Objective: Diagnostic delay is one of the major problems for patients with predominantly antibody deficiencies (PAD) that can lead to anxiety and depression disorders, like in other chronic diseases. We aimed to detect the frequencies of anxiety and depression in PAD patients. The second aim was to determine the influence of diagnosis delay on the patients’ anxiety and depression. Materials and Methods: In this prospective study, 40 patients and 50 healthy controls answered the Hospital Anxiety and Depression Scale (HADS). We compared the anxiety, depression, and the total scores of the patients and the healthy controls. We divided the patients into two groups as delayed and early diagnosed patients according to median diagnostic delay year and compared the HADS scores of the two groups. Results: The anxiety, depression and the total scores of PAD patients were significantly higher compared to the healthy controls; (p=0.001, p=0.001, p=0.001), respectively. The HADS scores were significantly higher in the delayed diagnosis patient group than the early diagnosed patient group (p=0.001, p=0.003, p=0.001), respectively. We also confirmed this positive relationship between delayed diagnosis and the HADS scores with Spearman’s correlation analysis. Conclusion: We demonstrated that psychiatric disorders such as anxiety and depression are common in PAD patients, and delayed diagnosis strongly affects their anxiety and depression. Collaboration with psychologists and psychiatrists during the management of these patients may improve the quality of their life.
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Objective: The coronavirus disease 2019 (COVID-19) pandemic creates secondary problems for the health care system, and understanding specific issues can guide the management of the pandemic and its future consequences. We aimed to characterize the problems and related risk factors experienced with outpatient compliance and dietary compliance of children with food allergies during the COVID-19 pandemic. Materials and Methods: A cross-sectional survey was conducted on the mothers of children with ongoing food allergies, eight months after Turkey’s first confirmed case of COVID 19. Results: Of the 288 patients, 76.3% and 40.2% were non-adherent to their scheduled appointments and oral food challenge, respectively, during the pandemic. The group non-adherent to their scheduled visit was significantly older (p=0.005), had more frequent home food trials without the consent of their physicians (p<0.001), and had less usable epinephrine auto-injectors (EAI) available compared with the adherent group (p<0.001). Eighty-nine patients (30.9%) with home food trial experience had more essential food allergies (p<0.001) and experienced more allergic reactions (p=0.002), compared with patients who adhered to dietary elimination. Thirty parents (10.4%) eliminated some foods from their children’s diet because of the suspected reactions. Conclusion: The COVID-19 pandemic, significantly reduces adherence with scheduled appointments and OFC, and increases home food trials and food eliminations without physician approval.
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Objective: Guidelines suggest using bronchial provocation testing (BPT), which is hard to attain, in patients with asthma-like symptoms presenting with nondiagnostic spirometric tests. To eliminate the risk of over/underdiagnosing asthma, we aimed to evaluate the predictive value of not only fractional exhaled nitric oxide (FeNO) but also other easily accessible clinical indices for ruling in/out asthma. Materials and Methods: This retrospective study included adults presenting to our clinic with respiratory symptoms suggestive of asthma but with normal spirometric values and negative reversibility test, who underwent FeNO and methacholine BPT (MchBPT). Medical records were used to obtain descriptive characteristics, clinical history, allergy screening, eosinophils in peripheral blood, and spirometry. Results: Among 51 patients, 19 were diagnosed with asthma. Body mass index and blood eosinophils were significantly higher in patients with positive MchBPT (p=0.042 and p=0.037, respectively). No significant difference was found in other indices, including FeNO (p=0.293). Receiver operating characteristic curve analysis revealed the best diagnostic cutoff level for FeNO as 14 ppb and blood eosinophil as 150/μl for the prediction of positive MchBPT (with 63.16%-62.5% and 80%-61% sensitivity-specificity, respectively). These two indices were the only independent predictors of positive BHR, and the model of FeNO>14ppb combined with eos>150/μl showed 100% specificity with a 100% negative predictive value. Conclusion: Our results suggest using the combination of FeNO with blood eosinophil count as a rule-out test, adding a new step in the algorithmic diagnosis of asthma. This might avoid an unnecessary BPT procedure, reduce the risk of over/under-diagnosis of asthma, and hasten the correct diagnosis.
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Omalizumab is a safe and effective treatment option for chronic spontaneous urticaria (CSU). Although cohort studies in patients with asthma show no increased risk of congenital abnormalities, very little data exist in the literature regarding the use of omalizumab for CSU during pregnancy. Herein, the safe and successful use of omalizumab updosing in a pregnant woman with CSU along with a review of the published literature is presented.
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Data regarding COVID-19 infection in patients with common variable immunodeficiency (CVID) are limited. Herein, we present a 28-year-old male patient with CVID admitted for intravenous immunoglobulin (IVIG) replacement with myalgia and a productive cough. A nasopharyngeal swab for the SARS CoV-2 polymerase chain reaction assay was positive. Chest computed tomography was consistent with COVID-19 pneumonia. The patient refused hospitalization and the applicable treatment for COVID-19. Although he was prescribed IVIG, he had a lapse in IVIG replacement due to supply problems. The patient was later brought to the emergency room due to the deterioration of his general condition with dyspnea, tachypnea, shortness of breath, cough, and fever five days after the initial presentation. He was treated with favipiravir and IVIG and had a positive outcome. Results of COVID-19 infection in CVID patients are diverse, possibly due to underlying genetic defects. Although our patient had an increased risk for severe disease due to CVID, a lapse in IVIG replacement, and obesity, he did not require intensive care or intubation. Further studies are needed to determine and develop treatment strategies for COVID-19 infection in patients diagnosed with CVID.
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Nebulizers generate aerosols and may potentially transmit respiratory viral particles including SARS-CoV-2. There is a great concernabout the use of a nebulizer in the treatment of asthma exacerbations in the hospital or home setting during the COVID-19 pandemicand its use is not recommended unless essential. However, aerosol therapy should not be avoided in obligatory indications. Therefore,indications of nebulizer use during the pandemic should be evaluated on an individual basis in case of a severe asthma attack, andinfection control recommendations should be followed by clinicians while using nebulizers. In this article, we aimed to assess the safetyin addition to the “pro” and “con” sides of nebulizer treatment in asthma exacerbation during the COVID-19 pandemic.
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Objective: We hypothesized that, compared with body mass index (BMI) alone, central obesity would provide added informationregarding types of asthma (allergic, nonallergic) and asthma severity.Materials and Methods: A total of 150 children aged between 7-17 years with 50 allergic asthma, 50 nonallergic asthma and 50 controlswere included in the study. Height, weight, waist and hip circumferences of the groups were measured. Waist-to-hip ratio and BMI werecalculated. Pulmonary function test results were recorded. The relation between anthropometric measurements, asthma, atopy, obesityand each other was analyzed.Results: Obesity according to BMI was higher in the group with allergic asthma than nonallergic asthma and the control group (p:0.014). A positive correlation was found between asthma and BMI percentile, BMI z score and waist-to-hip ratio (p: 0.002; 0.003; 0.040,respectively). Children with obesity according to waist circumference were more frequent in the groups with allergic and nonallergicasthma compared to the control group (p: 0.048). There was a significant relationship between asthma severity and central obesity (p:0.048). FEV1 / FVC and FEF25-75 were lower in the asthmatic groups compared to the control group (p: 0.028; 0.012, respectively).Conclusion: This study showed that central obesity was associated with asthma and asthma severity, but not with atopy. Moreinvestigation is needed to clarify how central obesity in children affects the control of asthma and the response to asthma medication.
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Oculocutaneous albinism (OCA) is a disorder of melanin biosynthesis characterized by hypopigmentation of the skin, hair, and retinalpigment epithelium. We present the clinical and laboratory features of two siblings, born to consanguineous Turkish parents, who werediagnosed with autosomal recessive OCA type 7. We detected a homozygous mutation in the C10ORF11 gene (p.A23Rfs * 39) in bothpatients. Interestingly, the medical history revealed that both patients had suffered from recurrent respiratory tract infections since birth.The patients were investigated for suspected immunodeficiency and the results of the immune screening assays were normal. We believethese patients are noteworthy to report since presentation with infections has not been described in the prior descriptions of OCA type7. As of this current writing, infectious problems have stopped in one of our cases since the age of five and a half years.
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Objective: Although there is no consensus regarding the etiology of paranasal mucous retention cysts (MRCs) in the literature, several studies suggest an allergic etiology. This study aimed to investigate a potential association between paranasal MRCs diagnosed with MRI scans and allergic sensitization in the pediatric population. Materials and Methods: A total of 4559 MRI scans were retrospectively evaluated for MRC in patients who presented to the pediatric neurology outpatient clinic with headache complaints. Fifty children with MRI findings conclusive for paranasal MRC and 50 children without such findings were included in the study. All study and control patients were invited for atopy/allergy evaluation. Total IgE measurements, blood eosinophil levels, nasal smear and skin prick tests were performed to evaluate the allergic status of the children. In addition, an allergic rhinitis symptom questionnaire was administered. Results: The mean age was 13.0±2.8 years (median 14 y, range 6-18 y) with a female-to-male ratio of 1.4:1 in the study group. The prevalence of MRC was found to be 1.1% (50 in 4559). The two groups did not differ with regard to the frequency of blood eosinophilia, nasal eosinophilia, serum IgE levels, and allergic rhinitis symptom severity (p>0.05). Positive skin test for at least one of the allergens tested was more common in the MRC group than the controls (40% vs. 16%, p=0.007). Multivariate analysis identified that a positive skin prick test for at least one allergen was a significant independent predictor of MRC (OR, 4.6; 95% CI 1.2-17.0, p=0.023). Conclusion: Our study showed that paranasal MRCs were significantly more frequent in atopic children compared to controls. Additionally, MRCs were found to be strongly associated with allergic sensitization.
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