Ersoy Civelek

The effect of polymorphisms at the CD14 promoter and the TLR4 gene on asthma phenotypes in Turkish children with asthma

Background:  Endotoxin, with its potential to enhance type 1 immunity, is a significant player in the hygiene hypothesis. The combined effects of the genetic variants of various molecules in the endotoxin response pathway on asthma related phenotypes are largely unknown.

ALOX5 promoter genotype, asthma severity and LTC4 production by eosinophils

Background:  The number of Sp1–Egr1 binding tandem repeats at the ALOX5 promoter influences gene transcription and may modify the response to anti‐leukotriene treatment. The relationship of ALOX5 variants to asthma severity and leukotriene production by eosinophils is unknown.

Chronic Urticaria: Etiology and Natural Course in Children

Background: Chronic spontaneous urticaria (CSU) in childhood is infrequent, and information about the disease in children is limited. We attempted to investigate its etiologic factors, natural course, and predictors of prognosis. Methods: All children aged ≤18 years followed for CSU during an 8-year period were analyzed retrospectively, and the final outcomes were queried via a telephone interview. Results: One hundred patients (male/female ratio 1.27) with a median age of 9.2 years (range 0.7–17.2) at symptoms onset were evaluated. The median follow-up was 2.5 years (range 0.2–18.1). An autologous serum skin test was positive in 46.7% of the subjects (n = 45), with a female predominance (71.4%) (p = 0.023). In 13.8% of the children, ANA titers were over 1/100. Food allergy (n = 1), thyroid autoantibodies (n = 3), possible collagen disease (n = 1), and drug usage (deferoxamine) (n = 1) were found to be associated factors. Infections could not be confirmed as the cause of CSU. Recovery was seen in 16.5, 38.8, and 50.0% of the children after 12, 36, and 60 months, respectively. Though in multivariate analysis none of the factors, including age, gender, autologous serum skin test positivity, the presence of angioedema, or other allergic diseases, appeared to predict the prognosis, in univariate analysis being female and being older than 10 years of age predicted an unfavorable prognosis. Conclusion: The etiology of CSU in children is mainly related to an autoreactive background, as in adults. CSU has a favorable prognosis, and resolution is seen in half of the children within 5 years. Girls older than 10 years may have an unfavorable prognosis.

Epidemiology and Burden of Rhinitis and Rhinoconjunctivitis in 9- to 11-Year-Old Children:

Background Rhinoconjunctivitis (RC) is regarded as the most common chronic disease of childhood; however, the currently available epidemiological studies on prevalence, burden, and risk factors of RC are insufficient. This analysis aimed to investigate potential risk factors, symptom frequency, and burden of RC. Methods Using the International Study of Asthma and Allergies in Childhood Phase II questionnaires, 6963 elementary school children aged 9–11 years were surveyed in five different city centers of Turkey. All participants were skin-prick tested with common aeroallergens. Results The prevalence of ever rhinitis, physician-diagnosed rhinitis, current rhinitis, and current RC were 51.6, 31.0, 43.5, and 23.1%, respectively; 19.8% of children with RC symptoms were atopic to at least one allergen. Among students with RC symptoms, 42.2, 23.9, 35.8, and 28.2% reported moderate–severe interference of daily activities, at least 1 day of absence from school, visit to a health care professional, and any drug usage for rhinitis, respectively. Nasal decongestants and oral antihistamines were the most frequently used treatment. Approximately 70% of RC patients reported perennial symptoms and 42.8% were classified as mild to intermittent. Multivariate logistic regression analysis revealed family history of asthma and/or allergic rhinitis (odds ratio [OR] = 1.863; confidence interval, [CI] = 1.583–2.191; p < 0.001), living in a house with mold and dampness in the 1st year of life (OR = 1.651; CI = 1.356–2.01; p < 0.001), maternal smoking in pregnancy (OR = 1.425; CI = 1.089–1.864; p = 0.011), low monthly income (OR = 1.685; CI = 1.422–1.998; p = 0.001), current wheezing (OR = 2.543; CI = 2.151–3.006; p = 0.001), and current atopic eczema (OR = 2.503; CI = 1.96–3.196; p = 0.001) as significant risk factors for current RC. Conclusion Along with the high prevalence of RC in childhood, underdiagnosis and undertreatment of the disease are also frequent. The socioeconomic burden of the disease can be reduced by increasing awareness and proper diagnosis/treatment.

Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers

Abstract Objective: To address the problems about correct use of inhaler devices, adherence to inhaler corticosteroid treatment and the effects of these problems on the control of asthma. Methods: Children with asthma were evaluated for the correct use of inhaler devices and adherence to therapy using a questionnaire. Effect of these on control of asthma was defined. Results: A hundred and seventy-one patients and/or their families were interviewed. The mean age was 8.29 ± 4.65 years (1–19) and 62.6% were male. Metered dose inhaler (MDI) with spacer was used by 119 (69.5%) patients and 52 (30.5%) used dry powder inhalers (DPIs). The devices were used correctly by 68.1% of patients using MDI and 34.6% of patients using DPI (p < 0.001). The most common improper step was “breathe in from the spacer 5–6 times or 10 s” for MDI (24.4%) and “exhale to residual volume” for DPI (51.9%). Frequency of correct use was higher in patients trained 3 times (p < 0.001). Asthma was controlled more frequently among correct users (p < 0.001). Partial or poor adherence was showed 22.8% of patients. Patients with mothers who had lower educational status had higher frequency of incorrect use of inhaler device (p = 0.007). Conclusion: It was found that asthma control was better among correct users. Repetitive training about using devices may contribute improving inhaler technique. Especially children whose mothers had low education level and patients using DPI should be evaluated more carefully.

Turkish physicians’ perception of allergic rhinitis and its impact on asthma

Background:  The clinical association of rhinitis and asthma has been recognized for centuries, leading to a current definition of ‘one airway, one disease’. Current findings indicate that the optimal treatment of rhinitis might improve coexisting asthma.

Are risk factors of childhood asthma predicting disease persistence in early adulthood different in the developing world

Background:  Predictive factors of childhood asthma for favorable prognosis may differ between populations where a variety of genetic and environmental factors are present.

Risk Factors for Current Wheezing and Its Phenotypes Among Elementary School Children

Accumulating evidence suggests, asthma includes many phenotypes with varying clinical and prognostic features. Epidemiological surveys documented a number of environmental risk factors for the development of asthma and interestingly these differ between and within countries, suggesting that the differences may be related with the different distribution of asthma phenotypes. This study aimed to investigate risk factors of current wheezing (CW) and different wheezing phenotypes in elementary school children.

Direct oral provocation tests in non-immediate mild cutaneous reactions related to beta-lactam antibiotics

Skin testing has a limited role in the diagnosis of non‐immediate beta‐lactam hypersensitivity in children. The aim of this study was to report the results of oral provocation tests performed without skin tests in children with non‐immediate mild cutaneous reactions without systemic symptoms caused by beta‐lactam antibiotics.

Pollen counts and their relationship to meteorological factors in Ankara, Turkey during 2005-2008

Pollen plays an important role in the development and exacerbation of allergic diseases. We aimed to investigate the days with highest counts of the most allergenic pollens and to identify the meteorological factors affecting pollen counts in the atmosphere of Ankara, Turkey. Airborne pollen measurements were carried out from 2005 to 2008 with a Burkard volumetric 7-day spore trap. Microscope counts were converted into atmospheric concentrations and expressed as pollen grains/m3. Meteorological parameters were obtained from the State Meteorological Service. All statistical analyses were done with pollen counts obtained from March to October for each year. The percentages of tree, grass and weed pollens were 72.1% (n = 24,923), 12.8% (n = 4,433) and 15.1% (n = 5,219), respectively. The Pinaceae family from tree taxa (39% to 57%) and the Chenopodiaceae/Amaranthaceae family from weed taxa, contributed the highest percentage of pollen (25% to 43%), while from the grass taxa, only the Poaceae family was detected from 2005 to 2008. Poaceae and Chenopodiaceae/Amaranthaceae families, which are the most allergenic pollens, were found in high numbers from May to August in Ankara. In multiple logistic regression analysis, wind speed (OR = 1.18, CI95% = 1.02–1.36, P = 0.023) for tree pollen, daily mean temperature (OR = 1.10, CI95% = 1.04–1.17, P = 0.001) and sunshine hours (OR = 1.15, CI95% = 1.01–1.30, P = 0.033) for grass pollen, and sunshine hours (OR = 3.79, CI95% = 1.03–13.92, P = 0.044) for weed pollen were found as significant risk factors for high pollen count. The pollen calendar and its association with meteorological factors depend mainly on daily temperature, sunshine hours and wind speed, which may help draw the attention of physicians and allergic patients to days with high pollen counts.