Filiz Sebik

Sensitization to cat allergens in non–cat owner patients with respiratory allergy

BACKGROUND Cats represent one of the most important sources of indoor allergens. The sensitization rate can reach up to 60% in western countries. Keeping cats indoors is uncommon in big cities in Turkey, but cats living in the streets are common. OBJECTIVE To investigate the prevalence of sensitization to cats in patients with respiratory allergy from Izmir, Turkey, and its relationship to home cat allergen levels. METHODS A total of 387 patients (70.8% female; mean age, 34.3 years) with respiratory allergic diseases (rhinitis and/or asthma) were included in this study. Skin prick test to cat was performed. House dust samples were collected from the living room of 25 patients and 14 healthy subjects. The major cat allergen (Fel d 1) levels were measured by Dustscreen. Fel d 1 levels given by the manufacturer were as follows: 0.05, 0.13, 0.40, 1.1, and 6.2 mU/mL. RESULTS The prevalence of cat sensitivity was 44.7% (n = 173). Only 6 patients (1.6%) had a history of feeding a cat in their houses. Thirty-six (92%) of 39 houses had detectable levels of cat allergen (mean Fel d 1 level, 2.24 +/- 2.69 mU/mL). The mean Fel d 1 levels were 1.58 +/- 2.51 mU/mL in the healthy group, 1.91 +/- 2.61 mU/mL in the asthmatic group, and 3.26 +/- 2.85 mU/mL in the group with allergic rhinitis (P = 0.12). The prevalence of cat sensitivity in patients who had 1.1 mU/mL of Fel d 1 in their homes was 57.1%. This rate was five times lower (11.1%) in patients who had the highest Fel d 1 level (6.2 mU/mL) in their homes. CONCLUSIONS The prevalence of cat sensitivity in Izmir, where cats are generally not kept within homes, is as high as in western countries. The sampled houses have measurable levels of Fel d 1 even in the absence of indoor cats. High prevalence of cat sensitivity in Izmir is probably due to indirect exposure.

The determinants of bronchial hyperresponsiveness in patients with allergic rhinitis

BACKGROUND Patients with allergic rhinitis and bronchial hyperresponsiveness (BHR) may be at higher risk of developing asthma. OBJECTIVE To investigate whether reactivity to aeroallergens in skin prick testing (SPT) and serum eosinophil cationic protein levels can be used to predict BHR in allergic rhinitis patients. METHODS Fifty-nine consecutive patients with allergic rhinitis underwent SPTs using grass, tree, weed, parietaria, Alternaria, Aspergillus, mites, and cat and dog dander extracts. Methacholine challenge tests were performed using spirometry. RESULTS Methacholine-induced BHR was detected in 23 patients (39%). Of 59 patients, 14 had 1 positive SPT response, 35 had 2 to 4 positive responses, and 10 had more than 4 positive responses. There was a significant inverse correlation between methacholine provocation concentration that caused a decrease in forced expiratory volume in 1 second of 20% (PC20) and the number of positive SPT responses (r = -0.28; P = .03). The BHR-positive patients had a mean of 4 positive SPT responses, whereas BHR-negative patients had a mean of 2.6 (P = .04). Nine BHR-positive patients (39%) and only 1 BHR-negative patient (3%) had more than 4 positive SPT responses (P < .001). There was no correlation between serum eosinophil cationic protein levels and methacholine PC20 doses. There was a strong association between hyperresponsiveness to methacholine and both cat and dog dander sensitivity (P < .001 and P = .001, respectively). CONCLUSIONS Allergic rhinitis patients with SPT responses to a higher number of allergens are more likely to have BHR. Whether the number of positive SPT responses correlates with the risk of developing asthma in allergic rhinitis patients remains to be determined.

Superior vena cava syndrome together with multiple venous thrombosis in Behçet's disease

In this paper, we describe a 25-year-old white man with Behçets disease who developed superior vena cava syndrome which was followed with the diagnosis of pseudotumour cerebri based on bilateral papilledema for 6 months. Complete superior vena cava obstruction was detected by magnetic resonance imaging (MRI). Secondary reasons for papilledema were all excluded. Treatment of prednisone, pulse cyclophosphamide and heparin was started and clinical symptoms and fundoscopic changes completely disappeared in 2 weeks. In conclusion, we think that Behçets disease should always be remembered in the differential diagnosis of unidentified neurological signs especially in regions where the disease is relatively common.

Serum Eosinophil Cationic Protein (ECP) Levels in Patients with Seasonal Allergic Rhinitis and Allergic Asthma

We studied serum ECP levels in 21 seasonal allergic patients (16 patients with rhinitis; 5 with rhinitis and asthma) diagnosed by history, skin tests, and RAST. Seventeen healthy subjects were selected as a control group. None of the patients had received medications. Total IgE levels were also measured and correlated with ECP levels. Mean IgE level was found to be higher in patients than controls (p < 0.05). Patients with asthma and rhinitis had higher IgE values than those with rhinitis alone (p < 0.05). Serum ECP levels in the patient group were significantly higher than those in the control group (p < 0.05). No statistically significant difference was found between ECP levels in patients with rhinitis and rhinitis plus asthma groups, although mean ECP was higher level in the later group. Total IgE and ECP levels were correlated positively in the patients (r = 0.630, p < 0.05). We conclude that the extent of allergic inflammation in mucosal surfaces such as allergic rhinitis plus asthma, might influence serum ECP levels.

T Cell Subpopulations and IL-2R in Vitiligo

Immunological alterations have been implicated in the etiopathogenesis of vitiligo. The aim of this study was to determine peripheral lymphocyte subpopulations and interleukin‐2 receptor (IL‐2R) in patients with vitiligo. Forty‐five vitiligo patients (24 female, 21 male) and 34 healthy controls (11 female, 23 male) were included into the study. Eight (17.8%) of the patients had the segmental type, and 37 (82.2%) had generalized vitiligo. The disease was active in 25 (55.6%) patients; the other 20 (44.4%) patients had static vitiligo. Flow cytometry was used to determine the percentages of total T‐lymphocytes, B‐lymphocytes, helper/inducer T cells, suppressor/cytotoxic T cells, natural killer (NK) cells, activated T cells and interleukin‐2 receptor (IL‐2R) with the use of CD3, CD19, CD4, CD8, CD16, HLA‐DR and CD25 monoclonal antibodies, respectively. The mean value of helper T cells showed a significant difference (p=0.01) between the two groups with the value being 32.5% in patients and 38.1% in control subjects. CD4/CD8 was significantly lower in vitiligo patients (p=0.04). There was also a statistically significant difference in the mean percentage of activated T cells between vitiligo patients and control subjects (4.7 and 8.1, respectively; p=0.001). No statistically significant differences were found when the values were compared between segmental and generalized vitiligo patients, or between active and static cases. In conclusion, T helper/inducer cells, CD4/CD8 ratio and activated (HLA‐DR+) T cells are decreased in vitiligo patients, suggesting a role for changes in cellular immunity.

House dust mite allergens in Turkish homes

Exposure to house dust mites (HDMs) is a major risk factor for allergic sensitization and asthma (1). Assessing HDM allergen exposure at home is critical to evaluate risk factors for sensitization and can play a role in controlling environmental factors that contribute to asthma severity (2). Although it is reported that the predominated HDM was Dermatophagoides pteronyssinus in Turkish homes (3), data on mite allergen levels has never been reported. Therefore, we aimed to investigate HDM allergen levels of homes in Izmir, the third populated city in Turkey situated next to Aegean Sea and to identify predictors of dust mite allergen concentration. Dust samples were obtained from 25 homes of allergic patients with perennial symptoms, consecutively referred to our out patient clinic for the first time for their allergies. Fourteen healthy subjects served as a control group. House dust samples were collected from an area of 1 m with a 1200-W, filtered vacuum cleaner. Dust mite allergen (Der p 1 and Der f 1) concentration was determined by Dustscreen assay, a method easier to perform and as satisfactory as enzyme-linked immunosorbent assay (4). The HDM allergen levels were expressed as lg/m. The minimum detection level of Der p 1 and Der f 1 was 0.1 lg/m. Independent predictors of allergen concentration were assessed. Either Der p 1 or Der f 1 was detected in 21 of 39 homes (53.8%). Dermatophagoides pteronyssinus predominated in most of the houses (71.4%). Twentythree percent of houses were coinhabited by D. farinae and D. pteronyssinus. Der p 1 was detected in twenty houses in the range of 0.4–5.4 lg/m (median 2). We observed Der p 1 >2 lg/m of dust in 55% of the houses. Whereas Der f 1 was detected in only six houses (median 1, range 0.1–6.4 lg/m). Der p 1 levels were significantly higher in allergic subjects houses than healthy controls (median 2 vs 0.4 lg/m, P 1⁄4 0.041). Twenty-one of 25 allergic subjects (84%) were sensitive at least to D. farinae or D. pteronyssinus assessed by skin prick test. Independent predictors of higher levels were evidence of moisture, such as mildew or water stains in the home and residency at seaside. In conclusion, more than half of the houses in Izmir had detectable levels of dust mite allergen. Dermatophagoides pteronyssinus was the most frequently found species. Allergic patients encountered more HDM allergens than normal subjects in their home, and this situation may emphasize the importance of environmental factors in the development of allergic diseases. Indoor moisture and residency at seaside were predictors of higher mite allergens.

The frequency of mouse and rat allergy among allergic individuals in Izmir (a preliminary report).

The author’s evidence for this event uses hieroglyphs found on two almost identical but only partially preserved ebony plates at one of the many putative Menes burial sites. In contrast to other clearly perceivable animals, Waddell interprets a half circle hieroglyph on plate no. 1 as a wasp or a hornet, using plate no. 2 for completion (Figs 1 and 2). However, the sting can only be seen on plate no. 1, giving the certainty to be only an accidental wooden scratch. Moreover, Waddell ignored the variation of the hieroglyphs on plate no. 2, where three wasps are noticeable instead of one. Never again have historians followed Waddell’s interpretation. In contrast, the wasps are seen without doubt as hieroglyphic numbers (5). Although Waddell’s fictional account of Menes death after a wasp sting has never been accepted by other Egyptologists it has reverberated through the medical literature on allergy to this very day.

Laryngeal edema due to European bee-eater (Merops apiaster) in a patient allergic to honeybee

Contact with the antigen may not always be obvious in allergic reactions. Inhalation of the bee allergens has been reported to induce allergic symptoms in beekeepers (1). Bee venom components found in honey can cause severe allergic reactions in sensitive individuals (2). We present a case of anaphylaxis after eating a bee-eater (BE) in a patient allergic to honeybee. European bee-eater (Merops apiaster) is a colorful bird which eminently eats bees, wasps and hornets (250 bees per day). Stings are frequently swallowed and found in their food remains. BEs are apparently immune to venom; they show pain when stung but no other effect is evident. They live in most parts of southern Europe, south-western Asia, northern and southern Africa and are found throughout Turkey (3). A 52-year-old hunter, ate BE meat 1 week before admission to our clinic. He experienced itching in the oral mucosa and difficulties in breathing 30 min after the meal. He was admitted in the emergency room where laryngeal edema was confirmed. He received treatment and was referred to our allergy clinic. He did not have personal or family history of atopy. In the past he had been stung six times by bees. The wasps never caused any reaction. But generalized urticaria, hypotension and unconsciousness had occurred for the last three times after he was stung by honeybees. The last reaction was at 4 months ago. Before the laryngeal edema episode caused by BE he had eaten the bird several times without any clinical reaction. He stopped eating this bird after systemic sting reactions caused by honeybees. Allergy tests were performed 2 months after the reaction. Skin prick test to honeybee venom revealed a wheal of 3 mm greater than the negative control (ALK 300 lg/ml). Serum-specific IgE (Pharmacia UniCAP, Uppsala, Sweden) for Apis mellifera was 17.5 kU/l (class 3). Tests for wasp venom remained negative. In addition to venom allergy via bee stings, venom allergens can cause reaction in sensitive patients when they are encountered unknowingly. Beekeepers may be sensitized to bee venom through inhalation as well as stings (1). Thirtyone percent of beekeepers had experienced nasal or eye symptoms correlated with the history of systemic sting reactions while working at beehives (4). Allergic symptoms ranging from itching in the oral mucosa to anaphylaxis have been reported in patients allergic to honey (5). In these individuals primary sensitization may be due either to the honey itself, to compositae pollen or to bee venom components (2). To our knowledge, this is the first case of laryngeal edema caused by ingestion of BE meat in a patient with a history of honeybee allergy. The mechanisms of this reaction remain unclear. But it is necessary to investigate whether major venom allergens are detectable in the bird’s blood or tissues. In conclusion, patients allergic to bees should avoid eating these birds.