There is a continuing debate about whether monoallergen subcutaneous immunotherapy (SCIT) is able to modulate immune and clinical responses toward main causal allergen in polysensitized patients.
To ...investigate short-term immunologic changes and clinical effectiveness of SCIT with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients who have rhinitis with or without asthma.
Nineteen monosensitized and 24 polysensitized patients participated in this prospective, self-placebo-controlled, interventional study. Cluster immunotherapy with D pteronyssinus was administered after 2 months of placebo in both groups. Immunologic parameters, including CD203c expression on basophils after allergen stimulation, total IgE, specific IgE, and specific IgG4, were evaluated at baseline, after placebo, and after immunotherapy. Clinical effectiveness was assessed using monthly symptom-medication scores, visual analog scale, quality-of-life questionnaire, and nasal allergen provocation test.
At baseline, polysensitized patients had higher CD203c expression on basophils than monosensitized patients (P = .007). Activated basophils expressing CD203c, total IgE, and specific IgG4 were significantly increased after immunotherapy compared with baseline and placebo in the polysensitized group (P < .025). After immunotherapy, specific IgE and D pteronyssinus-induced CD203c expression were significantly higher in polysensitized than monosensitized patients (P < .05). The total symptom scores and the Mini Rhinoconjunctivitis Quality of Life Questionnaire scores in polysensitized patients and the visual analog scale scores in both groups were lower after immunotherapy compared with baseline and placebo (P < .025). Titrated nasal allergen provocation test with D pteronyssinus increased after immunotherapy in the monosensitized group (P < .05).
This study indicates that monosensitized and polysensitized patients have distinct humoral response and basophil behavior to SCIT. However, a single-allergen immunotherapy corresponding to the most clinically troublesome allergy in polysensitized patients can lead to early clinical efficacy comparable to that seen in monosensitized patients.
clinicaltrials.gov Identifier: NCT01795846.
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by persistent airflow limitation and is associated with an enhanced chronic inflammatory response in the ...airways and the lung to noxious particles or gases. Interleukin-1 beta (IL-1β) is a major pro-inflammatory cytokine expressed by many cells such as macrophages, neutrophils and monocytes and functions in cellular activities such as proliferation, differentiation and apoptosis. Recent studies demonstrate controversial results about the relationship between IL-1β and COPD. The aim of this study is to investigate the association between IL-1β -511 (rs 16944) and +3954 (rs 1143634) gene polymorphisms and COPD in Turkish population.
A total of 152 subjects were recruited in the study and divided into three groups: 72 COPD patients, 41 healthy smokers and 39 never-smokers. PCR-RFLP method was used to determine the allele frequencies, genotype and haplotype distributions.
We did not find any significant difference between the gene polymorphisms and COPD by means of genotype frequencies, haplotype association, stage, gender or smoking status (p< 0.05).
Our results do not show any evidence of association between COPD and IL-1β -511 and +3954 gene polymorphisms in Turkish population.
To determine the relationship between adenoidectomy and/or tonsillectomy in childhood and allergic diseases in adulthood.
A survey investigating the history of adenoidectomy and/or tonsillectomy was ...administered to patients that were followed-up by our department between January and June 2014 with the diagnosis of asthma, allergic rhinitis, urticaria-angioedema, drug allergy, food allergy, and venom allergy; patients willing to participate were included in the study. The relationship and risk ratios were analyzed.
Totally, 510 (female/male: 379/131) patients were included in the study: 248 with asthma, 205 with rhinitis, 82 with drug allergy, 73 with urticaria, 24 with food allergy, and 14 with venom allergy. Of these, 65 (12.7%) had undergone adenoidectomy and/or tonsillectomy. Of these 65 patients, 41 had asthma, 33 had allergic rhinitis, and 28 had other allergic diseases. No relation between the history of atopy and adenoidectomy and/or tonsillectomy (p=0.129) was detected; however, there was a positive correlation between asthma and patients aged <15 years having a history of tonsillectomy and/or adenoidectomy (p=0.020). The risk of asthma was determined to be increased by 1.96 fold among the patients, provided the patient had undergone adenoidectomy and/or tonsillectomy (confidence interval CI:1.14-3.36). No connection was observed between atopic and non-atopic asthmatic patients in relation to adenoidectomy and/or tonsillectomy (p=0.46). No relationship was observed between allergic rhinitis and adenoidectomy and/or tonsillectomy.
Adenoidectomy and/or tonsillectomy in childhood increase the risk of asthma in adulthood, whereas it does not increase the risk of atopy. This result signifies the criticality of adenoidectomy or tonsillectomy in the pathogenesis of asthma.
Many risk factors that facilitate venom allergy and increase systemic reaction severity have been described in various studies, but the data are limited regarding this issue. We aimed to evaluate the ...impact of total immunoglobulin E (tIgE), specific IgE, and tryptase levels on the severity of systemic reactions in patients with a history of allergic reactions to Hymenoptera stings.
Eighty-two patients with a history of allergic reaction to Hymenoptera venom admitted to our outpatient clinic between March 2016 and August 2017 were included. Venom-specific IgE (Apis mellifera and Vespula vulgaris), total IgE, and basal tryptase levels were measured. Skin-prick tests were performed with inhalant allergens. The levels of specific IgE, total IgE, and tryptase were compared between patients with large local reactions and systemic reactions, and the relation of these parameters with the severity of systemic reaction was evaluated.
There were no significant differences in the specific IgE, total IgE, and tryptase values in patients with large local reactions and a history of systemic reactions (p > 0.05). The age, basal tryptase, and V. vulgaris-specific IgE levels of patients with a grade IV reaction history were higher than those with grades I-III reaction history (p < 0.05). An important finding was that high basal tryptase levels were a risk factor for grade IV reactions (p = 0.047, χ² = 4.512). There was a strong positive correlation between total IgE levels and V. vulgaris- and A. mellifera-specific IgE values in patients with a grade IV reaction history (r = 0.94, p = 0.005; and r = 0.88, p = 0.021, respectively).
Baseline serum tryptase levels were a risk factor for the development of severe systemic reactions in venom allergy. This risk increases with increasing age in these patients. Another notable finding was the correlation between total IgE and venom-specific IgE values in patients with severe systemic reactions.
In recent years, interest in the effects of vitamin D on human health and the immune system has increased.
This study aimed to investigate the relationship of vitamin D with asthma severity, attacks, ...and clinical and functional parameters in adult patients with asthma who were living in different geographic regions in Turkey.
A total of 384 patients with stable asthma and 87 control subjects were included. A physical examination and a pulmonary function test were performed, and routine blood analyses and vitamin D levels were evaluated. Asthma Control Test was applied. The number of exacerbations in the previous year, asthma therapy, and medication adherence were recorded.
In our study, vitamin D levels were below the target values in both patients with asthma (median minimum-maximum 16.0 ng/mL 3.5-48 ng/ml) and control subjects (median minimum-maximum 20.0 ng/mL 5.8-58.79 ng/mL). However, it was lower in the patients with asthma than in the control subjects (p = 0.001). There was a negative relationship between the levels of vitamin D and the severity of asthma (Kendall τ = -0.146; p < 0.001). Furthermore, the patients with severe asthma were received The Global Initiative for Asthma (GINA) step 5 treatment showed significantly lower vitamin D compared with the patients who received GINA step 4 treatment (p = 0.037). Vitamin D levels correlated with forced vital capacity (FVC), forced expiratory volume in the first second of expiration (FEV
), and peak expiratory flow (r, 0.221-0.236; p ≤ 0.001). In addition, a positive relationship was found between Asthma Control Test and vitamin D (r = 0.229; p = 0.001). However, body mass index (BMI), asthma exacerbation, and hospitalization were inversely related to vitamin D (r, 0.198-0.233; p = 0.001). Multivariable regression analysis revealed that FVC (p = 0.002), FEV
(p = 0.033), and BMI (p = 0.037) were independent determinants associated with vitamin D.
This study suggested a high prevalence of vitamin D deficiency in adults with asthma living in different geographic areas in Turkey. Vitamin D deficiency is associated with asthma severity, poor control, and lower lung function.
This study was performed in chronic obstructive pulmonary disease (COPD) patients to compare the SF-36 questionnaire with pulmonary function tests and non-functional parameters. Fourty-five COPD ...patients diagnosed according to GOLD 2004 criteria were included in the study. The stable patients were evaluated by spirometry, static lung volumes, diffusion capacity, 6 MWD, BORG scale, MMRC dyspnea measurement and SF-36 life questionnaire performed on the same day. The mean age of the patients was 66 +/- 10 years and the female/male ratio was 4/41. The mean FEV1/FVC ratio was 0.49 (moderate COPD n = 18, severe COPD n = 27). The RV/TLC ratio was 0.52. Walking distance was less than normal, with a mean of 375 +/- 119 m. All the SF-36 scale except pain index are low compared to normal. General health perceptions, physical functioning, role physical, role emotional, social functioning, energy and mental health index are as follows: 47 +/- 24, 50 +/- 30, 35 +/- 38, 49 +/- 37, 63 +/- 33, 49 +/- 20, 59 +/- 20, respectively. When the general health scale compared with FVC and FEV1 revealed moderate correlation was found (r = 0.56, r = 0.55, respectively). Physical functioning compared with FVC, FEV1, RV/TLC and IC revealed moderate correlation (r = 0.62, r = 0.67, r = -0.54, r = 0.65, respectively). General health and physical functioning scales correlated with the non-functional parameters (MMRC, 6 MWD) (r = -0.51, r = 0.53, r = -0.61, r = 0.64 respectively). The SF-36 general quality of life questionnaire is a useful measurement instrument for the evaluation of therapeutic efficiency and follow up of COPD patients.
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