7th Drug hypersensitivity meeting: part two

No abstract availabl

Immediate and late onset forms of insulin hypersensitivity presenting with glucose dysregulation [Glukoz disregülasyonu ile ortaya çikan erken ve geç başlangiçli ınsulin aşiri duyarliliği]

We report the case of a 35-year-old woman allergic to detemir, neutral protamine Hagedorn, and glargine. Initially, local reactions to the insulin preparations occurred, which continued even after the types of insulin and the application areas were changed. When the use of insulin therapy was continued, the local reactions developed into systemic forms. Interestingly, blood glucose levels kept increasing to uncontrolled levels every time the cutaneous reactions occurred. The patient was referred to our clinic for further investigation. The results of the skin prick tests with insulin preparations were negative; however, the intradermal test results were positive with the following dilutions of the insulin preparations: 1/100 detemir, 1/100 glargine, 1/1.000 neutral protamine Hagedorn, and 1/1.000 regular insulin. The intradermal skin test results for glulisine, aspart, and lispro were negative. The levels of immunglobulin E specific to human insulin were high (194 kU/L; N 0-87 kU/L); whereas, the specific immunglobulin G4 levels were normal (35 mg/dL; N 0-125 mg/dL). We attempted to treat the patient with glulisine and aspart; however, similar reactions were observed with these insulin preparations as well. As we considered the levels of the anti-insulin antibodies and the late-onset local reactions, the insulin allergy in our patient was reckoned to be mediated by Type 1 and Type 4 hypersensitivity. The only insulin preparation that had never been used with this patient before was lispro, which also demonstrated negative intradermal skin test results. Therefore, we suggested the use of a continuous subcutaneous insulin infusion pump with lispro. Finally, the insulin hypersensitivity was successfully treated, and glycemic control was achieved. © 2018 by Turkish Journal of Endocrinology and Metabolism Association

Quality-of-life in insect venom allergy: validation of the Turkish version of the “Vespid Allergy Quality of Life Questionnaire” (VQLQ-T)

Purpose: “Vespid Allergy Quality of Life Questionnaire (VQLQ)” has been used to assess psychological burden of disease. The aim of this study was to evaluate validity, reliability and responsiveness to interventions of the Turkish version. Methods: The Turkish language Questionnaire (VQLQ-T) was administered to 81 patients with bee allergy and 65 patients with vespid allergy from different groups to achieve cross-sectional validation. To establish longitudinal validity, the questionnaire was administered to 36 patients treated with venom immunotherapy. Results: The cross-sectional validation in patients with vespid venom allergy showed a correlation coefficient of 0.97 (Cronbach ?). Spearman’s correlation coefficient of the pretreatment VQLQ-T score with Expectation of Outcome (EoO) questionnaire score was 0.55 (p < 0.001). After treatment, correlation between VQLQ-T score and EoO score was 0.64 (p = 0.003) in these patients. The cross-sectional instrument validation for non-beekeepers with bee venom allergy yielded a correlation coefficient of 0.96 (Cronbach ?). Spearman’s correlation coefficient between pretreatment VQLQ-T score and EoO score was 0.47 (p < 0.001) and after treatment, correlation between VQLQ-T score and EoO score was 0.78 (p = 0.008) in these patients. These findings indicate cross-sectional validity of VQLQ-T. In the longitudinal validation, there was a positive correlation between EoO and VQLQ-T with a correlation coefficient of 0.562 (p < 0.001). While mean (±SD) VQLQ-T score was 5.27 (±1.29) in pretreatment, it was 2.78 (±1.01) after treatment (p < 0.001). The correlation between the mean change in VQLQ-T score and the mean change in EoO score was 0.42 (p = 0.011). Conclusions: The Turkish version of VQLQ-T enables measurement of Quality of Life (QoL) in patients with either vespid or bee venom allergy. Furthermore, responsiveness of this instrument demonstrates the questionnaire’s ability to detect changes over time. © 2016, The Author(s)

Low B12 levels in chronic idiopathic urticaria

PubMed ID: 15736714Recent studies suggest that autoimmune mechanisms may be involved in the etiology of chronic idiopathic urticaria (CIU). There is a higher prevalence of B12 deficiency in autoimmune diseases and possibly in gastric Helicobacter pylori (H. pylori) infection. The frequency of B12 deficiency in CIU is unknown. Our objective in this study was to determine the prevalence of B12 deficiency in patients with CIU and also its relationship to gastric H. pylori infection and serologic markers of autoimmunity in these groups. Thirty-three patients with CIU and 27 healthy controls were included in the study. Serum vitamin B12 levels, H. pylori infection and serological markers of autoimmunity (anti-thyroglobulin, thyroid microsomal, gastric parietal cell and antinuclear autoantibodies) were investigated. H. pylori infection was determined according to serology and gastric biopsy in 19 patients, serology and urea breath test in 4 patients and serology alone in the remaining 10 patients. Serum B12 levels were below the normal reference range in 11/33 (33.3%) patients with CIU. The mean serum B12 levels among patients with CIU and the controls were 281±127.5 pg/ml and 465.1±140.3 pg/ml (p=0.0001), respectively. Anti-thyroid antibodies were positive in 6 of 11 patients (54.5%) with low B12 levels, but only in 4 of 27 (14.8%) healthy controls (p=0.019). Anti-GPC antibodies were positive in 4 of 11 (364%) patients with CIU and low B12 levels, but only in 2 of 27 (7.4%) healthy controls (p=0.047). In CIU patients, there was no difference in the frequency of IgG H, pylori antibodies between those with low B12 levels and normal B 12 levels. Among the 19 patients who had been performed gastric endoscopy, 15 patients (78.9%) had chronic antral gastritis, 2 patients (10,5%) had atrophic gastritis and there were normal findings in 2 patients (10.5%). In conclusion, serum B12 levels were found to be below the normal reference range in 33% of the patients with CIU. An association between low B12 levels and H. pylori could not be shown. The higher frequency of anti-thyroid and anti-GPC antibodies in patients with low B12 levels suggest that low B12 levels in CIU may be autoimmune in nature. © 2004 Esmon Publicidad

An important source for cat and house dust mite allergens: Day-care centers [Kedi ve ev tozu akan allerjenleri igin önemli bir kaynak: Anaokullan]

Objective: Exposure to indoor allergens during childhood has been associated with an increased risk of sensitization. There is no data about indoor allergen levels in day-care centers in Turkey. We hypothesized that day-care centers (DC) would be relevant sources of cat and mite allergens. Material and Methods: Fifty-seven dust samples were collected from 19 DCs in Izmir, their gardens, and classrooms of the primary schools where the DCs are located in. A questionnaire about characteristics of DCs was completed. Feld 1, Der p 1 and Der f 1 allergen levels were quantitated by enzyme-linked immunoassay. Results: Feld 1 was detected in all, and mite allergens in 94.7% of the samples. Levels exceeding sensitization threshold level for cat and mite allergens were present in 73.7%, and 21.1% of DCs, respectively. Feld 1 levels exceeding threshold level that might cause asthma exacerbation was detected in 21% of DCs. Feld 1 levels in DCs and their gardens were higher than the classrooms of the same school. Der f 1 levels were identical in DCs, gardens and classrooms. Der p 1 concentration was higher in DCs with air-conditioning, than DCs without a ventilation system. Although there was no difference for Feld 1 levels in DCs with or without carpeted floor, Feld 1 concentrations in DCs with carpet were significantly higher than in classrooms with no carpet. Conclusion: Day-care centers in Izmir are important sources of indoor allergens that could cause sensitization or even allergic symptoms in children and their staff. © 2012 by Türkiye Klinikleri

Cutaneous Drug Reactions To Antiepileptic Drugs And Relation With Hla Alleles In The Turkish Population

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