Allergy Outpatient Clinic Research Articles

Evaluation of Sleep Disorders in Allergic Diseases in Childhood

Objective: Sleep is a vital component of human life that serves many critical roles in physical and mental health, and well-being. There were few studies on children, diagnosed with allergic diseases, especially preschool children. The aim of our study mas to evaluate sleep disorders in children with allergic diseases. Material and Methods: This retrospective study was conducted in Dr. Burhan Nalbantoğlu Hospital Child Immunology and Allergy outpatient clinic between January 1 and March 20, 2024, patients included who were diagnosed with allergic rhinitis, asthma and/or atopic dermatitis.The ‘Sleep Disturbance Scale for children (SDSC) was applied to the parents by the researcher during the outpatient clinic visit. Results: In this study, 145 patients were involved. Five (3.4%) patients had clinically significant SDSC score. There was a statistically significant difference in the Children’s Sleep Disturbance Scale mean score between having and not having symptoms of allergic diseases. Patients diagnosed wheezy child tended to have higher mean score of SHY. Among patients having symptoms of allergic diseases, there was statistically significant difference in the SDSC mean score between having nose congestion, cough, and activity limitation and not having these symptoms. Patients using oral antihistaminic treatment tended to have higher total mean scores of SDSC. Conclusion: In this study, out of 145 patients, 5 (3.4%) patients had clinically significant SDSC score. Patients having symptom of allergic diseases tended to have higher total mean score of childrens’ sleep disturbance scale. Patients diagnosed wheezy child tended to have higher mean score of SHY. Patients having nose congestion, cough, and activity limitation tended to have higher total mean score of SDSC.

Characteristics of Drug Hypersensitivity Reactions in Children: A Retrospective Analysis in an Allergy Outpatient Clinic

Objective: Confirmation of drug hypersensitivity reactions (DHRs) is crucial—as various nonallergic reactions, such as viral infections, in children can mimic such reactions. This study aimed to evaluate the characteristics of children with suspected DHRs applying to an allergy outpatient clinic. Material and Methods: This study involved children who visited our hospital’s pediatric allergy outpatient clinic between April 1 and December 31, 2023, with suspected DHRs . The data of patients analyzed retrospectively. Patient demographics, reaction characteristics, culprit drugs, diagnostic procedures (including skin and/or provocation tests), and final diagnoses were recorded. Results: The study included 163 reactions of 140 patients with 176 suspected drugs. The median age was 7.7 years (interquartile range [IQR]; 5.1–12 years), with an equal gender distribution. Notably, 27.1% of the patients presented with concurrent atopic diseases. The median age at the onset of reaction was 72 months (IQR; 34.5–108 months), with 16% of reactions occurring within hospital settings and the remainder at home. Oral administration accounted for 84.7% of the reactions, with antibiotics being the most common culprit drug group (75.5%). Immediate reactions constituted 41.1% (n = 67) of reactions, while delayed reactions accounted for 58.9% (n = 96). Skin symptoms were predominant (97.5%). DHRs were excluded in 75.5% (n = 123) of reactions but confirmed by diagnostic drug allergy tests in 4.9% (n = 8). Conclusion: A through evaluation of suspected DHRs in children is essential. Despite high suspicion rates, confirmation via diagnostic tests was low, emphasizing the need for referral to specialized clinics and appropriate diagnostics for accurate management.

Smoking and Real Life Results of Children and Adolescents

Aim: Smoking is a chronic disease and children are the most affected group. In this study, we aimed to question the smoking habits of children and their parents and examine the level of exhaled carbon monoxide (eCO) to evaluate the usefulness of the method in an outpatient allergy clinic. Methods: A questionnare was applied to 29 children who were smoker or exposed to second-hand smoke (SHS) and their parents separately. eCO levels of the participants were measured with CO Smokerlyzer. Results: The median eCO level of children who smoked was 10 (7-14) ppm and was significantly higher than children exposed to SHS (P <0.001). The children who smoked were significantly older, the more they had friends who smoked. Children who were not exposed to tobacco products had lower rates of hospitalization due to recurrent lower respiratory tract infections, and family history of asthma was lower than children exposed to SHS (p <0.05). All the children were aware of the harmful effects of smoking. 34.5% of the parents were never questioned by their physicians about tobacco and its products and were not informed about smoking. Conclusions: Using eCO in the clinic is a useful method to predict smoking status in daily practice. Children's attitudes towards smoking and peer relationships and parents' ignorance of smoking and SHS are still an unresolved issue.

COVID-19 vaccination rate in patients admitted to the Immunology and Allergy Outpatient Clinic

Aim
 Misinformation, lack of awareness, and beliefs about vaccines can cause hesitations about vaccines and affect the rate of vaccination. We aimed to reveal the vaccination rates against coronavirus disease-19 (COVID-19) (vaccine types and dose), and the reasons for not being vaccinated in patients admitted to the immunology and allergy outpatient clinic. In addition, we aimed to find out whether allergic reactions were observed in vaccinated patients.
 Methods
 The history of COVID-19 and vaccination of patients admitted to the Immunology and Allergy Outpatient Clinic between December 2021 and February 2022 were evaluated retrospectively.
 Results
 In our study, which included 451 patients, the median age of the patients was 35 (range 18-82), and 61.2% were women. 16.9% of the patients admitted to the immunology and allergy outpatient clinic were never vaccinated, while the rate of those who did not receive two doses of vaccine was 26.6%. The top three reasons for not being vaccinated were fear of allergies, fear of adverse effects, and distrust of the vaccine, respectively. Unvaccinated patients were younger, which is statistically significant. Vaccination rate was found to be lower in drug allergy and immunodeficiencies compared to other disease groups. 
 Conclusion
 Understanding the causes of vaccine hesitations and increasing the vaccination rate by organizing public health campaigns is an important point in the control of the pandemic. Despite being rare, allergic reactions can be observed with COVID-19 vaccines. Therefore, immunologists and allergists play an important role in the COVID-19 vaccine program.

Evaluation of Healthy Eating Index and Children's Diet Inflammatory Index according to asthma severity group

BackgroundDiet may contribute to better asthma control in children by impacting the immune and inflammatory pathophysiology. Therefore, this study aimed to investigate differences in nutrient intake, Children’s Dietary Inflammatory Index (C-DII), and dietary quality according to asthma severity.Materials and methodsAsthma severity, dietary inflammatory status, and diet quality were assessed in a sample of 202 children with asthma (55.6% males, aged 5–18 years) attending a pediatric allergy outpatient clinic. Asthma severity was evaluated according to the Global Initiative for Asthma criteria and categorized as mild, moderate, or severe. The Children’s Dietary Inflammatory Index (C-DII) and Healthy Eating Index (HEI-2010) were calculated based on information collected by the 24-h dietary recall method. Dietary quality was categorized as poor, moderate, or good diet according to HEI-2010.ResultsThe mean age of the participants was 9.6 ± 3.2 years. Children with severe asthma were younger on average (p < 0.05). Children with mild asthma had significantly higher fiber and iron intake than those with moderate asthma (p < 0.05). C-DII values did not differ significantly according to asthma severity (p > 0.05). Dietary quality was evaluated as moderate in 89.1% of the participants and also showed no difference based on asthma severity.ConclusionsThese findings suggest that inflammatory status and diet quality may not affect asthma severity in children, highlighting the influence of various genetic and environmental factors on the association between diet and asthma severity. More comprehensive and longitudinal studies are needed to investigate the mechanisms linking diet and asthma.

Vitamin D level in children with atopic dermatitis

Aims: Atopic dermatitis is a chronic relapsing skin disease that is mostly seen between the ages of 0-5. In our study, we aimed to reveal the difference in 25-OH vitamin D levels between the patient group diagnosed with atopic dermatitis and the control group. Methods: It was carried out at the Pediatric Allergy Polyclinic of Balıkesir University Faculty of Medicine Hospital between 2018-2021. A control group consisting of 220 patients between the ages of 0-17 who were diagnosed with atopic dermatitis and who applied to the Pediatric Allergy outpatient clinic and 220 patients who were not diagnosed with atopic dermatitis were included. The diagnosis of atopic dermatitis was made using the Hanifin-Rajka criteria. Disease activity was measured by the scorad index. Results: 25-OH vitamin D level and eosinophilia value in peripheral blood were found to be statistically significant between the patient and control groups. No significant difference was found between the patient and control groups in terms of parental age, parental education level, living place, weight, height, and body mass index (BMI) . Conclusion: 25-OH vitamin D levels were found to be lower and eosinophil levels were higher in patients with atopic dermatitis . No significant difference was found in terms of total IgE ( kU /L) level. More extensive studies are needed to determine how 25-OH vitamin D (ng/dl) level affects atopic dermatitis.

Nuts, vegetables, fruits, and protein dietary pattern during pregnancy is inversely associated with risk of childhood allergies: a case–control study

Allergic diseases are prevalent chronic conditions among children and can lead to significant health and economic issues. It is hypothesized that healthy and high quality diet during pregnancy can prevent the onset of allergic diseases in offspring. This study aimed to investigate the potential relationship between major dietary patterns during pregnancy and allergies in children under one year of age. This case–control study was conducted involving 244 participants (122 mothers of allergic children and 122 healthy controls) who visited pediatricians and allergy outpatient clinics in Khuzestan Province, Iran, between June 2022 and March 2023. Demographic information was recorded using a socio-demographic questionnaire. A food frequency questionnaire was used to identify the foods consumed during pregnancy. Major dietary patterns were extracted using principal component analysis, and the potential relationship between these patterns and childhood allergies was investigated using multivariable logistic regression models. The crude odds ratio (OR) analysis showed that the fourth quartile of "Nut, vegetables, fruits, and protein" dietary pattern was associated with lower occurrence of childhood allergies (OR: 0.214, 95% CI = 0.068–0.679; P trend = 0.211). After adjusting for cofactors in Model 3, this association was still observed in the fourth quartile (OR = 0.108, 95% CI = 0.019–0.613; P trend, 0.001). However, no significant association was observed between "Carbohydrate and cereals" and "Salty" dietary patterns and childhood allergies. The study findings suggest that a maternal dietary pattern rich in nuts, vegetables, and fruits during pregnancy may reduce the risk of allergic diseases in offspring.

COVID-19 frequency and clinical course in children with asthma.

The epidemic of severe acute respiratory syndrome coronavirus 2 infection, known as the coronavirus disease 2019 (COVID-19), has caused a global health concern. Since its emergence, numerous studies have focused on various clinical manifestations and outcomes in different populations. However, studies are ongoing as the consequences and impact of COVID-19 in children with chronic diseases such as asthma are controversial. To fill this research gap by retrospectively evaluating the course, laboratory, and clinical findings of COVID-19 among 414 asthmatic children followed up from the pediatric allergy outpatient clinic and known to have had COVID-19. The data of 5510 patients over the age of 5 diagnosed with asthma in our hospital's data were retrospectively scanned with specific parameters using protocol numbers from the hospital filing system. The data included retrospective evaluation of pulmonary function test results before and after COVID-19, routine hematological and biochemical parameters, sensitization states (total IgE, specific IgE, and skin prick test results), and radiological (computed tomography) findings. To inquire about the course and symptoms of COVID-19, asthma patients or their parents were then called and evaluated with a questionnaire. As a result of retrospectively scanning the data of 5510 asthma patients over the age of 5, it was determined that 414 (7.5%) patients had COVID-19. The mean age of 414 patients was 17.18 ± 4.08 (min: 6; max: 28) years. Two hundred and three of our 414 patients are male, and 211 are female. When their vaccination status was questioned, 21.5% were vaccinated. When the symptoms of our 290 patients were questioned, it was stated that 59.0% had fever symptoms. The rate of using regular prophylactic asthma medications was 19%. The rate of using salbutamol in asthma was found to be 22%. The rate of patients using methylprednisolone was 1%. Emergency service admission was 17.2%, and hospitalization was found to be 4.8%. Leukopenia (< 4000) was found in 14.1% of patients, and 8.08% of our patients had neutropenia (< 1500). Lymphopenia (< 1500) was detected in 44.4% of patients, and lymphocytosis (> 4000) was found in 5.05% of patients. In 65% of our patients, the C-reactive protein value was elevated. A high aspartate aminotransferase and alanine aminotransferase value was detected in 3.2% and 5.4% of patients were found, respectively. 31% of patients had an elevated lactate dehydrogenase value. Typical radiological findings for COVID-19 were detected in 3/309 of patients. According to our study, there is a correlation between the severity of COVID-19 and asthma symptoms and the course of the disease. However, it is worth noting that the retrospective nature of the study and the differences in sample size, age, and demographic characteristics between the two groups do not allow for an optimal comparison. Therefore, further investigation is needed to explore the relationship between COVID-19 and asthma, and it can be suggested that COVID-19 may trigger asthma attacks and asthma may impact the course of COVID-19.

Kounis syndrome: an underestimated emergency.

Background. Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. To establish the prevalence of KS among the patients with diagnosis of anaphylaxis, we described clinical features, cardiological and allergological outcomes of patients evaluated in our allergy outpatient clinic. Methods. A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents. Results. We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to Hymenoptera stings, 5/9 to drugs). Conclusions. The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.

The diagnostic weight of hemogram parameters in diagnosis, severity, and disease duration of childhood atopic dermatitis: a thorough evidence-focused study

Aims: We aimed to assess the association of hemogram parameters with atopic dermatitis (AD), severity of AD, and disease duration.&#x0D; Methods: We included the hemogram parameters of patients under follow-up in our pediatric allergy outpatient clinic and healthy group. The blood samples were drawn when they had no complaints or after at least 30 days of infection or a drug-free period. We built H1 and H0 (null) hypotheses, subjected data to Bayesian statistics, and assessed which hemogram parameters have potential and which shall not be used, with presenting evidence levels. We split the transactions into two groups (

Clinical Features of Drug Allergy and Factors Affecting Drug-Related Anaphylaxis: Single-center Experience of the Tertiary University Hospital

Background-Aims: Drug hypersensitivity is defined as any unfavorable reaction that occurs after the administration of any drug. We aim to determine the frequency, etiology, and clinical features of drug hypersensitivity reactions (DHRs), and to evaluate the factors affecting drug-related anaphylaxis among the patients admitted to the outpatient allergy clinic of the tertiary university hospital.&#x0D; Materials-methods: In this cross-sectional study, medical records of the 8295 patients who visited the allergy outpatient clinic of Sivas Cumhuriyet University Hospital from 2nd July 2018 to 10th December 2019 were retrospectively reviewed by the hospital data system using the ICD-code Y57.4. The frequency, etiologies, demographic and clinical features of the DHRs were evaluated.&#x0D; Results: Among the 8295 patients who visited the allergy outpatient clinic of Sivas Cumhuriyet University Hospital, 159 patients with a mean age of 40,52± 14,85 years (129 female, 30 male) were evaluated with the diagnosis of DHRs. The frequency of DHRs among admissions was found to be approximately 2%. Accompanying allergic diseases included respiratory (17%), cutaneous (10%), venom (n=3), drug (7%), and food hypersensitivity (n=2). Multiple allergic diseases were detected in 20%. Eighty-six % (n=138) could recognize the culprit drug. The causes of drug allergy were non-steroidal anti-inflammatory drugs (NSAIDs) (27%), beta-lactams (16%), co-sensitization to beta-lactams and NSAIDs (8%), antimicrobials except beta-lactams (8%), and other kinds of drugs (39%). Type 1 reaction occurred in 80%, type 4 in 21%, non-immune mediated in 7, and mixed type composed of type 1 and 4 in 9 patients. Anaphylaxis occurred in 46,5%. Fifteen% had grade 2, 22% had grade 3, and 4 had grade 4 anaphylactic reactions. According to systematical assessment, cutaneous symptoms were observed in 93%, respiratory in 38%, cardiovascular in 29,5%, neurologic in 25%, and gastrointestinal in 11%. Allergy to NSAIDs (88,6 %) and beta-lactams (82,5%) were more frequent in type 1 reactions than in type 4 and mixed type reactions (p

Characterization of clinical features of monosensitized and polysensitized allergic rhinitis patients with pollen allergy

Objectives: The present study evaluates the prevalence of monosensitization and polysensitization in patients with pollen-hypersensitive moderate-to-severe persistent allergic rhinitis (AR), and determines the clinical characteristics of the two phenotypes. Methods: This retrospective cohort study included 160 patients with moderate-to-severe persistent AR among the 3,699 patients who presented to allergy outpatient clinics who were found to have hypersensitivity to pollen based on a skin prick test and/or allergen-specific IgE positivity. The patients were divided into two groups: monosensitized (hypersensitivity to pollen alone), and polysensitized (hypersensitivity to pollen and other allergens). Both groups were evaluated for allergen hypersensitivity, symptoms of AR, symptom frequency and comorbidities related to AR. Results: Of the 160 patients, 83 (51.9%) were monosensitized and 77 (48.1%) were polysensitized. The mean age was 29.5 ± 10.7 yeasrs and 28.3 ± 8.3 years, respectively and the female-to-male ratio was 42/41 and 47/30 in the two groups. Nasal congestion was remarkably more common in the polysensitized patients than in the monosensitized patients (p = 0.01). Hypersensitivity to weed mix and Cupressus arizonica pollen identified with a skin prick test was significantly more common in the polysensitized patients than in the monosensitized patients (p = 0.03 and p = 0.01, respectively). The two groups were similar in terms of the prevalence of asthma and other comorbidities related to rhinitis (p = 0.78). Conclusions: In this single-center study, the rates of monosensitization and polysensitization were found to be similar in patients with pollen-hypersensitive moderate-to-severe AR, and the clinical characteristics of the polysensitized phenotype were different from those of the monosensitized phenotype.

The experiences of mothers of children with food allergy: A qualitative study

BackgroundFood allergies adversely affect the quality of life of the child and family, as they require lifelong treatment and follow-up. This study aims to examine the experiences of mothers who have children with food allergies within the framework of the biopsychosocial-spiritual model. MethodsThis study, using a qualitative research design, was carried out with mothers of children followed up with food allergy in the pediatric allergy outpatient clinic of a university hospital between December 15, 2022 and January 05, 2023. Purposive sampling method was used in the study and semi-structured interviews were conducted with 12 mothers. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist. FindingsThree themes, eight sub-themes, and 19 categories were identified: The effects of the disease on the physical health of the child and mother in the biological effects theme; psychosocial responses to disease, adaptation to treatment, future anxiety, coping strategies, and communication/interaction in the psychosocial effects theme; search for purpose-meaning in life and understanding belief/basic human values in the spiritual effects theme. DiscussionIt has been concluded that food allergies affect maternal health extensively, especially in the psychosocial field, and that it affects family relationships, the time that mothers spare for themselves, and physical and spiritual health. Application to practiceThe findings will be a guide for improving the quality of life of mothers followed up with food allergies and for the care and counseling support to be provided to mothers.

Retrospective evaluation of children with non-steroidal anti-inflammatory drug allergy

Aim: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs and are among the drug-related hypersensitivity reactions after antibiotics. There are limited studies evaluating nonsteroidal drug reactions in children. In this study, we aimed to evaluate the concomitant atopic diseases, admission clinic, laboratory findings and drug provocation test results of children with a pre-diagnosis of nonsteroidal drug reaction and who underwent allergy tests, retrospectively .&#x0D; Methods: In this study, patients who applied to the pediatric allergy outpatient clinic due to nonsteroidal drug reaction were included. In this group of patients, age, gender, fx5 (nutrient mix specific IgE), phadiatop (inhalant allergen mix specific IgE), skin prick tests and drug provocation tests were recorded from their files. Demographic and clinical features of the cases were compared.&#x0D; Results: 61 patients with suspected NSAIDs allergy were included in the study. When the admission clinics of the patients were evaluated, 54% (n:33) had urticaria, 22.9% (n:14) had isolated angioedema, 6.5% (n:4) had urticaria angioedema, 14.7% (n:9) had maculopapular eruption . Only 1 patient presented with anaphylaxis. NSAIDs allergy was confirmed in 16.3% (n:10) of the patients.. Single ibuprofen sensitivity was detected in 13.1% of patients (n:8), both paracetamol and ibuprofen sensitivity were detected in 1 patient (1.6%), and single paracetamol sensitivity was detected in 1 patient (1.6%).&#x0D; Conclusions: It is usually not easy to detect drug allergies in patients. These patients may usually misdiagnosed as NSAIDs allergy. In our study, it was revealed that drug provocation tests should be performed to confirm the diagnosis in case of suspected NSAIDs allergy.

The etiology, risk factors, and clinical features of anaphylaxis: The single-center retrospective cohort study of the tertiary university hospital

Background/Aim: Anaphylaxis presents in multiple ways, making its diagnosis challenging. Delayed diagnosis can lead to a postponement in administering crucial adrenaline treatment. The prevalence of anaphylaxis varies by geographical region and gender. However, there has been no comprehensive regional analysis of anaphylaxis data within our country. Despite an increasing incidence, our understanding of anaphylaxis etiology, risk factors, and clinical features remains limited, particularly within our nation. This study aims to assess the frequency, etiology, risk factors, and clinical findings of anaphylaxis among patients seen at the allergy clinic of a tertiary university hospital. Additionally, it seeks to compare regional data with existing literature. Methods: This retrospective cohort study reviewed the medical records of 8,295 patients who visited the allergy outpatient clinic at Sivas Cumhuriyet University Hospital between July 2, 2018, and December 10, 2019. The hospital’s data system retrospectively analyzed records using the ICD code T78.2 (anaphylaxis). Only cases where patients were prescribed an adrenaline auto-injector were included. The study evaluated anaphylaxis frequency, etiologies, demographics, and clinical features. Results: The study identified 77 patients (n=77) with a mean age of 40.29 (3.77) years, consisting of 47 females and 30 males. The frequency of anaphylaxis among allergy outpatient admissions was less than 1% (0.009%). Single-type atopic diseases included venom allergy (23%), drug allergy (14%), inhalant allergens (n=6), food allergens (n=4), and skin allergic diseases (n=3). Multiple allergic diseases were present in 40% (n=31) of cases. Prick tests were performed on 56 (72%) patients, with 25 (44%) yielding negative results. Among positive prick test cases, venom was the main cause of anaphylaxis (82%), while drug allergy was more prevalent (68.2%) among negative test results (P=0.016). Inhalant allergen sensitivity and allergen polisensitivity did not significantly influence the anaphylaxis cause (P&lt;0.001). Causes of anaphylaxis included drug allergy (47%), venom allergy (31%), food allergens (16%), food-dependent exercise-induced reactions (n=2), idiopathic cases (n=2), and cold urticaria (n=1). Non-steroidal anti-inflammatory drugs (NSAIDs) (44%) and beta-lactams (10%) were the primary culprits. In cases where neither drugs nor venom were involved, food allergies were the cause (P&lt;0.001). With venom allergy, the cause was venom, and without venom, drug allergy was the cause (P&lt;0.001). Female patients showed significantly higher drug- and food-related anaphylaxis rates than males (P=0.032 and P=0.042, respectively). History of Apis mellifera-related anaphylaxis was significantly more common than Vespula vulgaris-related cases (P=0.028). Anaphylaxis severity included grade 2 (30%), grade 3 (48%), and grade 4 (12%) reactions. Recurrent anaphylaxis episodes occurred in 55% (n=42) of patients. Initial hospital administrations involved epinephrine injections in only 25% (n=19) of cases. Cutaneous symptoms were present in 94%, respiratory symptoms in 88%, cardiovascular symptoms in 63%, neurological symptoms in 57%, and gastrointestinal symptoms in 12% of patients. Conclusion: This study identified drug allergy as the leading cause of anaphylaxis in the examined cases. Preventable factors contributing to drug-induced anaphylaxis included insufficient patient and physician knowledge and widespread over-the-counter drug use without medical consultation. Despite 55% of patients experiencing recurrent attacks, only a quarter received epinephrine administration. These findings emphasize the need to educate patients with recurrent anaphylaxis about avoidance strategies and to enhance healthcare providers’ understanding of anaphylaxis treatment.

What is the tolerance age of patients with cow's milk protein allergy? What are the parameters that can predict its persistence?

Objective: Cow’s milk allergy (CMA) is one of the most common food allergies in infants. The natural history of CMA indicates that resolution is common. Some studies suggest that food allergies are now being resolved at an older age. The aim of this study was to investigate the tolerance and persistence characteristics, as well as the timing of tolerance, in our own CMA patients. Material and Methods: Patients who were diagnosed with CMA and followed up in our pediatric immunology and allergy outpatient clinic between 2016-2021 years were evaluated retrospectively. Patients’ demographic characteristics, laboratory results, and tolerance time were recorded. Results: The 632 patients’ files were reviewed. 192 (30%) of the patients were followed for more than two years. The tolerance to baked products was observed with a median of 14 months, while the tolerance to fermented products was observed with a median of 17 months. Full tolerance was observed with a median of 25 months. The number of patients older than 2 years of age who could not consume any milk protein-containing product was 72 (11.4%) and 56 (77.7%) of them were IgE mediated CMA. The rate of girls with tolerance (43.5%) was found to be significantly higher than nontolerant girls (25%) (p=0.001). The mean skin test diameter of the tolerant group was significantly higher than the mean of the non-tolerant group (p=0.022). The percentage of eosinophils (p=0.003) and total IgE level (p=0.004) in the tolerant group were significantly lower compared to the intolerant group. There was no significant difference between the presence of tolerance in terms of allergy number, eosinophil count and specific IgE count (p&gt;0.05). Conclusion: Identifying the factors influencing tolerance can lead to changes in the management of the disease. We observed that 88.6% of patients older than 2 years were tolerant to milk proteins, and all patients with non-IgE mediated CMA achieved tolerance by 2 years of age. The ratio of total IgE to specific IgE, age, total IgE and specific IgE levels, presence of non-IgE or IgE mediated allergy, and gender were factors that influenced the development of tolerance in our study. Age at diagnosis and having a single or multiple food allergies did not impact the tolerance status. The prognosis for CMA remains favorable. The use of the milk ladder in managing CMA is an important approach for promoting early tolerance.

Evaluation of Serum Cathelicidin in Patients with Chronic Spontaneous Urticaria

Abstract Background Chronic spontaneous urticaria (CSU) has long been recognized as a major clinical problem with unknown cause, and it is well known that part of it is autoimmune. Cathelicidin as antimicrobial peptides was linked to autoimmune diseases. So, this study will be conducted as a step forward for better understanding of (CSU) pathophysiology. Aim of the Work Assessment of Serum Cathelicidin levels in patients with chronic spontaneous urticarial and correlate Serum Cathelicidin with Urticaria Activity Score. Patients and Methods This was a case control study conducted on 40 patients with chronic spontaneous urticaria attending the outpatient allergy and immunology clinic at Ain Shams University hospitals between October 2020 and August 2021 with 40 controls with matched age and sex were also included to evaluate serum Cathelicidin in patients with chronic spontaneous urticaria. Results The mean age of our CSU patients was 36.88 years; 67.5% were female. These demographic data are consistent with those of the literature. Our results showed that the distribution of the studied cases regarding demographic data, family history and duration of urticaria was no statistically significant difference between studied groups regarding sex, age. While for the family history there were 36 negative cases and only 4 had positive history. Regarding lab tests, we found that there was statistically significant difference between the studied Groups as regard the following WBC: (p value 0.023) being higher in group of patients than group of control, while for Total IgE: (p value &amp;lt;0.001) was being higher in group of patients than group of control. Also showed that there is no statistically significant difference between studied Groups regarding Hemoglobin, Plts, Eosinophils, with p value (0.056,0.989,0.411) respectively. The distribution of the studied cases according to Urticaria activity score (UAS7) in patients group was demonstrated as 12.5 % in Score 1, 50 % in score 2, 37.5 % in score 3. Conclusion Chronic spontaneous urticaria (CSU) has long been recognized as a major clinical problem with unknown cause, and it is well known that part of it is autoimmune. Cathelicidin as antimicrobial peptides was linked to autoimmune diseases. So, this study was conducted as a step forward for better understanding of (CSU) pathophysiology.

The relationship between aeroallergen sensitivity variations and Covid 19 in patients with rhinitis

Objective: There have been studies evaluating the association between AR and COVID-19 infection, but these studies did not evaluate the sensitisation of patients. The objective of this study was to examine the impact of allergen sensitisation on the transmission of viral infections and the progression of the disease. Material and Methods: Rhinitis patients admitted to the Adult Allergy Outpatient Clinic between April and June 2021 were included in the study. Aeroallergen sensitisation and COVID-19 disease status of the patients were evaluated. Results: Data were collected from 260 patients. It was determined that 23.8% (n=62) of the patients had COVID-19 and 17.7% (n=11) had COVID-19 pneumonia. This rate was higher than the incidence of COVID-19 in the general population. The rate of COVID-19 infection was significantly higher in patients with pollen allergy compared to other groups (p=0.049). When the COVID-19 transmission periods of the patients were analysed, it was observed that 55% of them were infected between March and September in accordance with the pollen map. Patients taking steroids (INCS or ICS) did not have an increased risk of COVID infection, and concomitant asthma did not pose an increased risk. Having chronic diseases was found to be a risk factor. Conclusions: This study provides clinical evidence of an increased frequency of infection in AR patients, especially in AR patients with pollen allergy. This result is valuable as it is a data not presented in existing studies. We also think that the risk of COVID-19 increases with pollen exposure. As pollen can suppress antiviral immunity, we recommend that chronic disease groups pay special attention to prevention methods, especially when pollen and respiratory virus seasons overlap.

The Effect of Glasgow Prognostic Score And Systemic Inflammatory Index On Mortality In Patients With Postoperative Pneumonia

The Effect of Glasgow Prognostic Score And Systemic Inflammatory Index On Mortality In Patients With Postoperative Pneumonia

The importance of skin prick test in differentiating cat sensitivities and allergies in children.

The incidence of cat allergies in children has increased over the years. Children with cat allergies have mostly reported respiratory symptoms. The skin prick test (SPT) is the most preferred method to demonstrate sensitization to allergens. However, not all children who develop cat sensitization due to environmental exposure become allergic to cats. In our study, we aimed to determine the frequency of sensitization to cat and cat allergy, cat-related symptoms, and the cut-off value for the SPT that may indicate cat allergy. Patients aged 2-18 years, who applied to the Health Sciences University İzmir Dr Behçet Uz Pediatrics and Surgery Training and Research Hospital and Balıkesir University Application and Research Hospital Pediatric Allergy outpatient clinics between January 01, 2019 and December 31, 2020, were included in the study. Patients who underwent SPT and found to be sensitized to cat allergen, were evaluated retrospectively. Clinical and laboratory findings of the patients were recorded. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value for the SPT. Sensitization to cat was detected in 140 (4%) out of 3499 patients who underwent SPT. The median age of the patients was 12 years (min-max: 5-18) and 67.1% were male. Eighty-eight (62.9%) patients were symptomatic upon contact with cats, predominantly with nasal symptoms. These patients had significantly larger cat SPT wheal size than asymptomatic patients. The cut-off value was determined as 5.5 mm with a sensitivity of 72.7% and a specificity of 61.5% (95% CI, 60.5%-78.4%). Symptoms resolved in about half of our patients by reducing contact with cats. The present study is the first to report the frequency and clinical findings of cat sensitizations and allergies in Turkish children. For effective treatment, cat allergy must be diagnosed. In this regard, the use of a practical, readily accessible 5.5 mm cut-off point on the SPT may be helpful.