The Turkish experience with therapeutic plasma exchange: A national survey.

Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE.

Vitamin D level among Egyptian patients with chronic spontaneous urticaria and its relation to severity of the disease.

Vitamin D has an important role in the immune system. Decreased serum vitamin D level is known to be associated with autoimmune and atopic diseases. This study aimed to assess vitamin D status in patients with chronic spontaneous urticaria (CSU) and its relation with severity of the disease. This case-control study was conducted on 22 patients and 20 age and sex matched controls. Patients were subjected to clinical assessment, routine laboratory examination: complete blood picture (CBC), erythrocyte sedimentation rate (ESR), hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (HCV Ab), anti-thyroid antibody, anti-nuclear antibody (ANA), total immunoglobulin E (IgE), vitamin D assay and stool analysis, and special investigations including: skin prick test (SPT), autologous serum skin test (ASST) and urticaria activity score (UAS). Patients' mean age was 32.8 ± 13.17 years. The median and interquartile range of duration of illness was 2.5 (1-4) years and of Ig E was 79 (62-312) IU/ml. According to UAS; 14 (63.6%) had severe and 8 (36.4%) had moderate degree illness. The mean vitamin D level among the patients was 28.4 ± 9.09 nmol/L. Vitamin D level was significantly lower among patients in comparison to controls (28.4 ± 9.09 vs. 104.5 ± 76.8, t = 4.4 P < 0.01). Vitamin D correlated negatively with IgE level (r = -0.45, P < 0.05), meanwhile it was insignificantly correlated with age and duration of illness (r = -0.117 and 0.34 respectively, P > 0.05). In conclusion; Low vitamin D level (r = 0.45) is associated with chronic spontaneous urticaria but has no relation with the severity of the disease.

Food-induced anaphylaxis: mast cells as modulators of anaphylactic severity.

A food-induced anaphylactic reaction can occur within seconds to a few hours following exposure to the causal food allergen and often affects multiple organ systems including gastrointestinal, cutaneous, respiratory, and cardiovascular. A conundrum in the allergy field is that consumption of the same allergen can cause reactions of vastly different severity in separate individuals; one patient may experience a mild non-life-threatening reaction characterized by pruritis of lips or urticaria whereas another may experience a life-threatening reaction that involves respiratory and cardiovascular compromise leading to loss of consciousness and sometimes death. While there are tests available to determine the predictive risk value of a positive food challenge test or clinical reactivity, there is currently no reliable method to distinguish between individuals who are at risk of mild non-life-threatening versus life-threatening reaction. Recent research has significantly advanced our understanding of the involvement of immune pathways in the effector phase of food-induced anaphylaxis; a void remains regarding our understanding of the contribution of these pathways to severity of disease. In this review, we discuss mild non-life-threatening versus life-threatening food-induced anaphylaxis and factors (co-morbidities and immune activation) that predispose individuals to more severe disease. Furthermore, we summarize recent advancements in our understanding of the involvement of underlying immune pathways in systemic and food-induced anaphylaxis in mouse systems and discuss how these pathways may contribute to more severe disease phenotype.

Life-threatening severe allergic reactions: urticaria, angioedema, and anaphylaxis.

Urticaria, angioedema and anaphylaxis are life threatening skin diseases. Allergological emergencies are common; drugs, food, food ingredients/additives, insects, and many other factors have been reported to elicit anaphylactic reactions. The severity of symptoms ranges from pruritus to generalized skin eruptions, gastrointestinal, bronchial problems to systemic anaphylaxis and cardiovascular emergencies. The pathomechanisms and treatment of urticarias, angioedema and anaphylaxis are described. In some situations emergency kit: antihistamines, steroids, betamimetics and adrenaline is needed. Familiarity with the early diagnosis and correct management should be acknowledegable for dermatologists to recognize these allergic reactions and must be prepared to administer emergency kit.