

Turkish version of the Drug Hypersensitivity Quality of Life Questionnaire: assessment of reliability and validity.

PURPOSE: The first disease-specific quality-of-life questionnaire in patients with drug hypersensitivity, Drug Hypersensitivity Quality of Life Questionnaire (DrHy-Q), was developed and validated recently. The aim of this study was to assess validity, reliability and responsiveness to interventions of the Turkish version of the DrHy-Q. METHODS: The Turkish version of the DrHy-Q was administered to prospectively enrolled 736 patients with drug hypersensitivity from ten allergy units. To assess validity, all patients completed the validated Turkish version of Psychological General Well-Being Index (PGWBI). For test-retest reliability, 182 patients completed the DrHy-Q 1 week after the first questionnaire administration without any intervention. Responsiveness was assessed on 97 patients who had a DrHy-Q recorded at a follow-up visit after the intervention. RESULTS: The internal consistency and test-retest reliability of the scale were adequate (Cronbach's alpha = 0.934, intra-class correlation coefficient = 0.783). The DrHy-Q scores showed weak negative correlations with the PGWBI total and domain scores (r = - 0.378 to -0.254, p < 0.001). DrHy-Q was able to discriminate the patients with one drug hypersensitivity reaction from the patients with two and above two reactions (p = 0.012 and p < 0.001, respectively), and the patients who experienced a respiratory reaction from the patients who did not (p = 0.018). However, it did not discriminate the patients with comorbid disease including psychiatric comorbidity (p > 0.05). The baseline DrHy-Q scores were significantly higher than the post-intervention scores (p = 0.008). CONCLUSION: The Turkish version of DrHy-Q is reliable and valid for evaluating quality of life in patients with drug hypersensitivity, and it appeared responsive to interventions.

The prevalence of Hymenoptera venom allergy in adults: the results of a very crowded city in Euroasia.

BACKGROUND: There are scarce data about the prevalence of Hymenoptera venom allergy in the general population. The aim of this study was to determine the prevalence of Hymenoptera venom allergy in the general adult population of Istanbul. METHODS: A total of 17,064 randomly selected telephone numbers were contacted and 11,816 (69.25%) individuals who agreed to participate completed a questionnaire. Those who disclosed hypersensitivity reactions due to Hymenoptera stings in this initial survey were called again and given another questionnaire. Those who were suspected of experiencing hypersensitivity reactions to Hymenoptera stings were invited for a clinical investigation with in vivo and in vitro diagnostic tests. RESULTS: According to the first questionnaire, a total of 1171 (9.9%; 95% CI: 9.38-10.47%) were suspected of having a hypersensitivity to Hymenoptera stings. 51.75% (n: 606) answered the second questionnaire and 21% (n: 128) of these were still suspected of having a hypersensitivity to Hymenoptera stings (1.1%; 95% CI: 0.9-1.29%). The confirmed prevalence of hypersensitivity to Hymenoptera stings according to skin tests and in vitro sIgE levels was 0.2% (95% CI: 0.14-0.30%). Nearly all of the participants with systemic reactions were admitted to the emergency department, although only one tenth of them received adrenaline in the emergency room. 2.3% carried an adrenaline injector, whereas none of the patients received venom immunotherapy. CONCLUSIONS: The prevalence of Hymenoptera sting reactions in our geographical region is comparable with other European studies. There is a need to increase the awareness of adrenaline in the emergency management of insect sting anaphylaxis and venom immunotherapy in the prophylaxis.

Conventional markers in determination of activity of sarcoidosis.

AIM AND BACKGROUND: Currently, there are no objective criteria to determine sarcoidosis activity. The present study aimed to discover a sensitive serum marker that would determine the activity of sarcoidosis and can be used during disease follow-up. METHODS: Forty-eight patients with sarcoidosis and twenty healthy volunteers as a control group were included in the study. On their control visits, the patients were divided into active and inactive groups based on their clinical, physiological, and radiological status. Angiotensin converting enzyme (ACE), adenosine deaminase (ADA), total IgE (T-IgE), C-reactive protein (CRP), serum amyloid-A (SAA), and soluble interleukin-2 receptor (sIL2R) serum levels and classical findings of activity were compared, and the utilization of these parameters as markers of activity was investigated. RESULTS: Thirty-nine cases were female (female/male: 39/9) and the mean age was 44.29±10.9years. Thirty-seven cases were active and 11 cases were inactive. Serum ACE, ADA, sIL2R, and SAA levels were significantly higher while T-IgE levels were lower in the sarcoidosis cases. A comparison of the markers between active and inactive cases showed that only SAA was significantly higher (p<0.001). sIL2R was elevated in cases with extra-pulmonary involvement (p<0.014). The area under the curve value was rather high for ADA (0.98 CI: 0.96-1.0); it also had high sensitivity (93.8%) and specificity (100%), and therefore had the highest diagnostic value (96.6%). CONCLUSION: The current study showed that SAA wil be helpfull for detecting the activity of srcoidosis, IL2R measurement in exploring the extra-pulmonary organ involvement.

Eosinophilic Lung Disease: Accompanied with 12 Cases.

OBJECTIVES: Eosinophilic lung diseases are a rare group of heterogeneous diseases characterized by the increase of the eosinophil ratio in airways and lung parenchyma. In our clinic, patients diagnosed with eosinophilic lung disease were evaluated with their clinical features and prognoses. MATERIAL AND METHODS: In our clinic, 12 cases that were diagnosed and followed up for eosinophilic lung disease [eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) (n=4), chronic eosinophilic pneumonia (CEP) (n=7), and simple pulmonary eosinophilia (Löffler's syndrome) (n=1)] were retrospectively evaluated. RESULTS: Of the 12 cases, 8 were females, and the average age was 43 (28-72) years. All cases were undergoing bronchodilator therapy with asthma diagnosis (2 months-40 years). Additionally, 4 of the cases had sinusitis, and 1 had allergic rhinitis. The most common complaints of the patients were difficulty in breathing and coughing, and the duration of complaints was a median of 2 months. Peripheral eosinophilia and total IgE elevation were present during the admission of all cases; additionally, leucocyte elevation was recorded in 10 of them, anemia in 4 of them, and thrombocytosis in 4 of them. Moreover, 43% of the recorded DLCO values were lower than normal. Of the 10 cases that underwent bronchoalveolar lavage (BAL), the eosinophil ratio was above 25% in 7 subjects. Of the 8 cases that underwent transbronchial biopsy, eosinophil-involving infiltration was detected in 6 subjects. Additional findings in cases diagnosed with EGPA were nasal polyposis (n=1), sinusitis (n=2), polyneuropathy (n=1), cardiac involvement (n=2), and skin involvement in biopsy (n=1). Spontaneous recovery was observed in the patient diagnosed with simple pulmonary eosinophilia during the follow-up that was performed based on the history and laboratory and BAL results of the patient. Prednisolone treatment was started for all cases, except for simple pulmonary eosinophilia, and their controls were performed. Relapse was observed in eight cases (EGPA: 4, CEP: 4); during the relapse treatment of one case diagnosed with EGPA, exitus occurred. One case rejected treatment despite the presence of peripheral eosinophilia, and the other cases are being followed-up without medication. CONCLUSION: Given that the clinical pictures in pulmonary eosinophilia syndromes are on a wide spectrum, a specific diagnosis is important. Progression may differ in each patient, and a close follow-up is necessary during and after the treatment.

The Turkish Hereditary Angioedema Pilot Study (TURHAPS): the first Turkish series of hereditary angioedema.

BACKGROUND: No published data presently exist concerning hereditary angioedema (HAE) in Turkey. The aim of the study was to initiate a preliminary multicentric evaluation about HAE and to determine the genetic properties of Turkish patients. METHODS: Based on records drawn from four medical centers we identified a total of 70 subjects, belonging to 60 unrelated families, fulfilling clinical and laboratory criteria for diagnosis of HAE with C1 inhibitor deficiency. Ten type I patients, and their first-degree relatives, underwent genetic analysis for HAE. RESULTS: The majority of patients were female (60%), the mean age was 37.7 ± 14.1 years. The mean age at the time of first angioedema symptom was 12.5 ± 9.2 years. Mean time lag between first symptom and diagnosis was 26 ± 14.4 years. All but 3 subjects had HAE type I. Family history of angioedema was present in 75.7% of the cases. Cutaneous swelling was reported by 87.1% of the patients, facial edema by 65%, abdominal symptoms by 74.3% and approximately one half (55.7%) had experienced one or more laryngeal attack. Genetic analysis of 10 families demonstrated that 5 carried a mutation that had never been previously described. CONCLUSION: We found that the clinical features of Turkish HAE patients were consistent with previously described patterns of this rare disease. The most noteworthy feature identified in the study was a significantly long duration between the first symptom appearance and final diagnosis. Our detection of different mutations in 10 patients confirms the allelic heterogeneity of the disease.

Latex sublingual immunotherapy: can its safety be predicted?

BACKGROUND: Complete avoidance sometimes cannot be possible in latex-allergic health care workers. So far, very few double-blind placebo-controlled studies revealed the efficacy of sublingual latex immunotherapy (SLIT) in those patients. OBJECTIVE: Our aim was to evaluate the efficacy and safety of latex SLIT in health care workers. METHODS: 30 patients (all health care workers) diagnosed as latex allergic were advised to avoid latex exposure and were given information about the prevention measures and asked to return two months later. 24 patients who were still symptomatic despite prevention measures were informed about the latex SLIT study and asked to participate. However, only 12 gave approval and were randomized to receive sublingual latex extract or placebo. Symptom scores and latex cutaneous provocation test scores were recorded at baseline and at the 6th and 12th months of the study. RESULTS: Two patients experienced anaphylaxis, 1 patient showed severe bronchial obstruction during dose incremental phase and were excluded from the study. The differences of the symptom and provocation scores between baseline and the 12th month of the treatment were significant in the active group (p = .042, p = .038, respectively). Also the symptom and provocation scores at 12 months were significantly lower in the active group than in the placebo group (p = .035, p = .013, respectively). CONCLUSION: Latex SLIT can be used as an effective treatment for latex-allergic health care patients having difficulties in applying adequate avoidance measures. However, the risk of systemic reactions should be kept in mind and sufficient precaution measures must be made available.

Neurotrophins: are they meaningful in chronic spontaneous urticaria?

Plasma neurotrophin levels are elevated in patients with allergic and autoimmune diseases. The present study was designed to investigate the serum neurotrophin levels in 42 patients displaying chronic spontaneous urticaria, as well as 22 healthy control subjects. Blood samples were obtained from subjects during their first visit to the clinic, and then again after one month of desloratadine therapy. No significant difference was found between patient and control groups in terms of basal serum neurotrophin levels. However, basal nerve growth factor levels in patients whose symptoms persisted despite treatment were significantly lower than those of the drug-responsive patients and the control group. In treatment-responsive patients, nerve growth factor increased after suppression of the symptoms. Our study suggests that chronic spontaneous urticaria is linked with changes serum nerve growth factor levels, and that the deregulation of neurotrophins may contribute to urticaria pathophysiology.

Allergic vs nonallergic rhinitis: which is more predisposing to chronic rhinosinusitis?

BACKGROUND: The impact of allergy on chronic rhinosinusitis (CRS) is controversial. OBJECTIVE: To evaluate whether a history of CRS is more prevalent in patients with allergic rhinitis than in those with nonallergic persistent rhinitis. METHODS: A total of 115 patients (78 females; mean age, 31.9 years; age range, 14-64 years) with persistent rhinitis were included in the study. A 7-point analog scale was used to report the severity of individual and global CRS symptoms and to determine the impact of rhinosinusitis symptoms on quality of life. The allergic status of the patients was evaluated using skin prick tests for common inhalant allergens, and asthma was evaluated by means of history, physical examination, and respiratory function tests. Rhinoscopy and paranasal sinus computed tomography were used to determine CRS. RESULTS: Asthma and CRS were not significantly different in allergic and nonallergic patients. Nasal polyps were found equally in both groups (8 patients). However, mean Lund-Mackay staging scores, postnasal drainage, dental pain, and global CRS scores were significantly higher in patients with nonallergic rhinitis (P = .045, P = .001, P = .02, and P = .01, respectively). No significant correlations, except for dental pain (correlation coefficient, 0.250; P = .008), were found between Lund-Mackay scores and CRS symptoms. In rhinoscopy, the only conspicuous difference was nasal purulence in allergic patients (P = .002). CONCLUSION: Allergic and nonallergic rhinitis may contribute similarly to the development of CRS.

Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria.

BACKGROUND: Chronic idiopathic urticaria (CIU) is a frequently occurring disease that has a great impact on the health-related quality of life (HRQL) of patients and seems to be associated with a number of psychological factors. OBJECTIVES: To determine the prevalence of psychiatric morbidity in patients with CIU and to determine HRQL of CIU patients compared with controls. METHODS: A semistructured interview form, a generic form of the HRQL questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and the Structured Clinical Interview for DSM-IV Axis Disorders (SCID-I) were administered to CIU patients who presented to the Allergy Department of the University of Istanbul (from January 1 to April 30, 2005). Healthy subjects matched sociodemographically with the study group were used as the control group. RESULTS: Eighty-four CIU patients and 75 controls were included in the study. The mean +/- SD age of the study participants was 36.83 +/- 10.26 years, and 84% were women. The mean +/- SD duration of the disease was 6.34 +/- 7.2 years, and symptoms were intermittent in 51%. The SCID-I revealed a psychiatric diagnosis in 60% of the patients. In terms of the distribution of psychiatric diagnoses, the most frequently occurring diagnosis was depressive disorders (40%). Most patients (81%) believed that their illnesses were due to stress. The subdomains on the SF-36 measurements were significantly lower than those of the control subjects (P < or = .005). The physical function, vitality, and mental health subdomains of the SF-36 in the patients with a psychiatric diagnosis were significantly lower (P < .05). CONCLUSION: These findings suggested that psychiatric morbidity is high among ICU patients and is detrimental to their quality of life.

Recurrent anaphylaxis due to non-ruptured hepatic hydatid cysts.

BACKGROUND: Hydatid disease, a parasitic infestation of humans, is endemic in the Mediterranean region, Australia, New Zealand and the Middle East, and mostly involves the liver. Anaphylactic reactions, which sometimes are the first manifestations of the disease, frequently occur due to cyst rupture after a minor/major trauma, though they may also be spontaneously seen on rare occasions. In extremely few studies, anaphylactic shock has been reported in patients without macroscopic rupture of the hydatid cysts. CASE REPORT: Our patient had recurrent anaphylactic episodes without any trauma and had been misdiagnosed for several years even though the patient was living in a region endemic for hydatid disease. CONCLUSION: We emphasize that physicians should be highly aware of hydatid disease as a possible etiology for seemingly idiopathic anaphylactic reactions, especially in endemic regions.

Serum amyloid A (SAA) in induced sputum of asthmatics: a new look to an old marker.

BACKGROUND: Some cellular and soluble markers of inflammation in induced sputum have been used for studying airway inflammation in asthma. The aim of this study was to assess the usefulness of systemic inflammation marker serum amyloid A (SAA) in blood and induced sputum to monitor the airway inflammation in asthmatic patients. METHOD: Seventeen non-smokers newly diagnosed mild to moderate asthmatic patients and 10 healthy volunteers were included in this prospective parallel designed study. Inflammatory cell counts, SAA and eosinophil cationic protein (ECP) levels were measured in sera and induced sputum of both groups. All tests were repeated in the asthma group after 6 months of inhaled steroid therapy. The diagnostic accuracy and reproducibility of sputum and blood SAA were estimated. RESULTS: Serum and induced sputum SAA and ECP levels, sputum eosinophils and neutrophils of untreated asthmatic patients were significantly greater compared to the control group. Sputum and sera SAA levels and sputum neutrophils remained unchanged after the 6 months of anti-inflammatory therapy, although ECP levels, sputum eosinophils and macrophages were significantly reduced. The area under the curve (AUC) for sputum SAA was found equal to AUC for sputum ECP (0.87). The reproducibility of sputum SAA was satisfactory (ICC=0.84) as well. CONCLUSION: Our findings suggest that systemic inflammatory marker SAA may be used as a reliable inflammatory marker in asthma. The facts that whether it remarks an ongoing inflammation unresponsive to treatment in the airways or reflects a systemic inflammation needs to be clarified with further studies.

Nigella sativa (black seed) oil does not affect the T-helper 1 and T-helper 2 type cytokine production from splenic mononuclear cells in allergen sensitized mice.

Nigella sativa Linn. (Ranunculaceae) is known to have beneficial effects on a wide range of diseases including asthma. However, the mechanism of action in asthma and other allergic diseases is not entirely clear. The present study was planned to evaluate the effects of Nigella sativa on cytokine production of splenic mononuclear cells in ova-sensitized mice. Nineteen two-month-old BALB/c mice were given 0.3 mL of Nigella sativa oil by oro-eosophageal cannula once a day for a month. The control group consisting of 10 mice took 0.3 mL of 0.9% saline solution by the same route for the same period. In the third week of the study, all mice were sensitized by means of intraperitoneal injections of 20 microg of ovalbumin (OVA-Grade VI, Sigma). Ova injections were repeated three times with 7-day intervals. After another week, all mice were sacrificed by means of cervical dislocation. Then the splenic mononuclear cells (MNCs) of mice were cultured with OVA or Concavalin A (Con-A). From the culture supernatants, IL-4, IL-10 and IFN-gamma were assessed by means of ELISA. The cytokine production of splenic MNCs of mice that were given Nigella sativa for 30 days was not significantly different than those who took saline solution instead. In conclusion, Nigella sativa oil seems not to have an immunomodulatory effect on Th1 and Th2 cell responsiveness to allergen stimulation.

[Evaluation of 105 cases with tuberculous pleurisy]. / Tüberküloz plörezili 105 olgunun degerlendirilmesi.

Tuberculous pleurisy has still importance in the group of exudative pleurisy. In this study we aimed to evaluate clinical, radiological, biochemical, bacteriological and histopathological findings of 105 cases with tuberculous pleurisy retrospectively, between January 1999 and December 2002. Female/male ratio was approximately 1/9 and mean age was 32.6 (range: 15-68). The common symptoms were chest pain (75.2%), cough (54.3%) and dyspnea (47.6%). In 17% cases parenchymal lesions were seen in the chest radiography while parenchymal lesions were found 52% of patients by computed tomography. Adenosine deaminase levels in pleural fluid were high in 80% of cases. PPD reactions was found positive in 84.7% of case. Sputum was studied in 52 cases. In 6 (11.5%) patients both ARB and culture were positive but in 4 (7.7%) patients was only culture positive. Pleural fluid ARB examination of all patients was negative whereas culture was positive only in 5 (5%) of patients. In two patients pleural biopsy material culture was positive for ARB. Cytological examination of pleural fluid revealed lymphocyte predominance in 81 (81%) of cases. Eighty one patients had pleural biopsy and pathologic evaluation revealed tuberculosis in 59 (73%) of them. At the end of the treatment 24 (23%) patients had pleural thickening. Pleural fluid LDH level of the patients with pleural thickening was higher than the other patients significantly (p=0.024). It is concluded that, pleural biopsy is the most effective diagnostic method for the tuberculous pleurisy and in the patient with elevated pleural LDH level, pleural thickening seems more.

[The influence of sarcoidosis on quality of life]. / Sarkoidozun yasam kalitesi üzerine etkisi.

In the follow up of chronic illnesses like sarcoidosis, the psychological and social dimensions are getting more important in addition to the clinical parameters. It is the quality of life (QoL) that brings psychological and social dimensions in to the clinic. In this study we aimed to investigate the QoL of patients suffering from sarcoidosis. Study Short Form (SF-36) QoL scala was applied to 70 sarcoidosis patients who have been followed up in our center at least for a year. Among these patients 49 were females, 21 were males and the mean age was 43.27 +/- 11.97, mean disease duration was 3.55 +/- 1.80 (1-8 years). In our study, we found that variables belonging to sarcoidosis influence the QoL as well as the patient herself/himself. While age and female gender influenced almost all parameters of QoL, in cases with symptoms physical component had been influenced most. Diffusing capacity (DLCO) showed positive correlation with many of the parameters of QoL, whereas disease stage did negative. Patients' income and their to be treatment did not affect QoL. In conclusion, we suggest that QoL may help to follow up and decide on the treatment of sarcoidosis along with the other treatment criteria.