Comparison of two diagnostic criteria in the diagnosis of anaphylaxis in a tertiary adult allergy clinic.

Background: Anaphylaxis is a very dynamic issue with its incidence and trigger profile changing over the years. We aimed to compile the characteristics of anaphylaxis cases diagnosed in our clinic prospectively and to make a comparison between diagnostic criteria proposed by National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) and World Allergy Organization (WAO). Method: Three-item diagnostic criteria recommended by NIAID/FAAN (2006) were used in the diagnosis of anaphylaxis. The clinical features of the cases, risk factors, etiologies, severity of anaphylaxis, and treatment approach were determined. The same patients were also classified by current WAO diagnostic criteria. Results: A total of 204 patients (158F/46 M, median age 45.3 years) were included. Drugs (65.2%), venom (9.8%) and food allergies (9.3%) were the top 3 etiologies. Among drug triggers, chemotherapeutics were the most common (17.7%), followed by antibiotics (15.3%) and non-steroidal anti-inflammatory drugs (14.2%). The patients were mostly diagnosed with the second criterion (84.8%), followed by the first criterion (11.8%) and the third criterion (3.4%) of the NIAID/FAAN criteria. In terms of WAO criteria, 82.8% of the patients were diagnosed with the first criterion, and 14.3% with the second criterion while 2.9% of the patients did not meet the WAO criteria. The severity of anaphylaxis was evaluated as grade-2, 3 and 4 in 30.9%, 64.2%, and 4.9% of the patients, respectively. Adrenaline was administered to 31.9% of the patients especially who had angioedema and bronchospasm (p = 0.04). Conclusion: Our data suggest that covering more details in patient's history may prevent possible underdiagnosis and WAO diagnostic criteria seem to be insufficient in some patients. We believe that our results will contribute to the literature on anaphylaxis and would be groundwork for future studies.

Rapid drug desensitization with platin-based chemotherapy: Analysis of risk factors for breakthrough reactions.

BACKGROUND: All platin-based chemotherapeutics can cause hypersensitivity reactions (HSRs). With rapid drug desensitization (RDD), few patients experience breakthrough reactions (BTR) during desensitization. However, data about risk factors for BTRs during RDD in patients with HSRs to platins are limited. We first aimed to describe characteristics of our platin-reactive population and to validate the Brigham and Women's Hospital's (BWH's) RDD protocol in our population along with their outcomes with RDD. Our second aim was to identify the risk factors for BTRs. METHOD: This was a retrospective chart review (2013-2020) of patients with symptoms of immediate HSRs to platins. Initial HSRs were classified as grade 1, 2, or 3 based on their severity. Skin prick tests (SPT)/intradermal tests (IDT) were performed with implicated platins. A 12-step protocol was used during RDD. RESULTS: The study comprised 65 women and seven men (mean age 57.78 ± 8.73 years). Initial HSRs to carboplatin, cisplatin, and oxaliplatin occurred in 38, 13, and 21 patients, respectively. All patients reacted at the fifth (median) recurrent infusions (min:1, max:20). The median values for carboplatin, cisplatin, and oxaliplatin were 6 (1-20), 3 (1-15), and 3 (1-11), respectively. Most initial HSRs were grade 2 (n = 40, 55.6%) and 3 (n = 27, 37.5%); only 6.9% (n = 5) were grade 1. Patients with grade 1, 2, and 3 initial HSRs had positive platin skin test results at rates of 80%, 74%, and 88%, respectively.A total of 232 RDDs were performed in 72 patients and 98.7% of these desensitizations were completed. BTRs occurred in 56 (24.1%) (grade 1 n = 14, 25%; grade 2 n = 32, 57%; grade 3 n = 10, 18%) of these desensitizations. Breakthrough reactions were more severe in patients with positive SPTs or 1:100 or 1:10 dilutions of IDT (p = 0.014). BTR was not observed during RDD in any of the patients with positive 1:1 dilutions of IDT. Positivity on prick or 1:100 or 1:10 IDT increased the risk of BTR 5.058 times. There was no significant association between the risk of BTRs and age, drug cycle, sex, comorbidities, or atopy. CONCLUSION: In our experience, 98.7% of 232 RDDs to platins were completed successfully, showing that RDD was safe and effective. Drug skin test positivity is a potential marker for identifying high-risk patients who will have BTRs during RDDs to platins.

[Asthma and nasal polyposis: Are biological treatments effective?] / Astim ve nazal polipozis: Biyolojik tedaviler etkili mi?

Chronic rhinosinusitis with nasal polyps often accompanies severe asthma. Uncontrolled nasal polyp does not only impair the quality of life, but also makes it difficult to control the accompanying asthma. Eosinophilic chronic sinusitis dominated by type 2 inflammation is phenotypically manifested by nasal polyps. In recent years, approaches towards phenotype and endotype have developed in patients with chronic sinusitis as well as in asthma; biological treatments come into question in uncontrolled patients with appropriate endotype. Randomized controlled trials conducted on treatments that antagonize the Ig-E, IL-5, and IL-4a pathways in these patients are promising. The effectiveness of biological treatments, which we think will be more involved in clinical practice in the management of nasal polyp patients in the near future, will become clear with the increase in real life data in the literature.

The Effect of Gum Chewing on Abdominal Pain and Nausea Caused by Polyethylene Glycol Solution Used for Intestinal Cleansing Before Colonoscopy: An Endoscopist-Blinded, Randomized Controlled Trial.

Gum chewing is known to have a positive effect on intestinal motility. Most studies have examined its effect on ileus, but there has been no discussion of the effects of polyethylene glycol used in preparation for colonoscopy. The purpose of this study was to determine the effect of gum chewing on abdominal pain and nausea caused by polyethylene glycol solution used for intestinal cleansing before colonoscopy. The study was planned as a single-center, randomized, controlled experimental study. The research sample was determined using power analysis (n = 60). Consecutive patients undergoing colonoscopy were randomized into the experimental and control groups. Patients in the gum group chewed mint-flavored sugar-free gum for 20 minutes every 2 hours until the start of colonoscopy after consuming 2 L of polyethylene glycol solution. Patients in the control group drank only polyethylene glycol solution. Examination of precolonoscopy pain and nausea revealed a statistically significant difference in the gum chewing group (p < .05). Patients using sugar-free gum experienced statistically significant fewer problems after colonoscopy. Gum chewing had a positive effect on abdominal pain and nausea. There are no drawbacks to presolution chewing, and it may be recommended for patients.

Serum interleukin-37 level and interleukin-37 gene polymorphism in patients with Behçet disease.

Behçet's disease (BD) is a chronic inflammatory disease. The etiopathogenesis of BD is not well understood and several cytokines and genetic factors have been investigated. Interleukin (IL)-37, which a member of IL-1 family is an anti-inflammatory cytokine. The aim of the study was to analyze serum IL-37 level and IL-37 gene polymorphisms to assess its possible role in BD. Two hundred twenty-three patients with BD and 80 healthy controls (HC) were enrolled. Serum IL-37 level was measured using an enzyme-linked immunosorbent assay (ELISA). Deoksiribo Nucleic acids (DNA) were extracted using a genomic DNA isolation kit. Single nucleotide polymorphism (SNP) of IL-37 gene (rs3811047) was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR/RFLP) methods. Serum IL-37 level was not significantly different in BD and HC (p > 0.05). Serum IL-37 level was not associated with the disease activity (p > 0.05). However, its level was higher in mucocutaneous involvement compared with systemic involvement (p = 0.002) and HC (p = 0.005). IL-37 gene polymorphisms were similar in BD and HC (p > 0.05). IL-37 may play a role in the etiopathogenesis of BD by contributing to manifestation with more moderate clinical symptoms.

Is primary hyperparathyroidism a cause of endothelial dysfunction?

OBJECTIVE: Symptomatic primary hyperparathyroidism (PHPT) is thought to be related to increased cardiovascular morbidity and mortality. In our study, we aimed to investigate endothelial dysfunction and markers of subclinical atherosclerosis in patients with PHPT. Also we aimed to demonstrate the effect of vitamin D supplementation on these parameters. MATERIALS AND METHODS: Twenty-nine patients followed by medical treatment (A), 25 preoperative (B) and 23 postoperative patients with PHPT (C), and 26 normocalcaemic subjects (D) were included. Groups were assessed by measurements of flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), serum levels of sCD40L, high-sensitivity CRP (hs-CRP) and interleukin-8 (IL-8). Thirteen patients with low levels of 25-hydroxy-vitamin D (25OHD) in the medical treatment group were assessed before and 3 months after vitamin D replacement. RESULTS: The median FMD was 5% in group A, 5.1% in group B, 7.6% in group C and 7.7% in group D. The FMD measurement in group A was significantly lower than groups C and D (P=.02) and was similar to the FMD measurement in group B. FMD measurements of group B were not significantly lower than groups C and D. In 13 patients with low 25OHD in group A, the median FMD increased to 7.07% from 4.71% after vitamin D replacement (P=.02). CONCLUSION: Flow-mediated dilation was impaired in patients with PHPT, particularly in the medically observed group. Vitamin D supplementation seems to provide improvements in FMD in medically observed PHPT patients with low 25OHD levels, and this was the novel observation of our study.