Osman Sener

Oxidative stress status and plasma trace elements in patients with asthma or allergic rhinitis

INTRODUCTION This study was conducted to evaluate the oxidant/antioxidant balance (oxidative stress status) and plasma essential trace element levels in patients with bronchial asthma or allergic rhinitis. METHODS A total of 94 individuals consisting of 19 allergic asthmatics; 17 non-allergic asthmatics; 22 patients with allergic rhinitis; and 36 healthy control people were enrolled into this study. Superoxide dismutase (CuZnSOD) and glutathione peroxidase (GSH-Px) activity as antioxidant defence mechanism parameters, along with malondialdehyde (MDA) as a marker of lipid peroxidation, were determined in erythrocytes of patient groups and controls. Plasma copper and zinc levels were also determined in all groups. RESULTS CuZnSOD activity was significantly lower in all groups of patients (p<0.001 for allergic asthmatics, p=0.008 for allergic rhinitis patients, and p<0.001 for non-allergic asthmatics) when compared to those of controls. Erythrocyte GSH-Px enzyme activity was not different when compared to that of the control group. Similarly, the patient groups had no difference from those of the controls with respect to erythrocyte MDA levels. While plasma Cu levels in all asthmatic patients were not different from those of the controls, allergic rhinitis patients had significantly elevated (p<0.001) Cu levels compared to those of the controls. No statistically significant difference was established between patient groups and controls with respect to plasma zinc levels. CONCLUSION While defective CuZnSOD activity observed in all patients groups was expected to cause an increase in lipid peroxidation indicated by high MDA levels in these patients groups, the fact that MDA levels were not different from those of controls in all patient groups indicates that other components of anti-oxidant defence system preserve their functions in these patients. On the other hand, statistically significant difference between all patients groups and controls with respect to trace elements was only observed in allergic rhinitis patients who had higher levels of Cu than those of controls.

Oxidative stress status in patients with chronic idiopathic urticaria.

AIM The controversial data related to oxidative stress status in patients with chronic idiopathic urticaria (CIU) have been reported. Therefore, the present study was aimed to contribute to this debate by determining oxidative stress markers along with some trace element levels in patients with CIU. METHODS Twenty-five patients with CIU (10 males, 15 females) and 36 healthy controls were enrolled into the study. Erythrocyte lipid peroxidation status, scavenger enzyme activities and trace element levels were determined. RESULTS While erythrocyte MDA levels, erythrocyte GSH- Px activities and erythrocyte Zn levels showed no differences between the patient and control groups, a statistically significant decrease and increase were observed in erythrocyte CuZn-SOD activities and Cu levels, respectively, in the CIU patients when compared to those of the controls (p < 0.001 for both of them). CONCLUSION In conclusion, an oxidative burden which can be relieved by some preserved antioxidant mechanisms seems to be present in patients with CIU even if they are clinically stable and it may probably have a role in the pathogenesis.

Nonpigmenting solitary fixed drug eruption after skin testing and intraarticular injection of triamcinolone acetonide

BACKGROUND Although several medications have been reported to cause fixed drug eruption (FDE) reactions, triamcinolone acetonide has not been previously described as an offending agent. OBJECTIVE To emphasize both an unprecedented causative agent and the extraordinary development of a FDE, we describe this response in a 42-year-old female patient. METHODS Because her history included a questionable reaction to corticosteroid preparations, prick and intradermal testing with triamcinolone acetonide was done to determine whether she could safely receive a triamcinolone acetonide injection. RESULTS Both skin test procedures and the intra-articular administration of triamcinolone acetonide caused FDEs on her right retroauricular area. CONCLUSIONS Because any drug may induce a FDE by any administration route, physicians should be aware of this delayed skin reaction when skin testing drugs.

Safety of subcutaneous immunotherapy with inhalant allergen extracts: a single-center 30-year experience from Turkey.

Abstract Context: Although subcutaneous allergen immunotherapy (SCIT) is effective in allergic rhinitis (AR) and asthma, it carries a risk of local and systemic adverse reactions. Objective: The aim of this study was to evaluate the rates and clinical characteristics of local and systemic reactions (LR and SR), and to identify their relation of demographic features, allergen extracts and diagnosis. Materials and methods: This study analyzed the administration of SCIT from 1983 to 2013; involving 1816 patients affected by allergic asthma and/or AR. Results: The rates of SR from SCIT were 0.078% per injection and 9% per patient. According to the World Allergy Organization 2010 grading system, 91 grade 1 reactions (44%), 67 grade 2 reactions (32.3%), 33 grade 3 reactions (16%) and 16 grade 4 reactions (7.7%) were seen. There was no fatal outcome from any of the SRs. Risk factors for a SR included: aluminium-adsorbed extract, pollen-containing vaccines, large LR and recurrent (≥2) LRs. The total LR rates were 0.062% per injection and 5.2% per patient; the small LR rates were 0.027% per injection and 2.3% per patient, and the large LR rate were 0.035% per injection and 2.9% per patient. Female gender, depot extracts, calcium phosphate-adsorbed extract and pollen vaccines were identified as risk factors for LR. Conclusion: The analysis of our data over a 30-year period confirmed that SCIT with inhalant allergens conducted strictly according to the standard protocols and when administrated by experienced staff is a safe method of treatment with only a few side-effects.

A case of textile dermatitis due to disperse blue on the surgical wound

Disperse blue (DB) 106 and DB 124 are the most frequent fabric dye allergens inducing textile dermatitis, but contact allergy to them may easily undiagnosed because the clinical picture usually needs high index of suspicion. We present the case of a 35-year-old woman who was referred for a recurred lesion over the incision scar of right total hip replacement surgery, which did not respond to treatment with povidone–iodine, mupirocin, and rifampicin. Patch testing, conducted with a European standard series and therapeutics that were used in the treatment of the lesion, revealed a positive reaction to dispersion mix blue 106/124. The patient was questioned in detail and reported that she has been wearing dark-colored synthetic panties for long years. The correlation was done between the positive antigen in the patch test and the clinical findings. The patient was treated with a corticosteroid cream for 2 weeks. She did not wear any dark-colored synthetic panties afterward and no flare-up was seen in the follow-up period. In this report, we emphasize the importance of detailed questioning of patients and that contact dermatitis should be considered potential cause of dermatitis at skin sites where the barrier function is compromised.

Chronic urticaria in patients with autoimmune thyroiditis: Significance of severity of thyroid gland inflammation

BACKGROUND There is a clear association between autoimmune thyroiditis (AT) and chronic urticaria/angioedema (CUA). However, not all patients with AT demonstrate urticaria. AIMS The aim of the study was to investigate in which patients with AT did CUA become a problem. A sensitive inflammation marker, neopterine (NP) was used to confirm whether the severity of inflammation in the thyroid gland was responsible for urticaria or not. METHODS Neopterine levels were assessed in patients with AT with urticaria and without urticaria. Furthermore, levels were compared in relation to pre and post levothyroxine treatment. Twenty-seven patients with urticaria (Group 1) and 28 patients without urticaria (Group 2) were enrolled in the study. A course of levothyroxine treatment was given to all patients, and urine neopterine levels before and after the trial were obtained. RESULTS All patients completed the trial. Mean age in Group 1 and Group 2 was similar (35.70 ± 10.86 years and 38.36 ± 10.38 years, respectively) (P=0.358). Pre-treatment urine neopterine levels were significantly higher in Group 1 (P=0.012). Post-treatment levels decreased in each group, as expected. However, the decrease in the neopterine level was insignificant in the patients of Group 2 (P=0.282). In Group 1, a significant decrease in post-treatment neopterine levels (P=0.015) was associated with the remission of urticaria. CONCLUSION In patients with CUA and AT, pre-treatment elevated levels of NP, and its decrease with levothyroxine treatment along with symptomatic relief in urticaria, may be evidence of the relationship between the degree of inflammation in thyroid and presence of urticaria.

Acute Generalized Exanthematous Pustulosis Due to Oral Use of Blue Dyes

Acute generalized exanthematous pustulosis is a rare severe pustular cutaneous adverse reaction characterized by a rapid clinical course with typical histological findings. It is accompanied by fever and acute eruption of non-follicular pustules overlying erythrodermic skin. The causative agents are most frequently antibacterial drugs. We present a patient with acute generalized exanthematous pustulosis caused by methylene blue and indigotin dyes.

An unexpected allergic reaction with Saccharomyces boulardii: a case report

Saccharomyces boulardii (S.boulardii), known as a nonpathogenic yeast probiotic shows its efficacy in inflammatory and infectious diseases of the gastrointestinal tract safely. This report presents an allergic reaction and positive skin test in a patient who takes S.boulardii as an antidiarrheal therapy.

Multifocal fixed drug eruption due to ornidazole

Ornidazole, a synthetic nitroimidazole derivative, is widely used in clinical practice. Ornidazol has low rate of side effects, but sometimes may cause significant allergic reactions such as fixed drug eruption (FDE). We describe a case of multifocal FDE caused by ornidazole.

Vitamin B12 allergy and successful desensitisation with cyanocobalamin: A case report

Vitamin B12, as it is not biosynthesised without certain bacteria and algae must be taken with a diet. The most important natural source of vitamin B12 is animal products and deficiency of vitamin B12 most commonly appears as pernicious anaemia. However vitamin B12 deficiency is not only associated with pernicious anaemia but is also linked with neurological conditions. Therefore, patients with low serum concentrations of vitamin B12 are given vitamin B12 supplements at regular intervals. Vitamin B12 deficiency is a common condition, although hypersensitivity reaction against vitamin B12 is rare. In this paper, vitamin B12 allergy developed in a patient who does not eat meat and a successful desensitisation procedure with cyanocobalamin is presented. The 39-year-old vegetarian woman with vitamin B12 deficiency (pernicious anaemia) who was taking monthly injections of 10 mg cyanocobalamin, referred to allergy clinic, and commonly presented with itchy, exanthematous skin rashes about 30 min after the tenth dose. The physical examination revealed widely distributed urticarial plaques all of the skin. The patient had no history of allergic disease. Skin prick tests (SPT) were performed with cyanocobalamin and a possible cross-reaction to the hydroxycobalamin (1 mg/ml dilutions). Both Drug allergies and treatmethe preparations did not contain any dyes or preservatives. Histamine and saline were used as positive and negative controls, respectively. SPT were positive for both preparations: cyanocobalamin; wheal 4 mm × 5 mm and flare 30 mm × 30 mm, hydroxycobalamin; wheal 4 mm × 3 mm and flare 20 mm × 30 mm, histamine (positive control); wheal 3 mm × 3 mm and flare 20 mm × 20 mm. Any wheal and flare reaction were not induced by saline (negative control). We desensitised the patient in our clinic as described in the literature (Table 1). After written consent was obtained, the desensitisation procedure began with 15min intervals, and the desensitisation process started with increasing doses, one, two and four-week intervals, were similar to literature. The patient did not receive any premedication before the desensitisation procedure. The desensitisation procedure was completed without any adverse events. At the end of the desensitisation procedure, SPT was performed with cyanocobalamin (1 mg/ml) and resulted negative. Drug allergies and treatment are the troublesome situations for the physicians in daily clinically practices. The patient who developed any adverse events after the drug treatment, the IgE-mediated allergic reactions should be confirmed with skin tests or specific IgE assays. Afterwards, desensitisation is performed in these cases if there are no suitable alternative drugs. Nowadays, desensitisation application is carried out successfully with antibiotics, aspirin, and even many different chemotherapeutic drugs. Unfortunately there is no standardised protocol for vitamin B12 desensitisation such as at antibiotics and aspirin. Therefore we used the same desensitisation protocol which Table 1 Desensitisation protocol with cyanocobalamin.