Adile Berna Dursun

Endobronchial metastases: a clinicopathological analysis

Objective:  It is important to distinguish endobronchial metastases (EBM) from both primary lung cancers and benign lesions, as treatment will differ. The clinicopathological characteristics of EBM cases were documented to see whether any distinguishing features exist.

Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity.

Data are limited about the value of skin tests in the diagnosis of proton pump inhibitor (PPI)‐induced hypersensitivity reactions and the cross‐reactivity between PPIs. We aimed to assess the role of skin testing in the diagnosis of PPI‐related immediate hypersensitivity reactions and the cross‐reactivity patterns among PPIs.

The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma

OBJECTIVES Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population and can complicate asthma management. The aim of this study was to evaluate the presence of OSA in patients with difficult-to-treat asthma (DTA) and to investigate the sleep quality in these patients. METHODS Patients with DTA were recruited from the adult allergy clinic of a tertiary care hospital. After completing the Sleep Questionnaire and Epworth Sleepiness Scale, all participants underwent overnight polysomnography. The demographic and asthma severity assessments included the following measures: the age at diagnosis, duration of illness, smoking and atopy status, results of pulmonary function tests, number of asthma control medications used, and number of hospitalizations and emergency room visits because of asthma and analgesic hypersensitivity according to apnea-hypopnea index (AHI) scores. RESULTS We analyzed 47 (M:9/F:38) DTA patients with a mean age of 48.74±9.45 years. The mean duration of asthma was 9.17±6.5 years. Twenty-four (51.1%) patients were atopic. The analgesic hypersensitivity rate was 27.7%. Fourteen patients (29.8%) were former smokers and 2 patients were current smokers. Sleep quality was impaired in all patients. Thirty-five patients (74.5%) had OSA, 11 of whom had mild OSA, and 24 patients had moderate-severe OSA. The presence of OSA was not statistically correlated with asthma characteristics. CONCLUSION The study showed that there is a remarkably high prevalence of OSA in DTA. Although no statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, all DTA patients should be assessed for OSA.

Management of Hypersensitivity Reactions to Proton Pump Inhibitors: A Retrospective Experience

Background: We previously reported perfect specificity and low sensitivity of skin tests in proton pump inhibitor (PPI)-induced immediate hypersensitivity reactions in a prospective multicenter study. Here, in a retrospective study, we aimed to further evaluate the diagnostic workup procedures and characteristics of the patients with suspected PPI hypersensitivity. Methods: This national multicenter study was conducted as a retrospective chart review of patients with a history of PPI-induced immediate hypersensitivity reaction. A total of 60 patients were included. Results of diagnostic workup procedures (standardized skin-prick, intradermal, and oral-provocation tests with PPIs) and the characteristics of the patients were analyzed. Results: Lansoprazole was the most commonly suspected drug with 41 patients (68.3%), followed by pantoprazole in 12 patients (20.0%), esomeprazole in 6 (10.0%), rabeprazole in 4 (6.7%), and omeprazole in 1 (1.7%). Anaphylaxis (40 patients, 66.7%) was the most common clinical presentation followed by urticaria (17 patients, 28.3%). Diagnostic skin tests with the culprit PPI were positive in 13/26 patients (50.0%). Diagnostic oral-provocation tests were negative in 6/8 patients; 5 of these 6 patients had skin test results with the culprit PPI, and all were negative. Ten patients had at least 1 cross-reactivity. Extensive cross-reactivity (between >2 PPIs) was detected in 4 patients. Conclusions: Lansoprazole was the most frequently implicated drug and anaphylaxis was the most frequent manifestation of PPI-induced hypersensitivity reactions. Physicians should be aware of the possible cross-reactivity among PPIs; however, a safe, alternative PPI can usually be detected by a thorough drug allergy workup.

Does gender affect asthma control in adult asthmatics

Several studies have shown gender differences in prevalence of asthma but there is little information about asthma control. In this study, we aimed to evaluate the effect of gender on asthma control in adult asthmatics. Medical records of 242 patients older than 18 years of age who regularly visited the allergy unit were evaluated. Standardized asthma questionnaires like the asthma control test (ACT) were performed. ACT scores, clinical characteristics, and demographic data such as smoking status, education, duration and severity of asthma, atopic status, family history of asthma, analgesic hypersensitivity, number of emergency visits, and hospitalization in the previous year were compared based on gender. In this study, 77.3% of the patients were female. Mean age, body mass index, and duration of asthma were 39.0 ± 0.7, 27.3 ± 0.3, and 6.6 ± 0.4 years, respectively. Of the total, 14.9% of the patients were smokers. Also, 55.8% of them were graduated from middle school, 22.7% from high school, and 14% from university. Atopy rate was 57%. Analgesic hypersensitivity was found in 18.6% of them. There was 30.2% family history of asthma. The asthma severity was mild in 45.5%, moderate in 40.9%, and severe in 13.6% of the patients. One-third of the patients were admitted to emergency room; 1/10th were hospitalized due to asthma in the previous year. ACT scores indicated complete control in 67.8%, partial control in 17.8%, and uncontrolled asthma in 14.5%. Comparing the results of males with females having asthma, there was no statistically significant difference between the two gender according to ACT scores and clinical characteristics. Finally, the results conclude that there was no effect of gender on asthma control assessed with standardized questionnaire in adult asthmatics.

Two Cases of Tracheal Disease Misdiagnosed as Difficult-to-Treat Asthma

Initial management of patients with difficult-to-treat asthma must begin with confirmation of the diagnosis. We present 2 cases of tracheal disease misdiagnosed as difficult-to-treat asthma. After systemic evaluation, tracheomalacia and tracheobronchial narrowing due to diffuse calcification of the cartilaginous rings were found as mimicking asthma.

Prediction of atopy via total immunoglobulin E levels andskin prick tests in patients with psoriasis

BACKGROUND/AIM Although the etiopathogeneses of psoriasis and atopy appear to be different, psoriasis has been found to be associated with atopy and atopic dermatitis. In this study, we aimed to determine the role of atopy by examining the medical history and clinical and laboratory findings of patients with psoriasis. MATERIALS AND METHODS Patients with psoriasis, asthma patients, and healthy volunteers were included in the study. Serum total immunoglobulin E (IgE) levels were obtained, and prick tests were administered to all groups. RESULTS Psoriatic patients demonstrated percentages of atopy history (21.3%) that were higher than those of the healthy subjects (15.7%). The median total IgE level in psoriatic patients was found to be statistically higher than that in the healthy control group (P > 0.05). With respect to mite positivity, there were statistically significant differences in the psoriatic (P < 0.05) and asthmatic groups (P < 0.001) when compared to the healthy control group. CONCLUSION Our study is the first to use skin prick tests with psoriatic patients. Skin prick test sensitivity to mites increased in psoriatic patients, and we believe that this finding may be useful in protecting psoriatic patients from activation of psoriasis and in determining the appropriate treatment approach.

Anxiety and depression levels are different in patients between allergic rhinitis and asthma

Methods Subjects without known psychiatric diseases were consecutively recruited from pulmonary and allergy outpatient clinics at the third level hospitals. Diagnosis of asthma and AR was based on GINA and ARIA guideline, respectively. Only patients without asthma were chosen for AR group in order to compare with asthma. Depression and anxiety symptoms were evaluated using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

Role of skin tests in the diagnosis of immediate hypersensitivity reactions to taxanes. Results of a multicenter study

BACKGROUND Immediate hypersensitivity reactions (HSRs) to taxanes have been increasing in recent years, but the importance of skin tests in allergological workup has not been established. OBJECTIVE In our study we tried to evaluate the role of prick and intradermal tests in the diagnosis of HSRs to paclitaxel and docetaxel. METHODS In this multicenter prospective study, we enrolled patients with immediate HSRs to the aforesaid agents. Skin tests were performed on these subjects and if results were negative, intradermal tests with the culprit drug were conducted. Patients with grade 1 reactions subsequently underwent graded challenge; in cases of grade 2 or 3 reactions and/or positive test results, the culprit drug was administered with a desensitization schedule. Skin tests were also performed in 30 control subjects exposed to the taxanes without HSRs. RESULTS A total of 84 patients (63 with HSRs to paclitaxel and 21 to docetaxel) were recruited in the period July 2015 to July 2017 by 8 centers; 58 patients (69%) developed grade 2 or 3 reactions. Prick test results were negative in all the cases, whereas intradermal test results were positive in 14 patients (10 with paclitaxel [15.9%] and 4 with docetaxel [19%]). The positivity of skin tests significantly correlated with grade 3 reactions and cutaneous involvement during HSRs. Graded challenge was performed in 16 patients without problems and 58 subjects underwent desensitization, which was well tolerated in all but 2 cases. In the control group, skin test results were negative in all the patients. CONCLUSIONS Skin tests for taxanes seem useful and can be performed in the allergological workup of subjects with HSRs to these agents, especially in cases of severe reactions with cutaneous involvement.

The comparison of anxiety and depression levels in asthma and COPD patients

Background: Both asthma and COPD affect mental health due to their impact on activities, sleep and social life of patients and can be resulted in anxiety and depression. Objective: To determine and compare the prevalence of anxiety and depression in asthma and COPD patients. Methods: Subjects without known psychiatric diseases were consecutively recruited from pulmonary and allergy out-patient clinics at the third level hospitals. Diagnosis of asthma and COPD was based on GINA and GOLD guideline, respectively. Depression and anxiety symptoms were evaluated using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Results: Study group consisted of 53 patients-30 with asthma and 23 with COPD. All patients had moderate-to severe diseases. COPD group was older, had more smoking history and higher number of hospitalization than those in asthmatics. Atopy rate and education level was higher in asthmatics than those in COPD group. The mean BDI and BAI scores were 17.96±12.39 and 20.57± 12.67 in the whole group. Both group had similar degree of anxiety (21.23±11.7 vs. 19.7±14), whereas BDI score was significantly higher in COPD group than that in asthmatics (15.63±13.6 vs. 21±10.1) (p=0.02). Age, gender, smoking history, education level, atopy status, number of emergency room admission was not correlated with scores of BDI and BAI for both group. The only effective parameter on BDI score in COPD patients was having comorbidities. Conclusion: Both asthmatics and COPD patients regardless of their socio demographic and clinical features have similar degree of anxiety. In addition, COPD patients are more depressive than asthmatics. The study indicates that psychiatric evaluation should be a part of tailoring therapy in chronic respiratory