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Ilkay Koca Kalkan,1 Gozde Koycu Buhari,1 Hale Ates,1 Buket Basa Akdogan,1 Ozlem Erdem Ozdedeoglu,1 Kurtulus Aksu,1 Ferda Oner Erkekol2 1Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey; 2Division of Immunology and Allergy, Department of Chest Diseases, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, TurkeyCorrespondence: Ilkay Koca KalkanDepartment of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Sanatoryum Cad, Keçiören, Ankara 06280, TurkeyTel +90 505 3117710Fax +90 312 3552110Email ilkay.koca@gmail.comPurpose: Local anesthetics (LA) are widely used and adverse drug reactions (ADR) occur in 2.5– 10%, but hypersensitivity reactions are rare (ranging between 0% and 4.3%). Risk is so overestimated causing too many allergy clinic referrals. There are limited and also conflicting results over the management of LA allergy. We aimed to find out who should be referred to an allergy clinic for a LA allergy testing, to define the subjects with an increased risk of LA allergy and to assess the need for testing for identifying alternative LA.Patients and Methods: We performed a retrospective study of patients referred to our clinic for diagnostic workup of LA hypersensitivity from 2006 to 2020.Results: In our cohort of 398 patients, tests were positive in 14 (3.52%) of them. Personal history of ADR with LA was the only independent risk factor for positive test (RR=4.007, p=0.033). Presence of generalized cutaneous symptoms and hypotension during past reaction were independent predictors of positive test (RR=9.043, p=0.021 and RR=10.445, p=0.038, respectively). The negative predictive value of intradermal test at dilution of 1:100 for immediate-type reaction was high (97.56%). Also, we demonstrated cross-reactivity within the amide-group LAs and co-occurrence of immediate- and delayed-type reactions.Conclusion: Only patients with an LA-induced ADR should be referred to an allergy clinic. History of generalized cutaneous symptoms and/or hypotension during the reaction may define subjects with an increased risk of LA allergy. A stepwise test procedure may start with skin tests especially for these patients with increased risk factors. In presence of LA allergy, alternative LA should always be confirmed by performing a challenge test.Keywords: intradermal tests, local anesthetics, drug hypersensitivity, skin tests, risk factors, prick tests

Introduction: When deferasirox is used in iron chelation therapy, maculopapular rash occurs in 10% of patients, but there is no accepted and implemented protocol for the management of these drug reactions in adults., Case Report: A 23-year-old woman diagnosed with thalassemia major is presented. She had taken 1,500 mg oral deferasirox for 1 week. Five hours after the last dose, a pruritic maculopapular rash developed on the body, face, and hands. The rash spread to the whole body within 3 days. The absolute necessity for the patient to take the drug was clarified by the hematology department. The patient's history was evaluated. A delayed-type hypersensitivity reaction due to deferasirox was considered., Management: The slow desensitization protocol described in the literature and applied on a case-by-case basis in pediatric patients was modified to shorten the duration by determining appropriate doses for the current preparation. The desensitization process was started with 1/100,000 of the total dose and the therapeutic dose was reached with a 2- to 2.5-fold increase in dose. No pre-medication was applied. During the procedure, at a low dose of 0.1 mg, local flushing and erythema was observed around the auricle on the face. The reaction did not progress., Conclusion: Slow desensitization protocol for oral deferasirox was successfully applied in an adult patient., Competing Interests: The authors acknowledge that they do not have any conflict of interest regarding the study. Table 1.Deferasirox slow desensitization protocols. Bruner et al. [4] protocolOur protocolTime intervals (days)Dose (mg)Dose (mg)Dose (mL)30.050.05Solution Ba 0.5 mL40.10.1Solution B 1 mL30.20.2Solution B 2 mL40.50.5Solution B 5 mL311Solution Ab 1 mL422Solution A 2 mL345Solution A 5 mL4810Solution A 10 mL31620Solution A 20 mL43240Solution A 40 mL36480Solution A 80 mL4125150Solution A 150 mL32502501 tablet45005002 tablets77507503 tablets71,0001,5006 tablets71,500 aA suspension was made by 1 : 10 dilution of solution A to a final concentration of 0.1 mg/mL (solution B); bA suspension was prepared by dissolving 1 tablet of deferasirox (250 mg) into a volume of 250 mL of water to a final concentration of 1 mg/mL (solution A)., (© Dustri-Verlag Dr. K. Feistle.)

Background: Data about drug hypersensitivity reactions with first-line antituberculosis drugs and their management is limited. Rapid drug desensitization seems to be an appropriate management., Objective: Evaluate the efficacy of the rapid desensitization protocols in patients who had a reaction phenotypically compatible with immediate-type drug hypersensitivity with first-line antituberculosis drugs and identify possible risk factors of breakthrough reactions during the protocols., Methods: This is a retrospective study of active tuberculosis patients who had a reaction phenotypically compatible with immediate-type drug hypersensitivity with first-line antituberculosis drugs and underwent desensitization with the drugs used during the reaction. Characteristics of drug hypersensitivity and breakthrough reactions, and outcomes of rapid desensitizations were recorded., Results: One hundred and seventy-nine patients were included in the study. Most of the initial reactions (n = 132, 73.7%) occurred within the first week of treatment and were mild (n = 146, 81.6%). A total of 690 desensitizations were performed. Desensitizations were successfully completed without any breakthrough reaction in 103 (57.5%) patients and in 29 of 36 (80.6%) patients after a breakthrough reaction. The overall success of desensitizations were found to be 95% (132 of 139 patients). Most of the breakthrough reactions (84%) were mild. Sixteen patients had breakthrough reactions with multiple drugs. Although pyrazinamide was the most common culprit of breakthrough reactions and had the lowest desensitization success, it had the highest rate of a single breakthrough reaction (p < 0.001). Timing of the initial reaction and concomitant breakthrough reaction with ethambutol were found to have increased the risk for breakthrough reaction caused by rifampicin (p = 0.017 and p = 0.010 respectively)., Conclusion: The rapid desensitization protocols used in this study provide a successful and effective management of the patients with a reaction phenotypically compatible with immediate-type drug hypersensitivity with first-line antituberculosis drugs., Competing Interests: The authors have declared no conflict of interest regarding to this manuscript., (© 2023 The Authors.)

Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention., Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes., Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group ( n  = 1535, 74.8%). The majority of the patients had allergic ( n  = 1158, 65.3%) and eosinophilic ( n  = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV 1 , existence of chronic rhinosinusitis and living in particular regions., Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV 1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Background and Aims: To evaluate asthma phenotypes in patients with asthma from different regions of Turkey., Methods: A total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011-January 2012., Results: The disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P < 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P < 0.01). Uncontrolled asthmatics have more severe disease (P < 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P < 0.01). Chronic rhino-sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P < 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P < 0.05)., Conclusion: In conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes., (© 2015 John Wiley & Sons Ltd.)

Background: Data are limited about the value of skin tests in the diagnosis of proton pump inhibitor (PPI)-induced hypersensitivity reactions and the cross-reactivity between PPIs. We aimed to assess the role of skin testing in the diagnosis of PPI-related immediate hypersensitivity reactions and the cross-reactivity patterns among PPIs., Methods: The study was designed in a prospective, national, multicentre nature. Sixty-five patients with a suggestive history of a PPI-induced immediate hypersensitivity reaction and 30 control subjects were included. Standardized skin prick and intradermal tests were carried out with a panel of PPIs. Single-blind, placebo-controlled oral provocation tests (OPTs) with the PPIs other than the culprit PPI that displayed negative results in skin tests (n = 61) and diagnostic OPTs with the suspected PPI (n = 12) were performed., Results: The suspected PPIs were lansoprazole (n = 52), esomeprazole (n = 11), pantoprazole (n = 9), rabeprazole (n = 2), and omeprazole (n = 1). The sensitivity, specificity, and negative and positive predictive values of the skin tests with PPIs were 58.8%, 100%, 70.8%, and 100%, respectively. Fifteen of the 31 patients with a hypersensitivity reaction to lansoprazole had a positive OPT or skin test result with at least one of the alternative PPIs (8/52 pantoprazole, 6/52 omeprazole, 5/52 esomeprazole, 3/52 rabeprazole)., Conclusion: Considering the high specificity, skin testing seems to be a useful method for the diagnosis of immediate-type hypersensitivity reactions to PPIs and for the evaluation of cross-reactivity among PPIs. However, OPT should be performed in case of negativity on skin tests., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Allergic bronchopulmonary aspergillosis (ABPA) occurs in approximately 1-7.6% of patients with asthma. This incidence is low enough not to be considered in the differential diagnosis but also high enough to be an important disease. Since the symptoms and laboratory tests are not specific for ABPA, the diagnosis may be delay for years. However the failure to diagnose and treat ABPA for long term may result in fibrotic lung disease. This article focuses on the clinical and the laboratory aspects, and the management of ABPA in the light of three cases.