Drug allergy in tertiary care in Turkey: Results of a national survey. The ADAPT study: Adult drug allergy perception in Turkey

BACKGROUND: No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. METHODS: This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. RESULTS: Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. CONCLUSION: Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH

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Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey.

BACKGROUND: No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. METHODS: This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. RESULTS: Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. CONCLUSION: Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.

Are chronic urticaria, analgesic intolerance and seasonal rhinitis markers of different severities and phenotypes of the asthma they accompany?

Background: Asthma is a heterogeneous disease that presents with different clinical phenotypes. We aimed to compare the patients with asthma diagnosis alone with the patients, who, in addition to their asthma had accompanying analgesic intolerance (AI), chronic urticaria (CU) or seasonal rhinitis (SR) if there are any distinctions and specific characteristics of these defined patient groups. Methods: Eighty-four asthma patients diagnosed with SR, 46 with CU, 75 with AI and 71 patients with asthma alone were enrolled to the study retrospectively. The reference group for the comparisons was the group with astma diagnosis alone. Results: The mean age of all patients was 37.2±13 (15–80) and 70.7% of them were females. Asthma patients with SR had a significantly earlier onset of asthma (age: 27.4±10.8 and 34.5±15.9; respectively, p<0.01), significantly better pulmonary function tests and were significantly more atopic (92.9% and 28.8%; p<0.001). Moderate-to-severe asthma significantly correlated with older age at the time of diagnosis, older age of asthma onset, higher body mass index, less atopy and fewer pollen sensitivity. Asthma severity of patients with SR was significantly milder than the reference group (OR: 0.6, 95% CI 0.5–0.8). Asthma with AI tended to be more severe although the relation was insignificant (OR:1.6 95% CI:0.8–3.5). Conclusions: Asthma patients with SR have significantly milder and earlier onset of asthma, better pulmonary function tests and are significantly more atopic while asthma with AI tends to be more severe. Asthma with CU does not show a specific phenotypic characteristic

Are chronic urticaria, analgesic intolerance and seasonal rhinitis markers of different severities and phenotypes of the asthma they accompany?

BACKGROUND: Asthma is a heterogeneous disease that presents with different clinical phenotypes. We aimed to compare the patients with asthma diagnosis alone with the patients, who, in addition to their asthma had accompanying analgesic intolerance (AI), chronic urticaria (CU) or seasonal rhinitis (SR) if there are any distinctions and specific characteristics of these defined patient groups. METHODS: Eighty-four asthma patients diagnosed with SR, 46 with CU, 75 with AI and 71 patients with asthma alone were enrolled to the study retrospectively. The reference group for the comparisons was the group with asthma diagnosis alone. RESULTS: The mean age of all patients was 37.2±13 (15-80) and 70.7% of them were females. Asthma patients with SR had a significantly earlier onset of asthma (age: 27.4±10.8 and 34.5±15.9; respectively, p<0.01), significantly better pulmonary function tests and were significantly more atopic (92.9% and 28.8%; p<0.001). Moderate-to-severe asthma significantly correlated with older age at the time of diagnosis, older age of asthma onset, higher body mass index, less atopy and fewer pollen sensitivity. Asthma severity of patients with SR was significantly milder than the reference group (OR: 0.6, 95% CI 0.5-0.8). Asthma with AI tended to be more severe although the relation was insignificant (OR:1.6 95% CI:0.8-3.5). CONCLUSIONS: Asthma patients with SR have significantly milder and earlier onset of asthma, better pulmonary function tests and are significantly more atopic while asthma with AI tends to be more severe. Asthma with CU does not show a specific phenotypic characteristic.

Hereditary angioedema associated with heterozygous factor V Leiden mutation in a patient with Purpura fulminans.

BACKGROUND: Hereditary angioedema (HAE) is an autosomal dominant, quantitative or functional defect of the C1 esterase inhibitor. The main role of the C1 esterase inhibitor is to regulate the activation of the complement system, the contact phase of the intrinsic coagulation system. On the other hand, factor V Leiden is the most common cause of primary and recurrent venous thromboembolism and displays a strong interaction with oral contraceptives. Here we report the case of a patient with HAE associated with the factor V Leiden mutation who had purpura fulminans when put on an oral contraceptive therapy. CASE: A 42-year-old woman presented to the emergency room with a history of livid skin changes on her legs during a flight. On physical examination, the vital signs were normal, but there were edemas in her legs. The livid skin changes tended to increase, eventually leading to skin necrosis on the next day. She had a history of a similar episode two months before and experienced both episodes of necrotic skin lesions just after she had been put on a hormone replacement therapy due to irregular menstruations. She also had a history of recurrent angioedema attacks since her childhood, triggered by stress and physical stimulants such as pressure and heat. Subsequent investigations revealed heterozygous factor V mutation, activated protein C resistance and reduced C1 inhibitor levels. CONCLUSION: Thrombosis is a multifactorial disease. The coexistence of multiple hereditary and acquired factors eases its occurrence. Women with HAE should be screened for the factor V Leiden mutation before pregnancy or the start of a hormone replacement therapy.

Bee and bee products allergy in Turkish beekeepers: determination of risk factors for systemic reactions.

BACKGROUND: The prevalence of allergic reactions due to bee stings in beekeepers varies in different regions of the world. The aim of this study was to evaluate the characteristics of sting reactions and the risk factors for developing systemic reactions in Turkish beekeepers. METHODS: A self-administered questionnaire was distributed to 1250 beekeepers to be completed in seven different cities of Turkey. A total of 494 (39.6 %) questionnaires were returned. RESULTS: There were 444 subjects (89.9 %) with a history of sting exposure in the previous 12 months. Systemic reactions were present in 29 subjects (6.5 %) and nine (2 %) reactions were anaphylactic. Fifty-five percent of beekeepers reported more than 100 bee stings in the previous year. When systemic reactions were controlled by age and duration of beekeeping in a logistic regression model, seasonal rhinitis (OR: 4.4, 95 % CI: 1.2-11.5), perennial rhinitis (OR: 4.6, 95 % CI: 1.2-18.2), food allergy (OR:7.0, 95 % CI: 2.0-25.0), physician-diagnosed asthma (OR: 8.0, 95 % CI: 2.5-25.6), having an atopic disease of any type (OR: 3.3, 95 % CI: 1.2-8.7) and having two or more atopic diseases (OR: 10.9, 95 % CI: 3.5-33.8) were significantly associated with systemic reactions due to bee sting in the previous 12 months. CONCLUSION: The incidence of systemic reactions in Turkish beekeepers is low, which might be due to the protective effect of a high frequency of bee stings. The risk of systemic reactions increases approximately three-fold when one atopic disease is present and eleven-fold when two or more concurrent atopic diseases are present with respect to no atopic disease.

Bee and bee products allergy in Turkish beekeepers: determination of risk factors for systemic reactions / Alergia a la abeja y a los productos de la abeja en apicultores turcos: determinación de los factores de riesgo de reacciones sitémicas

Background: The prevalence of allergic reactions due to bee stings in beekeepers varies in different regions of the world. The aim of this study was to evaluate the characteristics of sting reactions and the risk factors for developing systemic reactions in Turkish beekeepers. Methods: A self-administered questionnaire was distributed to 1250 beekeepers to be completed in seven different cities of Turkey. A total of 494 (39.6 %) questionnaires were returned. Results: There were 444 subjects (89.9 %) with a history of sting exposure in the previous 12 months. Systemic reactions were present in 29 subjects (6.5 %) and nine (2 %) reactions were anaphylactic. Fifty-five percent of beekeepers reported more than 100 bee stings in the previous year. When systemic reactions were controlled by age and duration of beekeeping in a logistic regression model, seasonal rhinitis (OR: 4.4, 95 % CI: 1.2-11.5), perennial rhinitis (OR: 4.6, 95 % CI: 1.2-18.2), food allergy (OR:7.0, 95 % CI: 2.0-25.0), physician-diagnosed asthma (OR: 8.0, 95 % CI: 2.5-25.6), having an atopic disease of any type (OR: 3.3, 95 % CI: 1.2-8.7) and having two or more atopic diseases (OR: 10.9, 95 % CI: 3.5-33.8) were significantly associated with systemic reactions due to bee sting in the previous 12 months. Conclusion: The incidence of systemic reactions in Turkish beekeepers is low, which might be due to the protective effect of a high frequency of bee stings. The risk of systemic reactions increases approximately three-fold when one atopic disease is present and eleven-fold when two or more concurrent atopic diseases are present with respect to no atopic disease

Antecedentes: la prevalencia de las reacciones alérgicas por la picadura de abejas en los apicultores varia en las diferentes regiones del mundo. Este estudio está encaminado a evaluar las características de las reacciones a la picadura y los factores de riesgo para que tengan lugar reacciones sistémicas en los apicultores turcos. Métodos: Se envió un cuestionario a 1.250 apicultores de siete ciudades diferentes de Turquía, para que lo retornarán tras cumplimentarlo, lo que hicieron 494 (39,6%) de ellos. Resultados: En los 12 últimos meses, 444 (89,9%) de los apicultores habían sufrido picaduras. 29 (6,5%) habían tenido reacciones sistémicas, 9 de ellas (2%) reacciones anafilácticas. El 55% de los apicultores habían sido sufrido más de 100 picaduras en el último año. Cuando las reacciones sistémicas se controlaron en función de la edad y la duración de la apicultura en un modelo de regresión logística, la rinitis estacional (OR: 4.4, 95% CI:1.2-11.5), rinitis perenne (OR: 4.6, 95% CI:1.2-18.2), alergia alimentaria (OR: 7.0, 95% CI:2.0-25.0), asma diagnosticada por el médico (OR: 8.0, 95% CI: 2.5-25.6), tener una enfermedad atópica (OR: 3.3, 95% CI: 1.2-8.7), y tener dos o más enfermedades atópicas (OR: 10.9, 95% CI: 3.5-33.8), estaban asociadas significativamente con reacciones sistémicas causadas por picadura de abeja en al menos los últimos 12 meses. Conclusión: la incidencia de reacciones sistémicas en los apicultores turcos es baja, lo que puede deberse al efecto protector de la alta frecuencia de picaduras de abeja. El riesgo de reacciones sistémicas aumenta aproximadamente tres veces cuando el apicultor ya padece una enfermedad atópica y once veces cuando concurren dos o más enfermedades atópicas, en comparación con los apicultores que no padecen enfermedades de esta naturaleza