Immunology Outpatient Clinic Research Articles

Retrospective evaluation of adults with primary immunodeficiency disease.

Primary immunodeficiency diseases (PIDs) are a group of heterogeneous disorders that result from one or more immune system abnormalities and have a wide range of clinical manifestations. To evaluate the demographic, clinical, and radiological features of adult patients with PID. We retrospectively reviewed the data of adult patients with PID who had been receiving immunoglobulin therapy at the adult allergy and immunology outpatient clinic between November 2017 and April 2022. Of the 23 patients included, 4 (17.4%) were females and 19 (82.6%) were males. The mean age was 38.7 ±16.2 (range: 18-75) years. Time of delay in the diagnosis of immunodeficiency was 14.9 ±15.7 (range: 0.5-49) years. The most common complaint on admission was sinopulmonary infection, and 65% of the patients had bronchiectasis. A total of 6 patients had a history of lymphoma, and 3 of them were diagnosed during the study period. Recurrence of lymphoma was observed in 1 patient. Patients with PID frequently have findings related to more than one organ system, and the diagnosis is often delayed in adults. Recognition and increased awareness of these manifestations is essential for early diagnosis and reducing morbidity and mortality.

Do Platelet Count and mean Platelet Volume have a Predictive Role as a Marker in Children with Atopic Dermatitis?

It is known that platelets play an important role in inflammatory diseases. Atopic dermatitis (AD) is a chronic, itchy, recurrent inflammatory skin disease that affects 2%-30% of the population, especially in childhood. We investigated the role of platelet count and mean platelet volume (MPV) as biomarkers in children with AD. This cross-sectional retrospective study examined the medical reports of patients who were referred to the Pediatric Allergy and Immunology Outpatient Clinic of the Medical Faculty Hospital, Istanbul Biruni University and the Pediatric Immunology and Allergy Diseases Outpatient Clinics of the Izmir S.B.U Tepecik Training and Research Hospital, for AD. A total of 167 children with AD and 170 healthy children were included in the study. Among all participants, 36.5% (n = 61) and 31.8% (n = 54) were female in the patient and control groups, respectively. The mean age was 2.8 ± 2.8 and 3.3 ± 2.5 years in the patient and control groups, respectively. MPV was statistically significantly higher in the patient group than in the control group (P =0.003). Mean platelet to neutrophil ratio and mean absolute lymphocyte count values were significantly higher in the patient group (P <.0001 for both values). However, the mean absolute neutrophil count was lower in the patient group than in the control group and it was considered statistically significant (P <.0001). In conclusion, we found significantly higher platelet counts in patients with AD. The decrease in the neutrophil to lymphocyte ratio rate was remarkable. However, there was no significant difference in the MPV values between the patient and control groups.

Serum Leptin in correlation to clinical severity in patients with chronic urticaria

Abstract Background Chronic urticaria (CU) is a complex disease associated with a systemic inflammatory response. This inflammation could be related to the release of adipokines with proinflammatory properties such as leptin. In recent years, leptin has been associated with different diseases, wound healing and immune cell activation. Objective to evaluate leptin levels in patients with chronic spontaneous urticaria, to investigate the possible role of leptin in chronic spontaneous urticaria pathogenesis and to outline relationships between serum leptin and urticaria severity. Methods A case-control study was conducted at the allergy and immunology outpatient clinic at Ain Shams University hospital, and included 60 patients with chronic spontaneous urticaria and 30 healthy individuals who were group matched with cases for age and sex serving as the control group. All the patients were subjected to the following: Full history, clinical examination, calculation of body mass index (BMI), CBC, ESR, CRP, Thyroid profile, AST, ALT, Skin prick test or Specific IgE for common allergens, and measurement of serum leptin level after overnight fasting by ELISA. Results The present study showed that patients with chronic spontaneous urticaria had higher level of serum leptin in comparison to control subjects and there was a positive correlation between leptin level and urticaria severity which was assessed by urticaria activity score. Conclusion serum leptin is increased in chronic spontaneous urticaria and it is positively correlated to urticaria severity.

Correlation between induration diameter of skin prick test result to house dust mite allergen with immunotherapy efficacy

Background: House dust mite (HDM) is one of the most aeroallergen causing allergy diseases. Skin prick test (SPT) is a simple test for hypersensitivity-related IgE. Positivity of house dust mite skin prick test results is essential to start immunotherapy. Objective: This study aimed to investigate the correlation between the induration diameter of skin prick test results to house dust mite allergen with immunotherapy efficacy. Methods: This retrospective study was conducted in the Pediatric allergy and immunology outpatient clinic of Dr. Soetomo General Hospital Surabaya. The medical record was taken from January 1st until December 31st 2020 period. House dust mite allergy was diagnosed based on the positivity of skin prick test to HDM. Immunotherapy efficacy was evaluated with daily symptom score (dSS), daily medication score (DMS), and Combined Symptom and Medication Score (CSMS) at least 3 months after immunotherapy. Age, gender, duration of illness, nutritional status, family history of atopic allergic disease, and other allergic comorbidities were stipulated as confounding variables. Statistical analysis was normality distribution test, wilcoxon rank test, spearman test, and regression analysis. Results: Sixty patients with HDM allergy (33 boys and 27 girls), were included in this study. Significant alteration of dSS, dMS, and CSMS before and after immunotherapy evaluated with wilcoxon rank test result (p=0.000 respectively). There was no correlation of each confounding variable to the induration diameter of SPT. Positive correlation between induration diameter and CSMS score was tested with Spearman test (p=0.003, r= 0.373). Conclusions: Smaller induration diameter of HDM SPT result could be predictive for immunotherapy efficacy.

Is Oral Food Challenge as Safe Enough as It Seems?

Oral food challenges (OFCs) assist in the diagnosis of food allergies and are essential to determine whether an allergy has been outgrown. During the OFC, a medical procedure e introduces foods suspected to be allergenic orally in increasing doses. Mild skin reactions such as urticaria or rarely serious life-threatening reactions such as anaphylaxis may develop. In this study, we aimed to retrospectively evaluate the clinical and laboratory characteristics of patients who experienced anaphylaxis during open OFCs in a tertiary care children's hospital. Patients who underwent OFCs to confirm the presence of a food allergy or to assess tolerance status at the University of Health Sciences, Ankara, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Pediatric Allergy and Immunology Outpatient Clinic between 1 January 2013 and 1 February 2016, were included in the study. Patients' data were obtained retrospectively from electronic medical records and challenge chart reviews. A total of 623 OFCs were performed during the period studied. Nine patients (1.4%) between 13 and 67 months of age (mean age: 38.3 months) developed anaphylaxis during their OFC. OFCs should be performed in a hospital or outpatient office under medical supervision that is adequate for anaphylaxis intervention by an allergy specialist. Close observation of objective and subjective symptoms is essential during the challenge because there are no laboratory tests that can predict an anaphylactic diagnosis or the severity of the reaction.

Fatigue: A forgotten symptom of asthma

Fatigue is a common symptom frequently reported in many disorders but little is known about the prevalence of fatigue in asthma. The objective of this study was to determine the prevalence of fatigue in asthmatic patients, the effect of fatigue on asthma quality of life and the relationship between fatigue and anxiety/depression MATERIALS AND METHODS: This prospective cross-sectional study was conducted in Uludağ University Faculty of Medicine, Department of Immunology and Allergic Diseases outpatient clinic from June 2019 to December 2019. Fatigue was assessed using the Checklist Individual Strength-Fatigue (CIS-Fatigue), psychological distress was assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) and quality of life were assessed using the Asthma Quality of Life Questionnaire (AQLQ). In the present study, a total of 168 patients are included with an average age of 43.8 ± 4.3 years. Nearly 64.8% of patients had controlled asthma and (35.2%) patients had uncontrolled asthma. Fatigue (CIS-Fatigue ≥ 27 points) was detected in 62.6% of patients and associated with asthma-related quality of life, asthma control, dyspnea, depression and anxiety (P <0.05). However, the degree of lung function impairment and asthma severity were not associated with fatigue. Fatigue as a symptom is common in asthmatic patients and correlates with asthma-related quality of life, asthma control, dyspnea, depression and anxiety. Future studies are needed to better understand the physical, psychological, behavioural and systemic factors that precipitate or perpetuate fatigue in asthma.

Characteristics of COVID-19 infection and antibody formation in patients known at a tertiary immunology department

BackgroundKnowledge about COVID-19 infections is expanding, although knowledge about the disease course and antibody formation in patients with an auto-immune disease or immunodeficiency is not fully unraveled yet. It could be hypothesized that immunodeficient patients, due to immunosuppressive drugs or their disease, have a more severe disease course due to their immunocompromised state. However, it could also be hypothesized that some of the immunosuppressive drugs protect against a hyperinflammatory state. MethodsWe collected data on the incidence of COVID-19, disease course and SARS-CoV-2 antibody formation in COVID-19 positive patients in a cohort of patients (n ​= ​4497) known at the Clinical Immunology outpatient clinic in a tertiary care hospital in the Netherlands. ResultsIn the first six months of the pandemic, 16 patients were identified with COVID-19, 14 by nasal swab PCR, and 2 patients by SARS-CoV-2 antibodies. Eight patients were admitted to the hospital. SARS-CoV-2 antibodies were measured in 8 patients and were detectable in all, including one patient on B-cell ablative therapy and one patient with Common Variable Immunodeficiency Disorder. ConclusionThis study indicates that the disease course differs among immunocompromised patients, independently of (dis)continuation of immunosuppressive drugs. Antibody production for SARS-CoV-2 in immunocompromised patients was shown. More research needs to be conducted to confirm these observations and guidelines regarding (dis)continuation of immunosuppressive drugs in COVID-19 positive immunocompromised patients should be developed.

Twelve-Week Internet-Based Individualized Exercise Program in Adults With Systemic Lupus Erythematosus: Protocol for a Randomized Controlled Trial.

BackgroundSystemic lupus erythematosus is a systemic autoimmune disease, which is associated with high cardiovascular risk, a predisposition to metabolic disorders, muscle wasting, and fatigue. Exercise therapy has become an important part of the long-term treatment of comorbidities in systemic lupus erythematosus. Exercise can lead to various benefits in patients with systemic lupus erythematosus such as increased aerobic capacity and exercise tolerance, resulting in an increased quality of life, decreased depression, and decreased fatigue. At the moment, no evidence-based treatment guidelines that recommend exercise for patients with systemic lupus erythematosus exist. Also, the efficacy of different training programs requires further investigation.ObjectiveThis study focuses on the feasibility, efficacy, and safety of an internet-based exercise program in patients with systemic lupus erythematosus. Furthermore, we investigate the feasibility and efficiency of anaerobic training compared to aerobic training.MethodsOverall, patients with systemic lupus erythematosus from the Division of Nephrology, Rheumatology, and Immunology outpatient clinic of the University Medical Center Mainz who are clinically stable status are included and randomized in an aerobic exercise group (n=10), anaerobic exercise group (n=10), or treatment as usual group (n=10). After completing initial clinical testing and physical fitness tests, patients undergo supervised 12-week online exercise programs, receiving weekly individualized training plans adapted to their physical performance. The primary outcome is change in physical fitness (VO2 peak) after 12 weeks compared to baseline. Secondary outcomes are disease activity measured via laboratory results (complement, autoantibodies) and questionnaires, as well as changes in muscle mass (anaerobic exercise group), results of the Chair-Stand test, and measurements of circulating cell-free DNA and extracellular vesicles.ResultsThe study was registered in May 2019. Enrollment began in May 2019. Of 40 patients who were initially screened, 30 patients fulfilled the inclusion criteria and were included in the study; 1 participant withdrew prior to the start of the exercise program. Among the 25 patients who completed the study, no serious adverse events have been reported; 3 participants withdrew during the program (due to frequent colds, n=1; Crohn relapse, n=1; physical strain, n=1), and 1 participant has not yet completed the program. Data analysis is ongoing, and results are expected to be submitted for publication in January 2021.ConclusionsWe expect the online exercise intervention to be a feasible and efficient tool to provide regular individualized exercise for patients with systemic lupus erythematosus.Trial RegistrationClinicalTrials.gov NCT03942718; http://clinicaltrials.gov/ct2/show/NCT03942718.International Registered Report Identifier (IRRID)DERR1-10.2196/18291

Three Characterisctics of Atopy to Diagnose Allergy in Children with Respiratory Symptomps

The prevalence of allergic diseases has increased in the last decade. Therefore, precise and reliable in predicting allergy in children were needed. However, in daily practice, most misdiagnosis occurs because it is only based on a family history of allergy. This study aims to evaluate the chronicity, recurrence of symptoms with similar exposure, and family history of allergy to be used as a predictor of allergy in children with respiratory symptoms. Cross sectional study was conducted in children who referred to the Pediatric Allergy and Immunology Outpatient Clinic, Dr. Soetomo General Hospital, Surabaya from January 1st - July 31st 2019. Children with a suspected allergy who developed respiratory symptoms was included. The data was taken from standardized medical record. The sensitivity and specificity of the 3 characteristics of atopic with positive SPT were calculated. A total of 115 children were admitted and 109 children fulfill the inclusion criteria. Gender 60% male and 40% female. The most common group of age founded was age 5-&lt;10 years 39.4%, followed by 1-&lt;3 years (25.8%), 3-&lt;5 years (22.9%), 10 years 8.3%, and &lt;1 year (3.6%). Fifty-four patients (49.5%) fulfilled 3 characteristics of atopy and there were 64 patients (58.7%) with positive SPT results. The sensitivity, specificity, positive predictive value and negative predictive value were 81.3%, 95.6%, 96.3%, and 78.2%, respectively. The 3 characteristics of atopy have good sensitivity and specificity to predict allergy in children.

Pyoderma gangrenosum and chronic granulomatous disease treated with adalimumab: Case-based review

BackgroundChronic granulomatous disease (CGD) is a rare immunodeficiency disorder that manifested by recurrent severe bacterial and fungal infection. It may be associated with non-infectious inflammatory complications that affect gastrointestinal tract, lung and skin. Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterizes by painful cutaneous ulceration. The coexistence of PG and CGD is very rare and the treatment is challenging; only few cases have been reported. Aim of the workTo describe the features and management of a challenging case of PG associated with CGD. Case reportA 20-year old male with a long history of recurrent bacterial and fungal infections due to CGD presented to the Rheumatology and Immunology outpatient clinic at Mansoura University hospital with an ulcerative cutaneous lesion with exudation and crusting on the left lateral malleolus. There were elevated inflammatory markers: erythrocyte sedimentation rate (ESR) 130 mm/1st h and C-reactive protein (CRP) 52 mg/dl. Histological examination of the lesion revealed diffuse dermal infiltrate of neutrophils and nuclear dust admixed with some histiocytes, lymphocytes and plasma cells, a picture suggestive of PG. Systemic and musculoskeletal examination were unremarkable except for low grade fever (37.7 °C). Conventional immunosuppressives were not satisfactory and adalimumab (40 mg/2 weeks) was added showing significant improvement of the lesion (ESR 7 mm/h, CRP 3 mg/dl). ConclusionCGD is a rare primary immunodeficiency disorders that can be associated with PG. The coexistence of these two conditions requires judicious use of immunosuppressive agents. However; adalimumab may be an effective and safe treatment option.

Reverse Angle: Immunological Evaluation of Patients with Bronchiectasis

Objective: Bronchiectasis is a chronic debilitating disease of the airways that results in chronic cough and production of viscous sputum due to dilatation of the airways and bronchial wall thickening. Although bronchiectasis is a common problem in immunodeficiencies and a well-known complication of these disorders, there are a limited number of studies on the frequency of immune abnormalities in adult patients with bronchiectasis. Materials and Methods: The records of adult patients who visited the Pulmonology Outpatient Clinic and whose immune system was assessed due to bronchiectasis at the Immunology Outpatient Clinic until June 2018 were retrospectively evaluated. The data of 84 patients with bronchiectasis (mean age: 48.5 ± 17.9 years, female: 45 [53.6%], male: 39 [46.4%]) were analyzed. Results: Six patients (7.1%) had at least one antibody deficiency. Four patients (4.8%) had low IgG levels, one (1.2%) had low IgA level, and one (1.2%) had low IgM level. Fourteen patients (16.7%) had high IgG (16-22 g/l), 10 (11.9%) high IgA (4.08 - 6.60 g/l) and one (1.2%) high IgM (8.87 g/l). Thirty-five patients (41.7%) had at least one abnormality in the peripheral lymphocyte subset analyses. Conclusion: Adult patients with bronchiectasis may have a variety of immunological abnormalities in addition to hypogammaglobulinemia. Therefore, clinicians should not overlook immunological evaluation in the etiological investigation of bronchiectasis, and patients with immunological abnormalities should be closely monitored.

A novel VPS13B mutation in Cohen syndrome: a case report and review of literature

BackgroundCohen syndrome, an autosomal recessive syndrome, is a rare syndrome with diverse clinical manifestations including failure to thrive, hypotonia, hypermobile joints, microcephaly, intellectual disabilities, craniofacial and limb anomalies, neutropenia and a friendly character. It is associated with mutations of the vacuolar protein sorting 13 homolog B (VPS13B) gene, which is involved in the development of the ocular, hematological and central nervous systems. This gene encodes a transmembrane protein playing a crucial role in preserving the integrity of the Golgi complex. To date, more than 150 mutations of VPS13B have been reported in over 200 Cohen syndrome patients. Missense or nonsense mutations are the most common mutations.Case presentationA 4-year-old girl, born to consanguineous parents, was referred to the pediatric clinical immunology outpatient clinic for investigation of recurrent neutropenia with a history of recurrent infections in the past year. On physical examination, she had the characteristic facial features of Cohen syndrome, developmental delay and speech disorder. She had a cheerful disposition, and her mother gave a history of feeding difficulties in her first months of life. She did not present any ophthalmologic or cardiac abnormalities. Her lab results revealed moderate neutropenia. Serum IgG, IgM, IgA and IgE levels were normal. She fulfilled the clinical diagnostic criteria for Cohen syndrome. WES revealed a novel homozygous frameshift variant in VPS13B (LRG_351t1: c.7095del; p.Ser2366AlafsTer49). Currently, she is not experiencing any severe problem, and she undergoes irregular medical treatment once her neutrophil count decreases under the normal limit. Her verbal and motor abilities have improved as a result of speech and occupational therapies.ConclusionWe reported a novel homozygous frameshift variant in VPS13B (LRG_351t1: c.7095del; p.Ser2366AlafsTer49) in a 4-year-old girl with Cohen syndrome. Cohen syndrome should be considered in differential diagnosis of any child with intellectual disability and neutropenia.

Trends of sensitization to aeroallergens in patients with allergic rhinitis and asthma in the city of Bursa, South Marmara Sea Region of Turkey

Background/aim Allergic rhinitis (AR) and asthma are the most common allergic disorders worldwide. Aeroallergens are critical causative factors in the pathogenesis of these disorders and sensitization to aeroallergens differs in various countries and regions. Identification of the most common aeroallergen sensitization is crucial in the diagnosis and management of AR and asthma. We examined the distribution of aeroallergen sensitizations detected by skin prick tests (SPTs) in adult patients with AR and/or asthma in the city of Bursa. Materials and methods Five hundred forty-five patients who underwent a SPT and were diagnosed with rhinitis and/or asthma in the Uludağ University Faculty of Medicine’s Department of Immunology and Allergic Diseases Outpatient Clinic from March 2018 to August 2018 were retrospectively evaluated. SPTs with standard extracts including house dust mites, pollens, molds, animal dander, and latex were performed for patients.Results A total of 545 patients were included and most of the patients (270; 49.5%) were between 30 and 49 years of age. The prevalence of atopy was 57.9%. The most common aeroallergens detected in SPTs were Dermatophagoides farinae (50%) and D. pteronyssinus (44%), followed by grass-rye mix (43%), grass mix (38.6%), olive (33.2%), and wheat (32.3%). The sensitization to olive pollen was higher in cases of mild asthma (52%), while sensitization to D. farinae was higher in patients with mild and moderate asthma (54.5%, 54.2%) (P < 0.05).ConclusionsOur study revealed that house dust mite was the most common sensitizing aeroallergen in patients with AR and asthma while pollens were the most common allergen in patients with only AR. The sensitization to grass and olive pollen was higher in cases of mild asthma than moderate and severe. Regional allergy panels may provide important clinical clues for characteristics and courses of allergic diseases.

Sputum periostin in patients with different asthma phenotypes

Abstract Background Asthma is a common respiratory condition causing symptoms such as cough, chest tightness and wheezing that are triggered by factors as exercise, allergens and viral infection. Asthma is characterized by airflow limitation, airway hyper-responsiveness and bronchial inflammation. Aim of the work to identify the different phenotypes in a group of asthmatic patients; and to evaluate the role of periostin in bronchial asthma and its different cellular phenotypes and its correlation asthma severity. Subjects and Methods This observational cross-sectional study was conducted on 96 adult asthmatic patients. They were classified into two groups: group (A) 48 patients with severe asthma (persistent airflow limitation), group (B) 48 patients with mild to moderate asthma according to (GINA 2016) criteria attending the Allergy and Clinical Immunology outpatient clinic, Ain Shams University Hospitals. The study also included 10 healthy controls of matched age and sex group. Results sputum periostin levels in asthmatic patients are higher than its levels in healthy controls. Sputum eosinophil percentage in asthmatic patients is higher than those in healthy controls. Sputum periostin levels in patients with severe asthma were found to be higher than sputum periostin levels in patients with mild to moderate asthma. There is high positive correlation between sputum periostin and asthma severity and age and there is negative but significant correlation between sputum periostin and (FEV1) and it is found to be correlated with duration of asthma and pattern of (PFT) abnormality (higher in mixed pattern) and sputum eosinophilia. Conclusion Sputum periostin is correlated with asthma severity and eosinophilic asthma. Periostin is considered to be an important biomarker for severe asthma and eosinophilic phenotype of asthma.

Sensitivity and specificity of serum soluble interleukin-2 receptor for diagnosing sarcoidosis in a population of patients suspected of sarcoidosis.

The soluble interleukin 2 receptor (sIL-2R) has been proposed as a marker of disease activity in patients with sarcoidosis. However, no studies have evaluated whether serum sIL-2R measurement is of use in establishing the diagnosis of sarcoidosis in patients who are suspected of sarcoidosis among other diseases. A cohort study was conducted, consisting of new patients who visited the immunology outpatient clinic and whose serum sIL-2R levels were available before a definitive diagnosis was established between February 2011 and February 2016. All patients underwent standard diagnostic testing for sarcoidosis (e.g. laboratory tests, radiographic and/or nuclear imaging and/or affected site biopsy). This resulted either in the diagnosis of sarcoidosis or the exclusion of sarcoidosis with the diagnosis of another disease. Results of sIL-2R and angiotensin-converting enzyme (ACE) levels, radiographic and nuclear imaging and histology results were collected and definitive diagnoses were recorded. Sensitivity, specificity, the concordance statistic from the receiver operating characteristic curve and Youden's Index were calculated to assess the performance of sIL-2R in the diagnosis of sarcoidosis and were compared to ACE, currently one of the most used diagnostic biomarkers in the diagnosis of sarcoidosis. In total 983 patients were screened for inclusion, of which 189 patients met the inclusion criteria. A total of 101 patients were diagnosed with sarcoidosis after diagnostic workup, of whom 79 were biopsy-proven. In 88 patients a diagnosis other than sarcoidosis was made. The sensitivity and specificity of serum soluble interleukin 2 receptor levels to detect sarcoidosis were 88% and 85%. The sensitivity and specificity of ACE were 62% and 76%. Receiver operating characteristic curve analysis revealed that sIL-2R receptor is superior to ACE (p<0.0001). Serum sIL-2R is a sensitive biomarker and superior to ACE in establishing the diagnosis of sarcoidosis and can be used to rule out sarcoidosis in patients suspected of sarcoidosis.

The assessment of radiosensitivity in patients with ataxia-telangiectasia syndrome and in carriers of the mutated ATM gene using lymphoblastoid cell lines

Introduction: Hypersensitivity to ionising radiation is most often observed in the course of primary immunodeficiency diseases, which are associated with dysfunctional DNA repair, especially with the repair of double-strand breaks. Due to phenotypic similarities between primary immunodeficiency diseases, radiosensitivity testing can prove useful in early differential diagnosis, when attempting to identify patients with increased toxic reactivity to radio- and chemotherapy, and can have an impact on the process of their preparation for stem cell transplantation. Aim: The aim of the study was to assess the radiosensitivity in vitro of patients with ataxia-telangiectasia (A-T) syndrome, and their parents, carriers of one copy of the mutated ATM gene. Material/Methods: Lymphoblastoid cell lines (LCLs) from 15 A-T patients (remaining under the care of the Immunology Clinic and Immunology Outpatient Clinic of the Children’s Memorial Health Institute) and 11 mothers and 11 fathers of A-T patients, were used for radiosensitivity assessment. A standard colony survival assay (CSA) was applied in the tests. Results: A markedly decreased survival fraction (SF) of LCLs after in vitro exposure to X-rays was observed in all A-T patients when compared to control cells. A clear diversification of radiosensitivity to ionising radiation was observed among obligate heterozygotes. SF for heterozygotes was between 1% and 53%, i.e. varied from the values in healthy individuals to the extreme values observed in A-T patients. Conclusion: The assessment of cell radiosensitivity in A-T patients using CSA may be a useful additional test for confirming a clinically suspected disease. In heterozygous carriers, it can be an indicator of increased risk of carcinogenesis, and in both A-T patients and their parents can be helpful in making decisions with regard to radio- and/or chemotherapy.

Prevalence of food allergens sensitization and food allergies in a group of allergic Honduran children

BackgroundFood allergy is a public health problem that has increased in the last decade. Despite the increasing rates in children, quality data on the burden of these diseases is lacking particularly in developing countries. Honduras has no studies in pediatric patients.ObjectivesThe objective of this research was to identify the most common sensitization patterns to food through epicutaneous skin testing and food allergy rates in children and their correlation with common allergic diseases in a group of patients from Hospital of Pediatrics Maria.MethodsCross-sectional retrospective, descriptive study in which records and database of all allergic patients in the immunology outpatient clinic from Hospital of Pediatrics Maria were reviewed between the periods of January 2015 through June 2016.ResultsA total of 365 children were analyzed, the age of participants were in the range from 1 to 18 years, with an average of 9.8 years. Sensitization to food allergens were found in 23, and 58.3% were poly-sensitized. The most common food allergens that patients were sensitized to: milk 9.0%, eggs 6.9%, peanut 4.9% and pork meat 4.4%. Food allergy was confirmed via oral food challenged in 9.3% of the patients. The most frequent food allergies found were: cow’s milk allergy 6%, hen’s egg allergy 5.2% and wheat allergy 1.9%.ConclusionsMilk and egg were the most common a food allergens found in the population studied. Most of the patients were found to be poly-sensitized. The frequent food allergies confirmed via oral food challenge were cow’s milk allergy, hen’s egg allergy and wheat allergy.

Prevalence of asymptomatic urethritis by Chlamydia trachomatis and Neisseria gonorrhoeae and associated risk factors among males living with HIV-1.

ABSTRACTObjectives The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection.Methods We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital.Results Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015).Conclusion The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged.

CETIRIZINE SUPPRESSION TO SKIN PRICK TEST RESULTS IN ATOPIC ALLERGY PATIENTS

This study was done to determine the suppression index of Cetirizine to the skin prick test results to obtain a correction constant or factor that can be used to assess the results of the skin prick test in patients who cannot stop the use of antihistamines (Cetirizine). This pre and post test study design clinical trial involved 22 atopic allergy patients who seek medical treatment at the Allergy and Immunology Outpatient Clinic Dr. Soetomo Hospital. Skin prick tests were done twice (SPT1 and SPT2) using house dust mite allergen extract to all study subjecs. The first (SPT1) were done after washout of all antihistamine for 1 week prior the test. All study subjects were then given Cetirizine 10 mg once daily for 5 days and on day 6 we performed the second test (SPT2). Cetirizine suppresion index and correction factor were calculated by comparing the wheal area of SPT1 and SPT2. All 22 study subjects (6 males and 16 females) were sensitized to house dust mite allergen. Mean serum total IgE levels were 176.42 + 352.5 IU/dL. Mean wheal area generated by the positive control (histamine 1 mg/mL) in SPT1 was 7.53 + 7.31 mm2, and in SPT2 was 1.08 + 1.46 mm2. Mean wheal area generated by house dust mite allergen in SPT1 was 43.57 + 36 mm2, and in SPT2 was 10.28 + 8.47 mm2. Cetirizine suppression index for positive controls (histamine 10 mg/mL) was 94.63 + 7.90% (p=0.000), while the Cetirizine suppression index for house dust mite allergen is 72.31 + 13.96% (p=0.000). There was no significant influence of serum total IgE levels to Cetirizine suppression index (p=0.381). The correction constant based on the calculation was 1.9. In conclusion, Cetirizine suppression index to the mean wheals area generated by house dust mite allergen was 72.31% and the correction constant was 1.9. In allergic patients who cannot stop their antihistamine drugs, Cetirizine 10 mg once daily can be used as a replacement and they still be able to undergo skin prick tests. The actual wheal diameter (or area) of the skin prick test results can be calculated by multiplying the measured wheal diameter (or area) under the Cetirizine administration with the correction constant.

Van İlinde Astım ve/veya Allerjik Rinitli Çocuklarda Tamamlayıcı ve Alternatif Tıp Uygulamaları

Objective: The aim of this study was to evaluate the complementary and alternative medicine (CAM) methods, the prevalence of their use, and to assess the factors that influence using these methods in children with asthma and/or allergic rhinitis in Van. Material and Methods: The study was conducted between June 2015 and January 2016. A survey form consisting of 15 questions was prepared. These questions were posed to the parents of the children with asthma and/or allergic rhinitis who were being followed-up at the pediatric allergy and immunology outpatient clinic. Results: The study included 127 parents of children aged 2-17 years. The mean age of the patients was 7.9 ± 3.6 years. 62 (48.8%) of the 127 parents stated that they had used CAM methods at any time of their life. 9 (14.5%) of the CAM users thought that they had benefited from these methods. The most common modality was molasses used in 45 (72.5%) of the patients. 44 (70%) of the patients used herbs and spices (linden, rosehip, mountain thyme, black pepper, cinnamon, etc.), 23 (37%) used honey, 13 (20%) used quail eggs, 10 (16.1%) used olive oil, 6 (9.6%) used cow’s milk, 1 (1.6%) used bee milk, 1 (1.6%) used bee pollen and 1 (1.6%) used Vicks application to the chest region. Most of the parents had accessed information about CAM methods through a herbalist and the media. Conclusion: In conclusion, the prevalence of reported CAM use among patients with diagnosed asthma and/or allergic rhinitis in Van was found to be high (48.8%) and at a similar rate with other regions of our country, with molasses (72.5%) being the most popular modality. The pediatric allergy specialist should have knowledge about these methods and inform parents about their possible side effects.