The demonstration that severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) enters the cell
the angiotensin-converting enzyme 2 receptor has raised concerns that, in hereditary ...angioedema (HAE), a disease characterized by bradykinin-mediated angioedema attacks, coronavirus disease 2019 (COVID-19) may trigger angioedema attacks, increase the frequency and/or severity of attacks, or cause more severe symptoms of COVID-19.
The objective was to evaluate the severity of COVID-19 in patients with HAE, the course of HAE attacks, angioedema activity, and the quality-of-life scores during COVID-19 pandemic.
Patients diagnosed with HAE for at least 6 months were included in the study. The 7-day Angioedema Activity Score and the Angioedema Quality of Life (AE-QoL) Questionnaire were first completed at the onset of the pandemic between March 12 and June 1, 2020, then during SARS-CoV-2 infection, and in the third month after recovering from COVID-19.
Ten of 67 patients with HAE (14.9%) were diagnosed with COVID-19. The median (interquartile range) age of the 10 patients diagnosed with COVID-19 was 35.5 years (28.0-55.0 years). Six of the 10 patients (60%) were women. During COVID-19, five of the 10 patients (50%) had no angioedema attack. Two patients with severe HAE experienced a significant increase in angioedema activity during COVID-19 compared with their basal activity scores. The remaining three patients had a similar or lower attack frequency than their basal level. Four (40%) of the 10 patients had a relative increase in their attacks during the convalescence period. There was no statistically significant difference among pre-COVID-19, during COVID-19 and post-COVID-19 periods in function, mood, fear and/or shame, nutrition, and total scores of the AE-QoL Questionnaire although the fear dimension was relatively more affected (p = 0.06).
Although the sample size was small, analysis of our data supported that the symptoms of COVID-19 were not more severe in HAE. Also, there was no significant difference in the AE-QoL Questionnaire scores, the frequency, and severity of angioedema attacks during the course of COVID-19 in the patients with HAE.
Introduction
Procarbazine is an oral chemotherapeutic agent used in the treatment of brain malignancies and is associated with hypersensitivity reactions. In case of grade 4 reactions, rechallenge ...should be avoided, and the agent should be replaced, unless the treatment is curative, in which case the application of a desensitization protocol should be considered. We present a successful case of desensitization in procarbazine anaphylaxis.
Case report
A 53-year-old male patient was diagnosed with recurrent anaplastic oligodendroglioblastoma. The patient received three cycles of procarbazine, lomustine, and vincristine chemotherapy for malignancy recurrence. In the fourth cycle, on the 12th day of procarbazine treatment, the patient developed anaphylaxis. Procarbazine was given together with premedication as part of the 12-step desensitization process, and the fourth cycle was successfully completed.
Management and outcome
Procarbazine hypersensitivity reactions are observed less frequently than reactions to other chemotherapeutics. We presented a case of procarbazine-associated severe anaphylaxis that was able to continue procarbazine chemotherapy with successful desensitization. This case is important in terms of confirming the procarbazine desensitization protocol.
Discussion
In literature there is only one protocol developed was successfully applied in one patient with procarbazine anaphylaxis. In the current case, we took this protocol into consideration in the management of our patient. Following the use of this protocol, the patient was able to continue procarbazine chemotherapy successfully. Procarbazine anaphylaxis is rare, and more cases are needed to be reported to confirm the desensitization protocol and when to continue procarbazine treatment.
Introduction: Cytokines are key mediators in immunological and inflammatory conditions, including chronic spontaneous urticaria (CSU).
Objectives: To investigate Th1, Th2, and Th17 cytokine profiles ...in CSU and to evaluate the possible effect of omalizumab treatment.
Methods: Patients who were followed up for CSU, as well as healthy volunteers, were included in the study. To assess urticaria activity, the 7-day-Urticaria Activity Score (UAS-7), the Urticaria Control Test (UCT), and the Chronic Urticaria Quality of Life Questionnaire (CU-QoL) were filled. Serum levels of IL-6, IL-17, IL-31, eotaxin, RANTES, TNF-α, and TSLP were analyzed by ELISA and compared in CSU and control groups. The patients were analyzed in two groups as the omalizumab group and the non-omalizumab group based on their treatment status.
Results: Total IgE, ESR, CRP, RANTES, and TNF-a were significantly different in the overall comparison of the three groups: CSU-receiving omalizumab, CSU-not receiving omalizumab, and control groups (P <0.01, 0.015, <0.01, <0.01 and <0.01 respectively). Total IgE, CRP, RANTES, and TNF-α values were similar in those who received and did not receive omalizumab, yet these biomarkers were significantly higher in both groups than in the control group (P < 0.05). Statistical significance in ESR was observed only between the CSU-receiving omalizumab group and the control group (P = 0.01). Within the CSU patients, there was a slight but significant correlation between UCT and TNF-α (P = 0.008, r = 0.32) and IL-17 (P = 0.06, r = 0.33) levels.
Conclusions: The investigated cytokine profile in CSU patients may differ from healthy controls, particularly with the higher levels of RANTES and TNF-α, and omalizumab treatment does not seem to affect that profile in CSU patients.
Primary antibody deficiency diseases result from a genetic defect that causes misfunction of 1 or more of the immune system elements. Due to the increased awareness among physicians and the success ...of new treatment modalities, the number of pediatric patients reaching adult age and the number of patients diagnosed in adult age is increasing. Adult patients comprise more than half of the total cases. Primary antibody deficiencies are the most common immunodeficiency type in adults, and these may cause recurrent upper and lower respiratory tract infections and result in the development of bronchiectasis. Among non-infectious pulmonary complications, any type of interstitial lung disease may be seen; however, a special type seen in patients with common variable immunodeficiency, namely granulomatous lymphocytic interstitial lung disease, is the one most commonly investigated. Underlying or accompanying immunodeficiency may be present in patients with asthma and chronic obstructive pulmonary disease, especially if the disease requires frequent hospitalizations and/or is severe. Early diagnosis and appropriate management of primary antibody deficiency diseases in patients with respiratory symptoms are crucial to decrease complications and increase survival.
Background: Modulator therapies improve weight and body mass index (BMI) in cystic fibrosis (CF) patients. We aimed to compare the nutritional risk index (NRI) in adult CF patients receiving ...modulator (MT) or only non-modulator (conventional) therapies (non-MT). Methods: A single-center prospective cohort study was conducted between June and December 2023. The NRI based on weight gain and albumin was calculated at beginning and end of a 12-week period in both groups. This design was pragmatic, since it was based on individual patient access to MT for 12 weeks. Results: In total, 107 patients were included mean (SD) age: 23.85 (4.98) years, 54.7% male, 46.7% MT. In the MT group, mean (SD) weight (kg) and albumin (g/dL) increased significantly changes: +3.09 (2.74) and +0.17 (0.37); p < 0.001. In the non-MT group, weight and albumin decreased significantly changes: −0.99 (1.73) and −0.12 (0.30); p < 0.001. Compared to the MT group, baseline mean (SD) NRI in the non-MT group was significantly higher 100.65 (11.80) vs. 104.10 (10.10); p = 0.044. At the end of the 12 weeks, mean (SD) NRI in the MT group was higher than in the non-MT group 104.18 (10.40) vs. 102.58 (12.39); p = 0.145. In the MT group, the NRI category improved in 22 (44%), and worsened in 3 (6%) patients (p < 0.001). In the non-MT group, the NRI category improved in 2 (3.5%), and worsened in 10 (17.5%) patients (p < 0.001). Conclusions: This is the first study reporting on a positive effect of MT on NRIs, based on weight gain and albumin. Personalized nutrition and routine follow-up of adults with CF based on NRI is recommended prior to MT initiation.
Artificial intelligence (AI) is rapidly becoming a valuable tool in healthcare, providing clinicians with a new AI lens perspective for patient care, diagnosis, and treatment. This article explores ...the potential applications, benefits, and challenges of AI chatbots in clinical settings, with a particular emphasis on ChatGPT 4.0 (OpenAI - Chat generative pretrained transformer 4.0), especially in the field of allergy and immunology. AI chatbots have shown considerable promise in various medical domains, including radiology and dermatology, by improving patient engagement, diagnostic accuracy, and personalized treatment plans. ChatGPT 4.0, developed by OpenAI, is good at understanding and replying to prompts in a way that makes sense. However, it is critical to address the potential biases, data privacy issues, ethical considerations, and the need for verification of AI-generated findings. When used responsibly, AI chatbots can significantly enhance clinical practice in allergy and immunology. However, there are still challenges in using this technology that require ongoing research and collaboration between AI developers and medical specialists. To this end, the ChatGPT 4.0 platform has the potential to enhance patient engagement, improve diagnostic accuracy, and provide personalized treatment plans in allergy and immunology practice. However, limitations and risks must be addressed to ensure their safe and effective use in clinical practice.
The data on the use of dual biologics are scant, but a topic of current interest.
In this report, the treatment regimen of a patient with two T helper 2 pathway-related comorbidities, severe asthma, ...and chronic spontaneous urticaria, was presented.
Both urticaria and asthma symptoms of the patient could not be controlled entirely with monotherapy while both diseases could be controlled after omalizumab-mepolizumab dual treatment. No adverse events were observed after 6 months of dual biologics use.
This report supports other publications in the literature involving the use of dual biologics and provides a summary of the literature.
: Occult tracheobronchial foreign body aspirations are infrequently seen in adults because there is usually a high index of suspicion. Occult foreign bodies can remain undetected for months to years ...and often are misdiagnosed. The aim of this paper is to report the cases of four adult patients with occult bronchial foreign body aspiration. None of the patients had a previous history of aspiration. One patient had been misdiagnosed as having asthma. One was thought to have tuberculosis, while unresolved pneumonia was present in another. A CXR showed the presence of a foreign body in only one patient because it was metallic. The foreign bodies included a stone, a tooth fragment, a bone fragment, and a needle. The foreign bodies were removed using a rigid bronchoscope in two patients and via a surgical procedure in the other two. In conclusion, tracheobronchial foreign body aspiration should always be taken into consideration in the differential diagnosis of radiographic lesions or chronic respiratory symptoms that are poorly explained, even in the absence of a previous history of aspiration.
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