Gülbin Bingöl

Correlation between atopic diseases and tuberculin responses.

Background: In recent decades, the prevalence of atopic diseases has risen steadily in developed countries. The reasons for this increase are not clear. It has been hypothesized that a reduction in infections and immunization programs may contribute to the increase in the prevalence of atopic diseases. We investigated the relationship between tuberculin response and atopic disease.

Prevalence of and risk factors for atopic dermatitis: A birth cohort study of infants in southeast Turkey

BACKGROUND Atopic dermatitis (AD) is most common in the first year of life. The aim of this study was to determine the prevalence of and risk factors for AD in a birth cohort of infants from southeast Turkey. METHODS Adana Paediatric Allergy Research (ADAPAR) birth cohort study was derived from 1377 infants who were born in Cukurova University, Medical Hospital, Adana, Turkey between February 2010 and February 2011. At birth, a physical examination was performed, cord blood samples were taken, and the mother completed a baseline questionnaire that provided data on gestational conditions, family history of allergic diseases and environmental exposures. Follow-up visits scheduled at 3, 6, and 12 months included an infant physical examination and an extended questionnaire. Skin prick test was performed and food-specific IgE levels were measured at 6 and 12 months. Atopic dermatitis was diagnosed based on confirmatory examination by a physician. RESULTS Of the 1377 infants enrolled, 59 (4.3%) were diagnosed with AD as of 12 months. Maternal allergic disease (ORs 6.28, 95% CI 1.03-38.30; p=0.046), maternal infection during gestation (ORs 3.73, 95% CI 1.25-11.09; p=0.018), and presence of food allergy (ORs 13.7, 95% CI 3.07-61.0; p=0.001) were identified as risk factors for AD. Breastfeeding and cord blood IgE levels were not identified as risk factors. CONCLUSIONS In this cohort we found prevalence of AD as 4.3% during the first year of life. Positive family history of atopic diseases, prenatal infections and presence of food allergy are the risk factors for early presentation of AD.

Fraction of exhaled nitric oxide as a predictor in juvenile idiopathic arthritis progression

In this study, the relation between the nitric oxide (NO) levels in the serum and fraction of exhaled nitric oxide (FENO) in children with juvenile idiopathic arthritis (JIA) and the activation criteria of the disease has been investigated. The study group consisted of 35 JIA-diagnosed patients and 18 healthy children. According to the clinical and laboratory findings, the patients with JIA were divided into two groups, active (group I) and in remission (group II). The healthy children were classified as group III. The activation criteria of the disease were determined for each patient. The serum NO level and FENO level were measured in all the patients. In the group with JIA, correlation was detected between FENO level and number of involved joints and number of joints with limited motion. In addition, correlation was determined between the FENO level and number of involved joints in group I and the serum NO level and activity score in group II. However, it was seen that there is no statistical difference in the serum NO level and FENO level of the patients with JIA and the control group and groups I and II. This study demonstrated the correlation between FENO level and number of involved joints and number of joints with limited motion in patients with JIA. Our results matter in terms of FENO being a noninvasive laboratory marker in following the progression of the disease.

The ADAPAR Birth Cohort Study: Food Allergy Results at Five Years and New Insights

Background: Although food allergy (FA) is often a transient condition during childhood, when and in whom FA will resolve can be affected by many factors. In this study, we analyzed the data at 5 years on 33 children diagnosed with FA in the ADAPAR (Adana Pediatric Allergy Research) birth cohort study in southern Turkey. Methods: Thirty-three infants detected as having FA at the end of their first year in the ADAPAR study were assessed every 6 months until the age of 5 years. Each follow-up included a clinical examination, questionnaire, blood sampling and a skin-prick test. Results: Culprit allergens were cows milk (n = 20), eggs (n = 17), chicken meat (n = 1) and bananas (n = 1). Of the 17 patients with egg allergy, 14 developed complete tolerance and 1 developed partial tolerance (i.e. tolerance to baked food). Of the 20 patients with milk allergy, complete tolerance was observed in 16 and partial tolerance in 1. The mean age of tolerance to egg was 22.4 ± 7.5 months and to cows milk, it was 20.9 ± 1.1 months. Complete tolerance developed in 1 case allergic to chicken meat and in 1 case allergic to banana. Other allergic conditions were also determined: allergic rhinitis in 27.2%, atopic dermatitis in 21.2%, asthma in 9%, urticaria in 9% and drugs in 9%. Conclusions: Our results confirm early and high tolerance rates before school age in children with food allergies that started in infancy. This will help pediatricians to give more informed advice to parents of infants with cows milk or hens egg allergy.

Effect of SIT on quality of life

. ALLERGIC rhinitis (AR) is one of the most prevalent of the chronic respiratory diseases and affects approximately 20±25% of the population (1). AR produces a signi®cant economic impact (2) and may also have an effect on the quality of life (QoL) of patients (3). There are no data on the cost of medication (CoM) in 1 year and the QoL measurement of children with AR treated with both allergen immunotherapy (AIT) and pharmacologic agents. The aim of this study was to investigate the CoM and QoL of patients with AR who were treated by pharmacologic agents and AIT. Sixty-seven patients with AR selected randomly were included in the study. In the group on AIT, there were 21 boys and 19 girls, ranging in age from 8 to 16 years (13.4u1.9 years). The group treated with pharmacologic agents consisted of 14 boys and 12 girls, ranging in age from 8 to 15 years (12.9u1.8 years). All patients had a positive prick test (Greer Laboratories, Inc., USA) and the presence of speci®c IgE at a RAST class of 3±4 (Pharmacia Diagnostics AB, Sweden). The patients on AIT had been receiving it for at least 2 years (3.2u1 years). We translated the rhinitis QoL questionnaire developed by Juniper et al. (3) into Turkish. The patients and/or their parents completed 19 items. The participants rated symptoms on a scale of 0±6 (0 represented no trouble and 6 meant extremely troubled). The QoL index was calculated as a mean of the items within each domain. Statistical analysis of data was performed by Students t-test and the Spearman rank test. The mean QoL of the AIT group (1.3u0.5) was signi®cantly lower than that of the other group (2.2u0.7) (P,0.01) There was signi®cant correlation between duration of the AIT treatment and improvement in QoL (R= ±0.4719, P=002). The decrease in QoL index indicated lower severity of symptoms and substantial improvement. The mean CoM in 1 year of the AIT group and the other group were 74.17u50.76 and 153.47u68.34 US dollars, respectively. This difference was signi®cant (P,0.001). But when the cost of AIT was added, CoM rose to a mean 183.67 US dollars. Patients on AIT had fewer symptomatic days than the patients treated with pharmacologic agents. The treatment of AR is based on three therapeutic techniques: avoidance of allergen, use of appropriate pharmaceutic agents, and AIT. AIT is usually considered when a reasonable trial of pharmacotherapy and environmental control has proved insuf®cient to control symptoms. The ef®cacy of AIT for AR has been clearly proven by studies (4). The results of our study demonstrated that allergen shots resulted in the reduction of the cost of pharmacologic treatment, and the reduction was correlated with the duration of AIT. These ®ndings were in agreement with those of previously published studies (5, 6). But these studies did not discuss the cost of AIT. To our knowledge, there are no published reports on measuring the ef®cacy of AIT on QoL in children with AR. There is only one study in adult AR patients (5). The results of our study are consistent with their results. In conclusion, this study suggests that AIT may have a positive effect on the improvement of QoL and on reducing the amount of the CoM of AR patients.

The Trend of Change of Allergic Diseases over the Years: Three Repeated Surveys from 1994 to 2014

Background: Although it is known that there has been an increase in asthma and allergic diseases among school-aged children, results vary between countries. The aim of this study was to examine trends in the prevalence of these diseases in the city of Adana (south Turkey) over the last 20 years based on the results of 3 cross-sectional studies. Methods: Three cross-sectional surveys were performed 10 years apart in south Turkey. Here, we compare the surveys conducted among children between the ages of 6 and 14 years from 1994, 2004, and 2014. The participants were randomly chosen among children attending participating primary schools in Adana. The questionnaire in the first survey contained almost the same questions as the ISAAC. In the 2 latter surveys, we used the ISAAC questionnaire to investigate the prevalence of asthma and other allergic diseases. Results: A total of 2,334 children in 1994, 3,728 children in 2004, and 3,209 children in 2014 were included in the final analysis. The results showed a statistically significant increase in the prevalence of physician-diagnosed allergic diseases across the years, respectively: asthma (5, 4.6, and 8.9%), allergic rhinitis (8.8, 11.4, and 15.6%), and atopic dermatitis (5, 9.9, and 7%). In contrast, the prevalence of parent-reported current wheeze (16.2, 13.2%) decreased in the last 10 years. Conclusions: Our findings were consistent with the increased prevalence of childhood asthma and other allergic diseases. However, this pattern did not occur in respiratory symptoms.

The Utility of Next-Generation Sequencing for Primary Immunodeficiency Disorders: Experience from a Clinical Diagnostic Laboratory

Introduction Primary immune deficiency disorders (PIDs) are a group of diseases with profound defects in immune cells. The traditional diagnostics have evolved from clinical evaluation, flow cytometry, western blotting, and Sanger sequencing to focusing on small groups of genes. However, this is not sufficient to confirm the suspicion of certain PIDs. Our innovative approach to diagnostics outlines the algorithm for PIDs and the clinical utility of immunophenotyping with a custom-designed multigene panel. Materials and Methods We have designed a diagnostic algorithm based on flow cytometry studies to classify the patients; then the selected multigene panel was sequenced. In silico analysis for mutations was carried out using SIFT, Polyphen-2, and MutationTaster. Results and Discussion The causative mutation was identified in 46% of PIDs. Based on these results, this new algorithm including immune phenotyping and NGS for PIDs was suggested for the clinical use. Conclusions This study provides a thorough validation of diagnostic algorithm and indicates that still the traditional methods can be used to collect significant information related to design of most current diagnostics. The benefits of such testing are for diagnosis and prevention including the prenatal and preimplantation diagnosis, prognosis, treatment, and research.