Comparison of inflammatory cytokine release from nasal epithelial cells of non-atopic non-rhinitic, allergic rhinitic and polyp subjects and effects of diesel exhaust particles in vitro

Background. Although studies have reported an association between air pollutants and increased allergic airway diseases, such as allergic rhinitis and nasal polyposis, the underlying mechanisms are not fully understood. A limited number of studies have suggested that diesel exhaust particles (DEP) play a role in atopy and the pathogenesis of allergic upper airway diseases. The aim of this study was to investigate the effect of DEP on inflammatory cytokine release, and mRNA expression of transcription factors such as JNK and NF-Beta in primary nasal epithelial cells (NECs), in vitro. Methods: NECs from non-atopic, non-rhinitic subjects (controls) and patients with allergic rhinitis and nasal polyps were cultured and incubated with 0-100 μg/ml DEP for 24 h. ELISA and RT-PCR were used to assess the release of IL-8, GM-CSF, and RANTES, and mRNA expression for JNK and NF-κB, respectively. Results: Compared to control cells, NECs from subjects with atopic polyps released significantly greater amounts of IL-8 (median = 887 vs. 176.6 pg/μg cellular protein; p < 0.0001) and RANTES (median = 0.191 vs. 0.02 pg/μg cellular protein; p < 0.001). While 50 μg/ml DEP induced release of RANTES in NECs from patients with allergic rhinitis, 100 μg/ml DEP decreased IL-8 levels in NECs from both control and allergic rhinitic subjects. DEP did not affect mRNA expression for JNK and NF-κB from NECs of subjects with polyps. Conclusions: NECs from subjects with various pathologies may respond differently to DEP (AU)

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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

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Storage mite sensitisation is associated with early life village residence in Turkey

Background: Storage mites (SMs) occur in house-dust and the rate of sensitisation to them is high. We aimed to investigate if past and current living conditions are associated with the risk of SM sensitisation. Methods: In total, 321 patients (70% females) aged 33.6 ± 11.9 years (range: 14–68 years) were studied at our allergy unit between September 2009 and December 2010. Patients with persistent or intermittent rhinitis and/or asthma were included in the study. Skin prick tests (SPTs) for SMs (Lepidoglyphus destructor, Tyrophagus putrescentiae, and Acarus siro) and other common aeroallergens were performed. Demographic data and characteristics of the patients’ homes were assessed via a questionnaire. Results: In all, 102 (31.8%) patients were sensitised to ≥1 SM, of whom 43.1% were also sensitised to Dermatophagoides pteronyssinus. Comparison between the SPT-negative group (n = 129) and the SM-positive only group (n = 33) showed that having lived in a village during the first years of life was associated with SM sensitisation. Current place of residence was not significantly associated with any of the study variables. Conclusions: Living conditions have been changing and SM sensitisation may be associated with a history of village residence. The high rate of SM sensitisation observed in the study population might indicate the necessity of including those mite species in SPT panels, but the clinical relevance of sensitisation remains unclear. The clinical importance of SM sensitisation in urban areas should be investigated further (AU)

Determining safe alternatives for multidrug hypersensitive patients with the alternative triple antibiotic-analgesic test

Background: Drug provocation tests (DPTs) need technical equipment, staff and time. There are very few allergy centres performing DPTs in Turkey. Therefore many patients are referred to these centres. One day triple–double antibiotic or non-steroidal anti-inflammatory drug (NSAID) oral DPT for determining safe alternatives is safe, cost-effective and time saving compared to conventional one day one drug oral DPT. Our aim was to investigate the safety of antibiotic–NSAID oral DPT performed on the same day to find safe alternatives in multidrug hypersensitive patients. Methods: Forty-two patients who had been diagnosed as having both antibiotic and NSAID hypersensitivity were enrolled to the study between 15 November and 15 July 2010. The reactions were urticaria and/or angio-oedema not including laryngeal oedema for all patients. Two antibiotics–one NSAID or two NSAIDs–one antibiotic triple test have been performed on the same day to study patients (n=22), while the control group (n=20) had taken drugs on three separate days. Results: Only two patients had positive reactions during triple test and two patients had adverse reactions; one had gastric pain, one had nausea. Three patients in the control group had positive reactions. There were no significant differences between the two groups in frequency of adverse and allergic drug reactions (p>0.05). Sixty days were spent for the tests of the control group with only 28 days for the study population. Conclusion: Triple test performed with antibiotic and NSAID on the same day for determining safe alternatives for multidrug hypersensitive patients reporting non-life-threatening allergic reactions seems to be safe and time-saving (AU)

Prediction of atopy by skin prick tests in patients with asthma and/or persistent rhinitis

Background Patient history gives important clues about the likelihood of atopy. However, the accuracy of assessment of atopy based on detailed allergy history is low. The objective of this survey was to determine the successful prediction rate of atopy by a questionnaire and the effect of various factors on the successful prediction. Methods A standard questionnaire including detailed allergy history was filled in by two experienced allergists for 169 patients having bronchial asthma and/or persistent rhinitis symptoms. Skin prick test (SPT) results were predicted based on the clinical data obtained by a questionnaire. Final diagnosis was made after SPT. Sensitivity and specificity analysis of SPT results prediction was investigated using two different cut-off values (3mm and 5mm) for positive tests, and factors associated with successful atopy prediction were analysed. Results SPT was predicted to be positive in 42.6% and was positive in 36.1%. Depending on SPT results with the cut-off value 3mm, prediction sensitivity was 77%, specificity was 65.3%, positive predictive value was 65%, and negative predictive value was 86%. Successful positive atopy prediction was associated with age; true negative prediction was also associated with age and high education. With the threshold of 5mm for a positive test, sensitivity, specificity, positive and negative predicted values were 91%, 61%, 14% and 99%, respectively. Conclusion It seems that the success rate of detailed history is high for negative prediction. However, detailed history alone does not seem to be efficient for atopy prediction(AU)