Aslı Gelincik

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.

Omalizumab markedly improves urticaria activity scores and quality of life scores in chronic spontaneous urticaria patients: A real life survey

Treatment of chronic urticaria consists of antihistamines as the first‐line treatment. For more severe symptoms, combinations can be necessary as well as dose augmentations. The recent guidelines suggest the possibility of using omalizumab in resistant cases, but this therapy is still investigational. We treated two patients with idiopathic recurrent angioedema and 12 patients with chronic spontaneous urticaria (CSU) with omalizumab, who had not benefited from the recommended first‐line, second‐line and third‐line treatments. To evaluate the efficacy of the omalizumab treatment, urticaria activity scores (UAS) and chronic urticaria quality of life (CU‐Q2oL) scores were measured at baseline, and at the end of the first and sixth month of the therapy. The dosage and intervals of omalizumab therapy were determined according to the rules suggested for severe asthma treatment. CU‐Q2oL scores and UAS displayed significant improvements in all 14 patients. None of the patients reported any adverse effect during the treatment until the submission of this data. Our results show that omalizumab apparently improves CU‐Q2oL as well as UAS in treatment‐resistant CSU in a real life setting.

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.

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.

Promising option in the prevention of idiopathic anaphylaxis: omalizumab.

Anaphylaxis is a serious and probably lethal systemic reaction which occurs instantaneously after exposure to an allergen. It can occur after exposure to various triggers including allergic and non‐allergic factors. When a trigger cannot be determined, idiopathic anaphylaxis is considered. In idiopathic anaphylaxis presenting with frequent attacks, long‐term prophylaxis with H1 antihistamine and steroid treatment are recommended. Omalizumab, a humanized monoclonal antibody drug which decreases free immunoglobulin E molecules in the circulation, is approved for the treatment of chronic severe persistent allergic asthma. We report a 46‐year‐old female patient with severe uncontrolled allergic asthma and idiopathic anaphylaxis presenting with attacks of abdominal pain, generalized urticaria, feeling of strangulation in her throat and unconsciousness. Omalizumab at a dose of 375 mg once every 2 weeks was administrated and at the end of 3 months anaphylactic attacks had ceased. At the end of the sixth month of omalizumab therapy, her injection intervals were extended to 4 weeks. After she began experiencing moderate attacks of urticaria and hoarsening, however, initial treatment plan was reestablished. Currently, she has completed her first year of treatment without further attacks.

The relationship between transforming growth factor-β1, vascular endothelial growth factor, nitric oxide and Hashimoto's thyroiditis

BACKGROUND Hashimotos thyroiditis (HT) is one of the autoimmune disorders of the thyroid gland. The pathogenesis of HT has not been clearly understood. This study was designed to investigate plasma transforming growth factor-beta1 (TGF-beta1), vascular endothelial growth factor (VEGF), and nitrate/nitrite (NOx - two end products of nitric oxide [NO] metabolism) in HT. METHODS Forty patients diagnosed HT and 40 age- and sex-matched healthy controls were included in the study. TGF-beta1 and VEGF levels were measured by ELISA, NOx levels were measured spectrophotometrically. RESULTS Plasma TGF-beta1 and VEGF were decreased, and NOx increased in HT patients in comparison with controls. There was a significant correlation between TGF-beta1 and VEGF, and weak but significant correlation between TGF-beta1 and NOx in HT. CONCLUSION This study indicates that TGF-beta1, VEGF and NO probably have a role in the pathogenesis of Hashimotos thyroiditis, and development of autoimmunity. Clearly, further studies are necessary to establish the exact mechanism of TGF-beta1, VEGF and NO interaction in Hashimotos thyroiditis.

Evaluation of hypersensitivity reactions to nonsteroidal anti-inflammatory drugs according to the latest classification.

The consensus document for hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs (NSAIDs) proposed by the European Network for Drug Allergy (ENDA) interest group (2011) was revised in 2013. We aimed to evaluate the usability of the latest NSAID hypersensitivity classification of ENDA.

Methotrexate: Can it be a Choice for Nasal Polyposis in Aspirin Exacerbated Respiratory Disease?

Nasal polyposis (NP) is considered a subgroup of chronic rhinosinusitis and is commonly associated with asthma, bronchiectasis, and cystic fibrosis. A certain subgroup of nasal polyposis is known as Aspirin Exacerbated Respiratory Disease (AERD), previously called Samters Triad or aspirin triad, comprising polyposis, asthma, and aspirin hypersensitivity and makes up almost 10% of cases of NP. Therapy of NP involves a combination of medical and surgical treatments. However, recurrences are common, particularly in patients with asthma and aspirin hypersensitivity. Both topical and systemic corticosteroids form the mainstay of conservative therapy for NP as well as a primary treatment and prevention for recurrences. They have been shown to improve nasal breathing, rhinitis symptoms, and reduce the size of NP, along with the rate of recurrence. There is great concern about the adverse effects of systemic steroids, especially when long-term usage is necessary to maintain improvement. So far, no knowledge exists about the effects of methotrexate (MTX) on NP of the patients with asthma. We report two patients whose NP dramatically reduced in size after a course of MTX therapy administered as an additional treatment for their steroid- dependent asthma.

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.

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.