False negative effect of high triglycerides concentration on vitamin D levels: A big data study.

Background: Inaccurate test results may be a reason why vitamin D deficiency is seen as a common problem worldwide. Interferences from the sample matrix during testing are the most important factors in measurement errors. In this study, the relationship between triglycerides and total cholesterol levels and vitamin D levels in Turkey was investigated. Methods: The 25-hydroxyvitamin D test results and lipid test results studied in Turkey in 2021 were compared. Data were obtained from the Ministry of Health National Health Database. Simultaneously, 25-hydroxyvitamin D, triglyceride, and total cholesterol levels were studied, and 1,135,644 test results were taken as the basis. Results: In the group of patients with total cholesterol levels between 0-10.33 mmol/L, the proportion of patients below 20 mg/L ranged from 56.8% to 61.8%. In the patient group with cholesterol between 10.36-259 mmol/L, the rate of patients with less than 20 mg/L was between 70.8-100%, while the rate of patients with cholesterol above 100 mg/L was 0%. The mean 25-hydroxyvitamin D level was 20.1 mg/L in the patient group with a total cholesterol level between 0-10.33 mmol/L, and 16 mg/L in the patient group with a cholesterol level above 10.36 mmol/L. The mean 25-hydroxyvitamin D level was 20.11 mg/L in the patient group with triglycerides 0-10.16 mmol/L, and the 25-hydroxyvitamin D level was 12.28 mg/L in the patient group with triglycerides 10.17-113 mmol/L. The proportion of patients with vitamin D levels above 100 mg/L was found to be 0% in the group of patients with triglycerides above 10.17-113 mmol/L. Conclusions: According to this study, there is a risk of toxicity when administering vitamin D therapy in patients with high cholesterol and triglycerides levels. This study is the first of this size in the literature. High triglycerides and cholesterol levels can cause inaccurate measurement of vitamin D levels, so care should be taken when evaluating these tests.

Omalizumab is effective in nasal polyposis with or without asthma, a real-life study.

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) can be recalcitrant in some patients despite medical therapies and surgery and has higher morbidity. Omalizumab is a new treatment option for patients with CRSwNP. The aim of this study is to evaluate the efficacy and safety of omalizumab (anti-IgE antibody) in patients with CRSwNP. Methods: The efficiency and adverse effects of omalizumab were evaluated based on the data extracted from medical records of patients with CRSwNP. Patients were evaluated monthly for efficacy and adverse reactions. Treatment efficacy was evaluated by visual analog scale (VAS) for rhinorrhea, postnasal drip, sneeze, smell, and nasal stuffiness complaints, sinonasal outcome test-22 (SNOT-22), and nose obstruction symptom evaluation (NOSE) score. Results: 17 patients with CRSwNP formed our cohort. The mean (SD) age, weight, and total IgE level were 41.9 (9.4) years, 78.6 (15) kg, and 198.8 (169.2) IU/mL, respectively. 3 patients had mild, 6 had moderate and 1 had severe asthma as comorbidity. The mean (SD) duration of omalizumab treatment and polypectomy numbers were 9.2 (13.3) months and 2.9 (1.5), respectively. All patients had at least one polyp surgery. All sinonasal outcome parameters were significantly improved by the omalizumab treatment, also in subgroups with and without asthma. The median changes from baseline at the last visit date for omalizumab treatment were as follows: SNOT-22 score decreased from 98 to 19, NOSE score decreased from 100 to 20, the VAS for postnasal drip, rhinorrhea, nasal stuffiness, smell and sneeze decreased from 8 to 2, 8 to 2, 10 to 3, 10 to 2, 6 to 1, respectively (P < 0.001). Patients experienced no adverse reaction with omalizumab treatment. Conclusion: Omalizumab was an effective treatment in patients with recalcitrant CRSwNP with or without asthma.

Higher Levels of Depression and Anxiety in Patients with Chronic Urticaria.

BACKGROUND Chronic urticaria (CU) is a common disease, characterized by the development of wheals, angioedema, or both. CU reduces quality of life and can also cause emotional distress. Studies addressing depression and anxiety in such patients are rare in the literature. The aim of this study was to determine the relationship between urticaria symptoms and depression and anxiety in patients with CU. MATERIAL AND METHODS The Hospital Anxiety-Depression Scale (HADS) was used to evaluate depression and anxiety in patients with CU. We included 50 patients with CU and a control group of 60 healthy volunteers. Urticaria activity score, medications, age, sex, comorbidities, occupation, and income of patients were recorded. Depression and anxiety scores were evaluated between the patient and the healthy groups. RESULTS The HADS questionnaire showed that 24 (48%) subjects in the patient group had depressive symptoms and 24 (48%) had anxiety, and both of these conditions were significantly more frequent than in controls (p=0.002 and p=0.001). The mean anxiety and depression scores ±SD were 10.82±4.29 and 7.74±4.49 in the patient group and 6.42±3.02 and 4.85±3.26, in the control group respectively (p=0.001). The mean score of the UAS ±SD was 23.14±13.40 and a significant positive correlation between UAS and the anxiety and depression scores was observed (r=0.400; p=0.004 and r=0.373; p=0.004, respectively). CONCLUSIONS Our data demonstrated that depression and anxiety symptoms are more common in patients with CU than in the control group. Therefore, we should pay attention to the potential of mental comorbidities while managing patients with CU.

Evaluation of long-term safety and efficacy of omalizumab in elderly patients with uncontrolled allergic asthma.

BACKGROUND: Severe asthma management in elderly patients may be difficult because of increased comorbid conditions, polypharmacy, physiologic changes that occur with aging, incorrect use of inhaler devices, and poor adherence. OBJECTIVE: To evaluate the long-term safety and efficacy of the anti-IgE antibody omalizumab in elderly (aged ≥65 years) patients with uncontrolled allergic asthma. METHODS: The efficiency and adverse effects of omalizumab treatment were evaluated based on data extracted from medical records. Patients were evaluated monthly for efficacy and adverse reactions. Treatment efficacy was evaluated by level of asthma symptom control, using the Global Initiative for Asthma guideline. RESULTS: Nineteen consecutive elderly patients with asthma (female to male ratio, 14:5) formed our cohort. The mean (SD) age, disease duration, and total IgE level were 69.3 (5.8) years, 19.4 (8.6) years, and 299.1 (197.2) IU/mL, respectively. The mean (SD) duration of omalizumab treatment was 35.6 (17.8) months (range, 9-66 months). All the patients had at least 1 perennial inhalant allergen sensitivity and had uncontrolled allergic asthma. Elderly patients experienced no significantly important adverse reaction considered to be related to omalizumab treatment. Only 1 patient had a local adverse reaction and 1 had myalgia that was considered to be drug related. After omalizumab treatment, asthma symptoms were well controlled in 9 patients (47.4%) and partly controlled in 8 patients (42.1%). Two of the patients (10.5%) still had uncontrolled asthma. CONCLUSION: Our study found that omalizumab is a well-tolerated and effective therapy for elderly patients with uncontrolled asthma.

Omalizumab treatment in asthma-COPD overlap syndrome.

INTRODUCTION: Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a poorly understood disease with an increasing morbidity and mortality. Currently, the most effective treatment for ACOS is unknown and omalizumab for ACOS has not yet been reported. METHODS: We report our experience with anti-IgE, omalizumab treatment on 3 patients with ACOS as a retrospective case study. RESULTS: After 1 year of omalizumab treatment, patients experienced significantly lower rates of asthma exacerbation and hospitalization and better asthma control test results. CONCLUSION: Our study shows that omalizumab may be an effective and safe therapy for patients with ACOS. However larger randomized trials are needed.