[Mycobacterium abscessus infection management: Macrolide and quinolone desensitization]. / Mycobacterium abscessus enfeksiyonu yönetimi: Makrolid ve kinolon desensitizasyonu.

Antibiotic hypersensitivity reactions can lead to marked morbidity, mortality and inadequate treatment options. Mycobacterium abscessus infection is a difficult management system for clinicians since it most commonly involves the lungs, progresses if untreated, and the organism is resistant to many antibiotics, as well as the agents used in treatment can cause undesirable side effects. Although macrolides are one of the most reliable antibiotic groups in terms of allergic reactions, early type hypersensitivity reactions against macrolides, one of the main antibiotics used in the treatment of Mycobacterium abscessus lung disease, may make the treatment management of the disease difficult. Due to the rapid increase in the use of quinolone in recent years, the frequency of developing allergic reactions with these agents also increases. In cases where antibiotic hypersensitivity is detected, the use of the responsible agent should be avoided, but desensitization may be necessary in cases without different treatment options. In this study, it was aimed to present a case of successful desensitization with clarithromycin and moxifloxacin in a patient who was diagnosed with Mycobacterium abscessus lung disease and developed anaphylaxis with clarithromycin and moxifloxacin after treatment was initiated.

COVID-19 in patients with severe asthma using biological agents.

As the COVID-19 pandemic continues, case reports have been published where patients with severe asthma using biological agents survived with a mild course of illness and encouraged the continuation of biological therapies in patients with severe asthma. However, contrary to previous information, a more severe course of COVID-19 has recently been reported in severe asthmatics using biological therapy compared to the general population. To evaluate the COVID-19 rate and disease severity in severe asthmatics using biological agents. A retrospective study was conducted in patients with severe asthma treated with biological agents. Data concerning whether the subjects had contracted COVID-19 and the severity of the disease were evaluated. Eihgty-four severe asthmatics using biological agents (omalizumab or mepolizumab) aged 48.3 ± 10.6 years (mean ± standard deviation) with female/male ratio: 53 (63.1%)/31 (36.9%) were included in the study. Among participants 13 (15.5%) had contracted COVID-19. The course of COVID-19 was mild in five (38.5%) and moderate in eight patients (61.5%), while none of the patients had a severe course of COVID-19. Mechanical ventilation or intensive care follow-up was not required in any of the six patients (46.2%) who were treated as inpatients. All participants survived COVID-19 in full recovery and no deaths occurred in the cases. A higher rate of COVID-19 was found in patients with severe asthma using biologics compared to those reported in previous reports. However, all patients with COVID-19 have a mild to moderate disease course.

Real-life adherence to subcutaneous immunotherapy: What has changed in the era of the COVID-19 pandemic.

BACKGROUND: Allergen immunotherapy (AIT) must be continued for 3 years, to achieve a long-term modifying effect. Adherence is a key to ensure effectiveness. The objective of this study was, first of all, to evaluate the adherence with subcutaneous immunotherapy (SCIT) and to identify the main causes of SCIT withdrawal in real-life practice in our clinic. Secondly, we also aimed to investigate to what extent the COVID-19 pandemic altered our SCIT receiving patients' treatment adherence behaviors and the factors that affected their decisions. METHODS: Retrospective analysis of the medical records of patients ages ≥18 years, who had started SCIT in January 2014 or later until September 2020 in our department for the diagnosis of allergic rhinitis, allergic asthma or venom allergy, were included in the study. Adherence was determined as the accomplishment of 3 years of SCIT. RESULTS: A total of 124 patients (72 female [58.1%]; median age, 35 [19-77] years) were included. The adherence rate to SCIT in our tertiary center's real-life setting was 56.25% with a follow-up duration of 3 years before COVID-19 pandemic. Dose modification, defined as reducing patient's planned SCIT dose due to a systemic allergic/large local reaction or missed injection, and its frequency, which is the number of dose adjustments done throughout the SCIT, was found to be the only factor related to nonadherence. But with the pandemic only in 6 months, among 63 patients receiving SCIT, 15 patients (23.81%) dropped out, and the most common reason was fear of being infected with COVID-19 virus during receiving SCIT in hospital (93.33%). The only independent predictor of drop-out during the COVID-19 pandemic was short duration of AIT (p = 0.012). When we compare the dropped-out cases before and after the start of pandemic, AIT duration was significantly shorter in pandemic period (p = 0.005). CONCLUSION: Adherence rate to SCIT in our real-world setting study was 56.25% before the COVID-19 pandemic. Our results indicated that patients requiring dose modification were more prone to be non-adherent. Approximately one quarter of patients dropped-out with the start of pandemic, almost all due to fear of being infected during receiving SCIT in hospital. Since short SCIT follow-up time was found to be the only risk factor for drop-out during the COVID-19 pandemic, we believe that patients who are in the early phases of their treatment should be observed more closely and their concerns should be answered by their doctors.

COVID-19 in a patient with severe asthma using mepolizumab.

Background: There is a lack of information about the course of coronavirus disease 2019 (COVID-19) in patients with severe asthma who were treated with biologics. Some reports indicated that treatment with benralizumab, dupilumab, and omalizumab in patients with severe asthma was not associated with significant adverse effects during COVID-19. Methods: Asthma itself or the biologic agents used to treat asthma can have a positive effect on the course of COVID-19. There seem not to be any cases that specifically reported the use of mepolizumab in a patient who was infected with COVID. Results: We reported of a 55-year-old woman with a diagnosis of severe asthma for; 3 years and who was being treated with mepolizumab, with no evidence of loss of asthma control, at the time of contracting COVID-19 and who had been followed up in the allergy clinic. In addition, there are no data on mepolizumab therapy in patients with elevated liver enzyme levels. Conclusion: With this case, we also reported that no adverse effects were observed during mepolizumab treatment in a patient with elevated liver enzyme levels.

Effects of long-term non-invasive home mechanical ventilation on chronic respiratory failure.

OBJECTIVE: Chronic respiratory failure (CRF) is a syndrome defined by certain disturbances in arterial blood gases. Non-invasive mechanical ventilation (NIMV) is an increasingly used treatment modality in respiratory failure. The aim of this study was to investigate the long-term effects of NIMV on pulmonary function and survival of patients with CRF. METHODS: The study enrolled 170 CRF patients who it was decided should receive long-term home mechanical ventilation. Patients were stratified into two distinct groups - Group I (patients for whom NIMV was recommended and who had used it) and Group II (patients for whom NIMV was recommended at least 1 year ago but who had not used it for various reasons). Best arterial blood gas and pulmonary function test values in the year before the NIMV recommendation were obtained from patient records. The same tests were performed at least 1 year (1-5 years) after initiation of NIMV therapy in Group I patients and at least 1 year (1-5 years) after prescription of the device in Group II. RESULTS: In the assessments performed 1 year after NIMV recommendation, no difference was found between groups in terms of hospital admissions. However, in Group I, intra-group analysis showed a reduction in the number of hospitalizations 1 year after NIMV. A marked reduction in PaCO(2) level was found in Group I patients 1 year after NIMV therapy. Mean survival after NIMV recommendation was 40.27 +/- 3.56 months in Group I, and 27.35 +/- 3.68 months in Group II (log rank = 7.79; p = 0.005). It was found that survival time increased as duration of NIMV usage increased. CONCLUSION: NIMV therapy has some important and significant benefits in patients with hypercapnic chronic respiratory failure. This study has some limitations in terms of patient selection, power analysis and survival analysis. To assess the effects of NIMV on mortality and pulmonary functions, the authors believe that there is need for prospective, controlled, multicentre studies with longer follow-up periods, improved adherence and novel ventilator modes and settings.