Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults

Prevalence of allergen sensitization among children with allergic rhinitis in Changzhou, China: a retrospective observational study

OBJECTIVE

To determine the prevalence of sensitivity to common inhaled and food allergens among children with allergic rhinitis (AR) in Changzhou in eastern China and provide a basis for epidemiological research of pediatric allergic rhinitis and allergen avoidance in this region.

METHODS

This was a retrospective observational study, a total of 1248 children with AR were enrolled at the Third People's Hospital of Changzhou between January 2018 and December 2019. The serum-specific immunoglobulin E (sIgE) to 19 kinds of inhaled and food allergens and serum total IgE were detected with the AllergyScreen test (Mediwiss Analytic GmbH, Moers, Germany). All participants had a positive reaction to at least one allergen in the test (the sIgE concentration ≥ 0.35 IU/ml).

RESULTS

Among the patients, 818 (65.54%) were male and 430 (34.46%) were female, with 81 (6.50%) aged 1-3 year, 501 (40.14%) aged 4-7 year, and 666 (53.36%) aged 8-14 year. The positivity rate of inhaled allergens was 80.05% (n = 999), while the positivity rate of food allergens was 66.19% (n = 826). 828 patients (66.35%) were sensitized to multiple allergens. The most common inhaled allergens were Dermatophagoides pteronyssinus (65.38%), mold mix (25.56%), house dust (20.67%), and dog hair dander (13.94%), and the most common food allergens were cow's milk (30.31%), cashew nut (27.9%), egg (22.68%), and beef (12.98%). With an increase in age, the inhaled allergen positivity rate showed a significant increase (P < 0.01), while the food allergen positivity rate decreased significantly (P < 0.01). There were significant age differences in total IgE levels (P < 0.01) and the total IgE level was highest in the group aged 8-14 year.

CONCLUSIONS

Dermatophagoides pteronyssinus was the most common sensitizing allergen in pediatric patients with AR in Changzhou. Several other inhaled and food allergens were also common. We observed that multiple allergenic factors play an important role in the occurrence and development of AR.

Relationship between asthma and IL-17 gene polymorphism in a Turkish population

BACKGROUND

Asthma is a prevalent chronic obstructive disease of the airways.

AIMS

The aim of our study was to investigate the relationship between asthma and IL-17F gene 74488 T > C, IL-17A gene -197G > A, and IL17A gene -737C > T polymorphisms in Turkish population.

METHODS

In our study, peripheral blood samples collected from a total of 127 subjects, with 65 in the patient group and 62 in the control group, were analyzed for IL-17F gene 74488 T > C, IL-17A gene -197G > A, and IL17A gene -737C > T polymorphisms using next-generation sequencing.

RESULTS

There was no statistically significant relationship between IL-17A gene -197G > A and IL-17A gene -737C > T polymorphisms and the risk of developing asthma. It was found that the risk of developing asthma was 2.9-fold higher in individuals with a C allele in the IL-17F gene 7488 T > C polymorphic site than the individuals with a T allele. It was shown that ATT and GCT haplotype carriers had a greater disease risk compared with the GTT haplotype carriers.

CONCLUSIONS

In conclusion, IL-17F gene 7488 T > C polymorphism was found to be associated with asthma in the Turkish population. The IL-17 gene should be further investigated as a potential candidate gene in predicting asthma susceptibility and in the treatment of asthma.

The management of allergic rhinitis by pharmacists in public services: a proposed PhaRmacISt-led Education Model (AR-PRISE)

Allergic rhinitis has been identified as a major respiratory disease that places a significant burden on patients and the healthcare system. Nevertheless, the management of allergic rhinitis is challenging for both patients and practitioners. Pharmacists have been recognised as strategic in providing advice for allergic avoidance, disease information, and pharmacological care for allergic rhinitis management. This role has been underutilised in the public health service sector in Malaysia due to variation in practice, regulation, and health system structures when compared to the international guidelines. This article proposed a PhaRmacISt-led Education Model (AR-PRISE) that includes explicit patient education materials and an algorithm for structured counselling by pharmacists in the management of patients with allergic rhinitis.

Expert Opinion on Practice Patterns in Mild Asthma After the GINA 2019 Updates: A Major Shift in Treatment Paradigms from a Long-Standing SABA-Only Approach to a Risk Reduction-Based Strategy with the Use of Symptom-Driven (As-Needed) Low-Dose ICS/LABA

PURPOSE OF REVIEW

This expert opinion, prepared by a panel of chest disease specialists, aims to review the current knowledge on practice patterns in real-life management of mild asthma and to address the relevant updates in asthma treatment by The Global Initiative for Asthma (GINA) to guide clinicians for the best clinical practice in applying these new treatment paradigms.

RECENT FINDINGS

On the basis of the emerging body of evidence suggesting the non-safety of short-acting β2-agonists (SABA)-only therapy and comparable efficacy of the as-needed inhaled corticosteroids (ICS)-formoterol combinations with maintenance ICS regimens, GINA recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The new GINA 2019 recommendations no longer support the SABA-only therapy in mild asthma but instead includes new off-label recommendations such as symptom-driven (as-needed) low-dose ICS-formoterol and "low dose ICS taken whenever SABA is taken." The GINA 2019 asthma treatment recommendations include a major shift from long-standing approach of clinical practice regarding the use of symptom-driven SABA treatment alone in the management of mild asthma. This expert opinion supports the transition from a long-standing SABA-only approach to a risk reduction-based strategy, with the use of symptom-driven (as-needed) low-dose ICS/LABA in mild asthma patients, particularly in those with poor adherence to controller medications. The thoughtful and comprehensive approach of clinicians to these strategies is important, given that the exact far-reaching impact of this major change in management of mild asthma in the real-world settings will only be clarified over time.

Challenges and recommendations for the management of asthma in the Middle East and Africa

Clinical presentation of asthma is variable, and its diagnosis can be a major challenge in routine health-care practice, especially in low-and-middle-income countries. The aim of asthma management is to achieve optimal asthma control and to reduce the risk of asthma exacerbations and mortality. In the Middle East and in Africa (MEA), several patient- and physician-related factors lead to misdiagnosis and suboptimal management of asthma. A panel of experts comprising of specialists as well as general health-care professionals met to identify challenges and provide recommendations for the management of asthma in MEA. The major challenges identified for diagnosis of asthma were lack of adequate knowledge about the disease, lack of specialized diagnostic facilities, limited access to spirometry, and social stigma associated with asthma. The prime challenges for management of asthma in MEA were identified as overreliance on short-acting β-agonists (SABAs), underprescription of inhaled corticosteroids (ICS), nonadherence to prescribed medications, and inadequate insurance coverage for its treatment. The experts endorsed adapting the Global Initiative for Asthma guidelines at country and regional levels for effective management of asthma and to alleviate the overuse of SABAs as reliever medications. Stringent control over SABA use, discouraging over-the-counter availability of SABA, and using as-needed low-dose ICS and formoterol as rescue medications in mild cases were suggested to reduce the overreliance on SABAs. Encouraging SABA alone-free clinical practice in both outpatient and emergency department settings is also imperative. We present the recommendations for the management of asthma along with proposed regional adaptations of international guidelines for MEA.

Eczema, facial erythema, and seborrheic dermatitis symptoms among young adults in China in relation to ambient air pollution, climate, and home environment

A questionnaire survey on dermal symptoms and home environment was performed in eight Chinese cities (40 279 participants). Data on city level temperature, precipitation, PM₁₀ , NO_2, and gross domestic product (GDP) per capita were collected. In total, 2.2% had eczema, 2.4% facial erythema (FE) and 2.6% seborrheic dermatitis symptoms (SD). Higher temperature was associated with eczema (OR = 1.09). Higher GDP per capita was related to less SD. Higher PM₁₀ was related to SD. Suburban living was protective for eczema (OR = 0.77) (vs. urban). Living in old buildings (built before 1991) was related to eczema (OR = 1.42). Living near heavily trafficked roads was related to FE (OR = 1.33) and SD (OR = 1.35). Having new furniture was related to all symptoms (OR = 1.26-1.47). Burning mosquito coils (OR = 1.37-1.57) and incense (OR = 1.33-1.37) were associated with eczema, FE, or SD. Presence of cockroaches and rats/mice was associated with FE or SD (OR = 1.31-1.40). Using air conditioner, daily cleaning and frequently exposing bedding to sunshine were protective (OR = 0.60-0.83). In conclusion, higher temperature, higher PM₁₀ , urban living, living near heavily trafficked roads, old buildings, new furniture, burning mosquito coils and incense, and presence of cockroaches/rats/mice increased the risk of eczema, FE, or SD. Higher GDP, air conditioner, daily cleaning, and exposing bedding to sunshine were protective.

Altered serum elements, antioxidants, MDA, and immunoglobulins are associated with an increased risk of seborrheic dermatitis

Background

The exact mechanism for the pathophysiology of seborrheic dermatitis (SD) remains unknown. According to past knowledge, neuropsychiatric disorders, weak immune responses, fungal infections, antioxidants deficiencies, and inadequate nutrition might involve in SD. Here we evaluated serum trace elements, micronutrients, antioxidants, malondialdehyde (MDA), and immunoglobulins in SD patients.

Methods

This case-control study recruited 75 SD patients and 76 age-and sex-matched healthy controls (HCs). We measured serum micronutrients using atomic absorption spectroscopic methods. Similarly, we assessed serum antioxidants applying the RP-HPLC techniques. Also, serum MDA and immunoglobulins levels were evaluated by UV-spectrophotometric and turbidimetric methods, respectively.

Results

We observed higher serum levels of copper, manganese, iron, calcium, magnesium, and MDA in SD patients than HCs. Together with vitamin E, we noticed lower serum concentrations of immunoglobulin A, G, and M in SD patients than HCs. The present study detected a positive correlation between serum zinc and calcium levels (r = 0.365, p = 0.009) in SD patients. However, we identified a negative correlation between serum copper and calcium levels (r = -0.298, p = 0.035).

Conclusion

The present study suggests that the altered levels of micronutrients, antioxidants, MDA, and immunoglobulins are associated with the pathophysiology of SD. These changes may not be the cause but the consequences of the disease. These findings might help to understand the etiopathology and management of SD.

Asthma and allergic rhinitis among young parents in China in relation to outdoor air pollution, climate and home environment

We estimated associations between ambient air pollution, home environment and asthma as well as rhinitis among adults across China. A total of 40,279 young adults from eight Chinese cities participated in a questionnaire survey (participation rate 75%). There were questions on health and home environment. Information on city level gross domestic product (GDP) per capita, ambient temperature and PM₁₀ and NO₂ were collected from registers. Two-level logistic regression models were used to study health associations. Totally 1.6% reported asthma and 6.6% reported allergic rhinitis (AR). Higher temperature was associated with more asthma but less AR. Higher GDP was associated with less asthma but more AR. Higher degree of urbanization, higher level of NO₂ and living near heavily trafficked road were risk factors for asthma and AR. Participants in older buildings reported more asthma. Redecoration and buying new furniture were related to more asthma and AR (OR = 1.15-1.91). Using natural gas (OR = 1.34) and biomass (OR = 1.35) for cooking were risk factors for AR. Burning mosquito coils and incense increased the risk of asthma and AR. Cat keeping (OR = 2.88), dog keeping (OR = 2.04), cockroaches (OR = 1.54) and rats or mice (OR = 1.46) were associated with asthma. Cockroaches increased the risk of AR (OR = 1.22). Air humidifier and air cleaner were linked to asthma and AR. Frequent cleaning and exposing bedding to sunshine were protective. In conclusion, urbanization, NO₂ and traffic exhaust can increase the risk of adult asthma and AR. Higher ambient temperature was related to more asthma but less AR. Indoor animals such as cats, dogs, rats/mice and presence of cockroaches were associated with asthma or AR. Indoor chemical sources such as redecoration and new furniture were other risk factors. Cooking with natural gas or biomass and burning mosquito coils and incense were associated with asthma or AR. Frequent cleaning and exposing bedding to sunshine were protective.

Prevalence and Risk Factors of Asthma in Preschool Children in Shanghai, China: A Cross-Sectional Study

BACKGROUND

Previous studies have shown the increasing prevalence of childhood asthma around the world as well as in China. Nevertheless, little is known about the epidemiology of asthma in preschool children. Thus, the present study investigated the prevalence and severity of asthma in Shanghai, China, and identified related risk factors for asthma in children at the age of 3-6.

METHODS

Information was obtained through the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Risk factor analysis was carried out using univariate and multivariate logistic regression. The odds ratio (OR)/adjusted odds ratio (aOR) and the 95% confidence interval (CI) were determined.

RESULTS

A total of 6,183 children (3,165 boys and 3,018 girls) covering 12 communities were included in our study, with an average age of 4.2 ± 0.7 years. The prevalence of ever asthma, current asthma, and physician-diagnosed asthma was 16.0, 11.2, and 5.3%, respectively. Parental allergic history, including rhinitis and asthma, was significantly associated with asthma symptoms. The strongest association with current asthma was paternal asthma (aOR = 5.91, 95% CI 3.87-9.01), and maternal asthma had the second strongest association with current asthma (3.85; 2.40-6.17). Among personal factors, allergic rhinitis history, eczema history, food allergy history, and antibiotic use in the first year of life were significantly associated with current asthma (aOR = 1.89, 95% CI 1.52-2.34; aOR = 1.34, 95% CI 1.09-1.64; aOR = 1.68, 95% CI 1.37-2.06; aOR = 1.53, 95% CI 1.25-1.87, respectively). More than once paracetamol use per year and per month were associated with current asthma in a dose-response manner. Additionally, female sex was an independent protective factor for ever asthma (0.82; 0.70-0.96). Among environmental factors, dampness or mildew at home was an independent risk factor for ever asthma (1.50; 1.15-1.97) and current asthma (1.63; 1.21-2.19). Floor heating system was significantly associated with ever asthma (1.57; 1.25-1.98) and current asthma (1.36; 1.04-1.78). Furthermore, dampness or mildew, infrequent house cleaning, and truck traffic in residential streets were significantly associated with asthma symptoms only in old communities, while paracetamol use in the first year of life and flooring materials were significant factors only in new communities.

CONCLUSION

The prevalence of asthma has increased among preschool children in Shanghai over the past three decades. The identified risk factors indicated the combined effects of genetic, personal, and environmental factors on asthma symptoms. Differentiated strategies should be taken for preventing asthma in old and new communities.

Rare atopy in COVID-19 patients or COVID-19 famine in atopic patients?

Background

There are conflicting results in the literature regarding the frequency of allergic diseases in COVID‐19 patients. The effect of having an allergic disease on COVID‐19 disease severity has been little studied.

Purpose

In this study, we tried to determine the frequency of allergic diseases in COVID‐19 patients and the effect of having an allergic disease on COVID‐19 disease severity.

Design/Method

A retrospective cross‐sectional study was conducted in patients diagnosed with COVID‐19 in a state hospital in Istanbul, Turkey. Patients were contacted by phone and those who approved to participate in the study were questioned about their sociodemographic characteristics, body mass index, smoking history, and about their atopic status. Rate of atopic diseases among mild and severe COVID‐19 patients and risk estimates for mild disease in atopic and non‐atopic COVID‐19 patients were calculated.

Results

Study population consisted of 235 adults with COVID‐19 (mean age, 45.3 years [standard deviation, 15.0 years]; 139 [59.1%] male). Among study population, 16 (6.8%) subjects had one of the three atopic symptoms, which were wheezing, rhinitis, or eczema. Among the subjects with atopic status, four (1.7%) subjects had wheezing, eight (3.4%) had rhinitis, and four (1.7%) had eczema within the last 12 months. Although atopic status is associated with 3.1 times higher odds for mild disease, being atopic or not being atopic was not found to be associated with COVID‐19 severity (P = .054).

Conclusion

The information that atopic diseases are less common in COVID‐19 patients may guide clinical risk classification.

Prevalence of atopy and allergic rhinitis in patients with adult non-cystic fibrosis bronchiectasis

Background/aim

Non-cystic fibrosis bronchiectasis (non-CF BR) is common in developing countries.Limited data are available regarding the impact of atopy, and no data are available regarding allergic rhinitis in patients with adult bronchiectasis.The aim of this study was to evaluate the prevalence of atopy and allergic rhinitis in the clinical conditions of patients with BR.

Materials and methods

The study enrolled 101 patients who were diagnosed with non-CF BR using high-resolution computed chest tomography. Allergic rhinitis (AR) was defined by skin prick test (SPT) positivity and the presence of any nasal symptoms (watery runny nose, nasal obstruction, nasal itching, and sneezing).

Results

The mean age of patients was 48 ± 15 years (range 18–82); 55 (54.5%) patients were female. SPT positivity was detected in 37 (36.6%) cases. AR was detected in 32 (31.7%) patients with non-CF BR. AR was related to dyspnea (P = 0.04) and number of admissions to an emergency department in the previous year (P = 0.01). Forced expiratory volume in 1 s and forced vital capacity in patients with and without AR were different (P = 0.01 and P = 0.01, respectively). AR was correlated with number of admissions to an emergency department in the last year (r = 0.417, P = 0.005).

Conclusion

We concluded that atopy was detected in more than one-third of adult non-CF BR patients. This study demonstrated that non-CF BR patients might have AR; it might be important to be aware of nasal symptoms in non-CF BR patients.

Screening instrument to identify skin prick test-negative patients with asthma and/or rhinitis

INTRODUCTION

To the best of our knowledge, there is no prediction tool for determining respiratory allergy in patients with asthma and/or rhinitis.

OBJECTIVES

As such, this study aimed to develop an instrument for identifying skin prick test (SPT)-negative patients with asthma and/or rhinitis.

METHODS

This cross-sectional study screened 510 consecutive patients diagnosed with asthma and/or rhinitis between November 2009 and May 2011 in Ankara, Turkey. A structured questionnaire was the screening tool that was administered during the initial visit by the treating specialist and compared with a SPT result. All 15 variables were analysed using the logistic regression model to obtain β values (a score) for each variable. Each variable had a score, and scores were summed up to obtain final score for each patient.

RESULTS

The study included 363 patients, of which 165 (45.5%) were SPT positive. The final model included 13 variables. The lowest and highest scores were -21 and 26. A total score of 5.5 had sensitivity of 63% and specificity of 80%. The area under the receiver operating characteristic curve was 0.78. The histogram of the total scores for the study population was bimodal.

CONCLUSIONS

We designed a highly specific 13-item instrument for identifying SPT-negative patients. It may be used in middle income countries where allergy testing is expensive, not reimbursed or few allergy clinics are available. We think that our idea is interesting, that needs further research.

The clinical burden of allergic rhinitis in five Middle Eastern countries: results of the SNAPSHOT program

Background

The SNAPSHOT program provides current data on the allergic rhinitis burden in the adult general population of five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia and the United Arab Emirates, the latter three grouped into a Gulf cluster).

Methods

A multi-country, cross-sectional, epidemiological program conducted by telephone in a random sample of the adult general population; quotas were defined per country demographics. Subjects were screened for allergic rhinitis using the Score For Allergic Rhinitis questionnaire. Current prevalence (last 12 months) was estimated. Disease severity and control were assessed using the Allergic Rhinitis and its Impact on Asthma classification and Rhinitis Control Assessment Test respectively. Quality of sleep, impact on daily activities and quality of life were measured using the Epworth Sleepiness Scale, Sheehan Disability Scale and EuroQol Five-Dimension questionnaire respectively. Multivariate logistic regression analyses were used to investigate risk factors and co-morbidities.

Results

1808 of 33,486 subjects enrolled in the SNAPSHOT program fulfilled the case definition for allergic rhinitis. Prevalence was 3.6% [95% CI 3.2–4.0%] in Egypt, 6.4% [95% CI 5.9–6.9%] in Turkey and 6.4% [95% CI 6.0–6.9%] in the Gulf cluster. Risk factors identified were country, co-morbid asthma and income. Subjects with allergic rhinitis reported a significantly lower quality of life compared to the general population (p < 0.0001). Overall, 55% of allergic rhinitis subjects were moderate/severe and 33% were uncontrolled. Both these groups reported impaired quality of life and quality of sleep and increased impairment of daily activities compared to mild/well-controlled subjects (p < 0.0001).

Conclusions

Although the observed prevalence of allergic rhinitis in these Middle Eastern countries is low compared to western countries, its burden is considerable. Allergic rhinitis in general, and specifically uncontrolled and severe disease, results in a negative impact on quality of life, quality of sleep and daily activities.

Prevalence of asthma among the adult general population of five Middle Eastern countries: results of the SNAPSHOT program

BACKGROUND

Asthma is a common chronic respiratory disease leading to morbidity, mortality and impaired quality of life worldwide. Information on asthma prevalence in the Middle East is fragmented and relatively out-dated. The SNAPSHOT program was conducted to obtain updated information.

METHODS

SNAPSHOT is a cross-sectional epidemiological program carried out in five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia, and the United Arab Emirates, the latter three grouped into a Gulf cluster) to collect data on asthma, allergic rhinitis, benign prostatic hyperplasia and bipolar disorder. The survey was carried out by telephone in a random sample of the adult general population with quotas defined according to country demographics. The analysis presented in this paper focuses on asthma. Subjects were screened for asthma based on criteria from the global Asthma Insights and Reality studies. Current prevalence (last 12 months) was estimated. Multivariate logistic regression analyses were used to investigate risk factors related to asthma and the association with allergic rhinitis and other co-morbidities. Quality of life was assessed using the three-level EQ-5D questionnaire.

RESULTS

2124 out of the 33,486 subjects enrolled in the SNAPSHOT program fulfilled the criteria for asthma. The adjusted prevalence of asthma ranged from 4.4% [95% CI: 4.0-4.8%] in Turkey, to 6.7% [95% CI: 6.2-7.2%] in Egypt and 7.6% [95% CI: 7.1-8.0%] in the Gulf cluster. Prevalence was higher (p < 0.0001) in women than men and increased with age (p < 0.0001). Co-morbidities occurred more frequently in asthma subjects compared to the non-asthma population (38% vs. 15% p < 0.0001). Subjects with asthma reported a lower (p < 0.0001) EQ-VAS score (68.2 ± 22.9) compared to the general population (78.1 ± 17.5). The risk factors associated with asthma were age, gender, country, and certain co-morbidities, namely respiratory, cardiovascular, gastrointestinal, nervous, and neurological diseases.

CONCLUSION

The observed adjusted prevalence of asthma in the Middle East ranges from 4.4% to 7.6%, which is comparatively lower than the reported prevalence in Europe and North America. Asthma has a negative impact on quality of life, and is associated with high levels of co-morbid diseases, indicating a need for physicians to check for co-morbidities and ensure they are managed correctly in all asthma patients.

Mothers' Attitudes Toward Feeding Twin Babies in the First Six Months of Life: A Sample From Sakarya, Turkey

BACKGROUND

It is stated in the literature that a mother's breast milk is sufficient for more than one baby.

OBJECTIVES

This descriptive study aimed to determine whether twin babies are breastfed during their first six months of life.

MATERIALS AND METHODS

We studied the twin birth cases in a state hospital in Sakarya, Turkey between October 2011 and March 2013. The population of the study consisted of entire mothers who had delivered twins in the maternity ward of the hospital. The sample comprised 30 twins' mothers who agreed to participate in the study via telephone for six months. During these phone calls, they were asked how they preferred to feed their babies. The data were expressed as the mean and percentage.

RESULTS

The average age of the mothers participating in the study was 30.17±5.16 years (min. 19; max. 38). The number of mothers who stated that they had no previous experience of breastfeeding twin babies and had received training to breastfeed multiple babies was 17 (56.7%). Twenty-seven (90%) of the mothers had had caesarean sections, and half of the babies were preterm. Only a few of the babies were fed breast milk for five months. During the following months, the breastfeeding regimen was as follows: 5 babies were breastfed for a month, 5 babies for 2 months, 4 babies for 3 months, 4 babies for 4 months, 2 babies for 5 months, and no babies in the sixth month.

CONCLUSIONS

It was found that the number of twin babies who were only breastfed in the first six months of life was low. According to the literature, a mother's breast milk is sufficient for multiple babies. Mothers expecting twin babies should be informed about the benefits of breastfeeding and be encouraged to breastfeed. They should also receive training on this subject.

Effect of lipid peroxidation, antioxidants, macro minerals and trace elements on eczema

The exact etiology and pathogenesis of eczema are not yet fully understood, although different factors are considered as pathogenic mechanisms in the development of eczema. Our study was designed to determine extent of serum lipid peroxidation, antioxidants, macro minerals and trace elements in patients with eczema, and thereby, find any pathophysiological correlation. The study was conducted as a case-control study with 65 eczema patients as cases and 65 normal healthy individuals as controls. Lipid peroxidation was assessed by measuring the serum level of malondialdehyde (MDA). Antioxidants- vitamin A and E concentration was determined by RP-HPLC method whereas vitamin C was evaluated for serum ascorbic acid by UV spectrophotometric method. Serum macro minerals (Na, K, Ca) and trace elements (Zn, Fe) were determined by Atomic Absorption Spectroscopy (AAS). This study found significantly higher level of MDA (p < 0.001) and lower level of antioxidants (p < 0.05) in patients in comparison to the control subjects. Analysis of serum macro minerals (Na, K and Ca) and trace elements (Zn, Fe) found that the mean values of Na, K, Ca, Zn and Fe were 2771.60 ± 75.64, 66.33 ± 3.03, 48.41 ± 2.50, 0.30 ± 0.02 and 0.29 ± 0.009 mg/L for the patient group and 3284.81 ± 34.51, 162.18 ± 3.72, 87.66 ± 2.10, 0.75 ± 0.06 and 0.87 ± 0.06 mg/L for the control group, accordingly. There was a significant difference for all the minerals between the patients and controls (p < 0.001). This study suggests a strong association between the pathogenesis of eczema with the elevated level of MDA and depleted level of antioxidants, macro minerals, and trace elements.

The Prevalence of Allergic Diseases and Associated Risk Factors in School-Age Children and Adults in Erzurum, Turkey

OBJECTIVES

Allergic diseases are a major public health problem, owing to their socioeconomic burden and high frequency. The aim of this study was to assess the prevalence and risk factors of allergic diseases in adults and children in the province of Erzurum.

MATERIAL AND METHODS

Primary school students aged 11-12 years old filled out the International Study of Asthma and Allergies in Childhood (ISAAC) phase II questionnaire, and their parents filled out the European Community Respiratory Health Survey (ECRHS) questionnaire by themselves. We enrolled 494 questionnaires for ISAAC and 946 for ECRHS.

RESULTS

The survey response rates were 91.8% for ISAAC and 87% for ECRHS. The frequencies of doctor-diagnosed asthma, allergic rhinitis, conjunctivitis, atopic dermatitis, and food allergy in children were 11.9%, 8.9%, 27.3%, 3.6%, and 6.5%, respectively. In adults, the rates of wheezing in the chest, accompanying shortness of breath, and wheezing in the absence of flu within the last 12 months were 8%, 8%, and 5.5%, respectively, whereas the rate of asthma attack in the last 12 months was 2.9%, the rate of asthma medication usage was 2.6%, and the frequency of allergic rhinitis was 1.6%. The determined risk factors for childhood were "duration of attending a nursery" for asthma (p=0.02, OR=2.51, 95% CI=1.14-5.53), "having ever been to a nursery" for atopic dermatitis (p=0.02, OR=3.83, 95% CI=1.24-11.8), and "a family history of rhinitis" for food allergy (p=0.01, OR=2.94, 95% CI=1.13-6-57).

CONCLUSION

The prevalence of allergic diseases in children and adults in Erzurum was found to be lower than in studies conducted throughout Turkey and in western regions of the Country. Going to a nursery, the length of nursery education, and a family history of rhinitis were identified as the risk factors for allergic diseases in children. The identification of regional risk factors and taking preventive measures in this regard may provide a reduction in the incidence of allergic diseases.

Rhinitis, asthma and respiratory infections among adults in relation to the home environment in multi-family buildings in Sweden

Risk factors for rhinitis, asthma and respiratory infections in the home environment were studied by a questionnaire survey. Totally 5775 occupants (≥ 18 years old) from a stratified random sample of multi-family buildings in Sweden participated (46%). 51.0% had rhinitis in the last 3 months (current rhinitis); 11.5% doctor diagnosed asthma; 46.4% respiratory infections in the last 3 months and 11.9% antibiotic medication for respiratory infections in the last 12 months. Associations between home environment and health were analyzed by multiple logistic regression, controlling for gender, age and smoking and mutual adjustment. Buildings constructed during 1960-1975 were risk factors for day time breathlessness (OR = 1.53, 95%CI 1.03-2.29). And those constructed during 1976-1985 had more current rhinitis (OR = 1.43, 95%CI 1.12-1.84) and respiratory infections (OR = 1.46, 95%CI 1.21-1.78). Cities with higher population density had more current rhinitis (p = 0.008) and respiratory infections (p<0.001). Rented apartments had more current rhinitis (OR = 1.23, 95%CI 1.07-1.40), wheeze (OR = 1.20, 95%CI 1.02-1.41), day time breathlessness (OR = 1.31, 95%CI 1.04-1.66) and respiratory infections (OR = 1.13, 95%CI 1.01-1.26). Living in colder parts of the country was a risk factor for wheeze (p = 0.03) and night time breathlessness (p = 0.002). Building dampness was a risk factor for wheeze (OR = 1.42, 95%CI 1.08-1.86) and day time breathlessness (OR = 1.57, 95%CI 1.09-2.27). Building dampness was a risk factor for health among those below 66 years old. Odor at home was a risk factor for doctor diagnosed asthma (OR = 1.49, 95%CI 1.08-2.06) and current asthma (OR = 1.52, 95%CI 1.03-2.24). Environmental tobacco smoke (ETS) was a risk factor for current asthma (OR = 1.53, 95%CI 1.09-2.16). Window panel condensation was a risk factor for antibiotic medication for respiratory infections (OR = 1.41, 95%CI 1.10-1.82). In conclusion, rhinitis, asthma and respiratory infections were related to a number of factors in the home environment. Certain building years (1961-1985), building dampness, window panel condensation and odor in the dwelling may be risk factors.

Prevalence and triggers of allergic rhinitis in the United Arab Emirates

BACKGROUND AND OBJECTIVES

Allergic rhinitis is a morbid condition that is frequently overlooked by patients and physicians. This type of atopy has not been adequately investigated in the United Arab Emirates.

METHODS

This cross-sectional, population-based observational study was conducted in the seven Emirates (Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al-Quwain, Ras Al-Khaimah, and Fujairah). It used the European Community Respiratory Health Survey (ECRHS II) to screen for allergic rhinitis in people living in this region.

RESULTS

Symptoms of allergic rhinitis were present in 85 (7%) of the 1,229 study population. Only 33 (39%) patients received treatment. Seventy-six (89%) patients had asthma. Thirty-seven (44%) patients were poly-sensitized. Symptoms were aggravated by dust (59%), grass/pollens (44%) and proximity to animals (21%). Winter was the peak season (37%), followed by spring (30%), autumn (18%) and summer (15%). Grass/pollen allergies were clustered in the winter, spring and summer (p ≤ 0.001). Dust was non-seasonal (p ≥ 0.121) and animal allergy was worse in the winter (p = 0.024) and spring (p = 0.044). Spring symptoms were less common in people living in the inner city (p = 0.003).

CONCLUSIONS

At least 7% of the studied population had allergic rhinitis. Most (71%) of these patients had environmental triggers and remained untreated. Allergic rhinitis awareness and measures to control allergens and dust are needed. The impact of preventing allergic rhinitis on other common atopies in the region deserves future studies.

Investigation of knowledge of asthma and inhaler devices in pharmacy workers

OBJECTIVE

Effective management of asthma requires the development of a partnership between the patient and his or her health care professionals. In a number of countries, including Turkey, pharmacy workers are the last link in the asthma therapy chain and usually give information to their patients about the use of these drugs and asthma. As a result, we investigated knowledge of asthma and the use of inhaler devices in pharmacy workers in Istanbul pharmacies.

METHODS

The study was performed with 266 pharmacists and 261 pharmacist assistants selected from 4221 pharmacies in Istanbul by random sampling, with a 90% confidence interval. Each patient was asked to fill out a questionnaire that measured their knowledge of asthma. They were also asked to demonstrate how to use the inhaler devices.

RESULTS

The high number of incorrect answers to the 11th question, that ''the majority of upper respiratory tract infections triggering asthma are viral'', may be a contributor to the unnecessary use of antibiotics in Turkey (incorrect answers from 41.2% of pharmacists and 34.5% of pharmacist assistants). Scores for inhalation device techniques for the pharmacists were as follows: metered-dose inhaler (MDI), 4.9 ± 3.9; discus, 4.4 ± 3.7; aerolizer, 4 ± 3.1; and turbuhaler, 3.8 ± 2.9.

CONCLUSIONS

Istanbul pharmacy workers have limited knowledge about asthma and inhaler devices and need further education, which may contribute to improved asthma control in Turkey.

Allergic rhinitis and its impact on asthma classification correlations

OBJECTIVE

Allergic rhinitis is inflammation of the nasal mucosa following exposure to allergens. A few studies have investigated how the Allergic Rhinitis and its Impact on Asthma classification correlates with symptom severity and skin prick test results in allergic rhinitis patients. Our objective was to evaluate such a correlation.

MATERIALS AND METHODS

The study population consisted of 268 patients who had allergic symptoms and were diagnosed with allergic rhinitis.

RESULTS

Analysis of the Allergic Rhinitis and its Impact on Asthma classification with regard to symptom severity revealed that there were statistically significant differences between the groups for nasal symptoms, wheezing, eye itching/watering and eye redness. Symptom frequency and severity increased gradually towards the moderate to severe persistent allergic group. There was a statistically significant difference between the groups for grass pollen and house dust mite allergy.

CONCLUSION

The Allergic Rhinitis and its Impact on Asthma classification, which takes symptoms and quality of life into consideration in addition to allergen exposure, is a useful classification system for allergic rhinitis.

Rhinitis symptoms and asthma among parents of preschool children in relation to the home environment in Chongqing, China

Risk factors for rhinitis and asthma in the home environment were studied by a questionnaire survey. Parents of 4530 1-8 year old children (one parent per child) from randomly selected kindergartens in Chongqing, China participated. 70.4% were females; 47.1% had rhinitis symptoms in the last three months (current rhinitis, CR); 1.6% reported a history of allergic asthma (AA); 2.7% reported a history of allergic rhinitis (AR); 16.4% were current smokers; 50.8% males and 2.4% females were current smokers. Stuffy odor, unpleasant odor, tobacco smoke odor and dry air were associated with CR (adjustment for gender, current smoking and other perceptions of odor or humidity). Associations between home environment and CR, AR, and AA were studied by multiple logistic regression analyses, adjusting for gender, current smoking and other significant home factors. Living near a main road or highway was a risk factor for both CR (OR(95%CI): 1.31(1.13,1.52)) and AR (OR(95%CI): 2.44(1.48,4.03)). Other risk factors for CR included living in rural areas (OR(95%CI): 1.43(1.10,1.85)), new furniture (OR(95%CI): 1.28(1.11,1.49)), water damage (OR(95%CI): 1.68(1.29,2.18)), cockroaches (OR(95%CI): 1.46(1.23,1.73)), and keeping pets (OR(95%CI): 1.24(1.04,1.49)). Other risk factors for AR included redecoration (OR(95%CI): 2.14(1.34,3.41)), mold spots (OR(95%CI): 2.23(1.06,4.68)), window pane condensation (OR(95%CI): 2.04(1.28,3.26)). Water damage was the only home factor associated with AA (2.56(1.34,4.86)). Frequently put bedding to sunshine was protective for CR (OR(95%CI): 0.79(0.68,0.92); cleaning every day was protective for AR (OR(95%CI): 0.40(0.22,0.71)). In conclusion, parents' CR and AR were related to a number of factors of the home environment.

Prevalence of allergic diseases in Izmir Province, Turkey

BACKGROUND

The aim of the present study is to determine the prevalence of allergic diseases and related risk factors in Izmir, Turkey, and to assess the positive immunoglobulin E (IgE) levels against common allergens.

METHODS

The questionnaires were completed via face-to-face interview with a total of 2937 individuals. Specific IgE was studied in the serum samples by enzyme-linked immunosorbent assay (ELISA). This cross-sectional population-based study comprised adolescents over the age of 15 years and adults of Izmir province.

RESULTS

In Izmir, the prevalence of self-reported allergy was 35.5%. Allergy was statistically significantly more common in females, university graduates, in those with high income, with family history for allergy, aged 40-49 years, those living in a flat, keeping pet(s), and in those using central heating. The prevalence of atopy according to the serum IgE levels (Class 3 with any of 3 IgEs) was found 1.6%.

CONCLUSION

In conclusion, the prevalence of atopy was found lower in Izmir as compared to the results of other studies.

Maternal employment and atopic dermatitis in children: a prospective cohort study

BACKGROUND

Considering the early onset of atopic dermatitis (AD), which most often arises in the first year of life, risk factors occurring very early in life must be considered. Little is known about the effects of maternal occupational exposure on the development of atopic disorders in children.

OBJECTIVES

The aim of this study was to evaluate associations between maternal employment and childhood AD.

METHODS

We used multistage stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth register. Information on maternal occupation categories, work stress, working time, shift work and potential confounders during pregnancy was gathered by questionnaires after birth. At 3 years of age, information on the development of AD was assessed by home interviews. Multiple logistic regression analysis was performed to estimate the association of maternal employment and AD.

RESULTS

Overall, 11,962 out of 19,381 mothers (61·7%) worked during pregnancy. The children of mothers who worked during pregnancy had an increased risk of AD compared with those whose mothers did not work [odds ratio (OR) 1·38, 95% confidence interval (CI) 1·25-1·53]. The children of mothers with a professional or technical occupation had a higher risk of AD (OR 1·64, 95% CI 1·44-1·87). The risk of AD was found to increase with maternal work stress during pregnancy in a dose-response manner (P(trend)<0·01). The mothers of children with AD had a longer working time than those without AD (P<0·0001). However, no significant association between AD and maternal shift work was found.

CONCLUSIONS

Working in professional or technical occupations increased the risk of childhood AD in addition to work stress during pregnancy.

The general characteristics of acute urticaria attacks and the factors predictive of progression to chronic urticaria

BACKGROUND

The natural history of progression from acute urticaria (AU) to chronic urticaria (CU) remains poorly understood. This study aimed to investigate the potential triggers of AU attacks and factors associated with their duration, as well as the factors which may be predictive of progression to CU.

METHODS

The study included 281 AU patients (AU group). Data were obtained from 207 AU patients retrospectively and from 74 AU patients prospectively. The CU group consisted of 953 patients, whose data were previously published.

RESULTS

According to the medical history, the most common potential triggers of AU attacks were drugs (38.1%); infections (35.2%); stress (24.7%); and foods (17.8%). Attack duration was shorter in cases in which food (p=0.04) or infection (p=0.04) was the suspected trigger. Patients with a history of rhinitis (p=0.04) and food allergy (p=0.04), and positive skin prick test results for pollens (p=0.02) and dog (p=0.02) also had attacks of shorter duration. Patients with asthma had attacks of longer duration (p=0.01). Based on history and/or provocation test results, the prevalence of non-steroidal anti-inflammatory drug hypersensitivity (NSAIDH) was significantly higher in the CU group than the AU group (24.9% vs. 4.3%, respectively, (p<0.01)), as was antibiotic hypersensitivity (10.6% vs. 4.6%, respectively, (p<0.01)) and food allergy (18.3% vs. 3.9%, respectively, (p<0.01)).

NSAIDH (OR

7.97; 95%CI: 4.33-14.66; p<0.01) and food allergy (OR: 5.17; 95%CI: 2.71-9.85; p<0.01) were observed to be independent factors associated with CU.

CONCLUSIONS

As NSAIDH and food allergy were associated with CU, their presence should be carefully evaluated in patients with AU in order to predict progression to CU.

Urban vs. rural factors that affect adult asthma

In this review, our aim was to examine the influence of geographic variations on asthma prevalence and morbidity among adults, which is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity. Asthma is a complex inflammatory disease of multifactorial origin, and is influenced by both environmental and genetic factors. The disparities in asthma prevalence and morbidity among the world's geographic locations are more likely to be associated with environmental exposures than genetic differences. In writing this article, we found that the indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke in both urban and rural areas. Asthma and asthma-related symptoms occurred more frequently in urban than in rural areas, and that difference correlated with environmental risk exposures, SES, and healthcare access. Environmental risk factors to which urban adults were more frequently exposed than rural adults were dust mites,high levels of vehicle emissions, and a westernized lifestyle.Exposure to indoor biological contaminants in the urban environment is common.The main risk factors for developing asthma in urban areas are atopy and allergy to house dust mites, followed by allergens from animal dander. House dust mite exposure may potentially explain differences in diagnosis of asthma prevalence and morbidity among adults in urban vs. rural areas. In addition, the prevalence of asthma morbidity increases with urbanization. High levels of vehicle emissions,Western lifestyles and degree of urbanization itself, may affect outdoor and thereby indoor air quality. In urban areas, biomass fuels have been widely replaced by cleaner energy sources at home, such as gas and electricity, but in most developing countries, coal is still a major source of fuel for cooking and heating, particularly in winter. Moreover, exposure to ETS is common at home or at work in urban areas.There is evidence that asthma prevalence and morbidity is less common in rural than in urban areas. The possible reasons are that rural residents are exposed early in life to stables and to farm milk production, and such exposures are protective against developing asthma morbidity. Even so, asthma morbidity is disproportionately high among poor inner-city residents and in rural populations. A higher proportion of adult residents of nonmetropolitan areas were characterized as follows:aged 55 years or older, no previous college admission, low household income, no health insurance coverage, and could not see a doctor due to healthcare service availability, etc. In rural areas, biomass fuels meet more than 70% of the rural energy needs. Progress in adopting modern energy sources in rural areas has been slow. The most direct health impact comes from household energy use among the poor, who depend almost entirely on burning biomass fuels in simple cooking devices that are placed in inadequately ventilated spaces. Prospective studies are needed to assess the long-term effects of biomass smoke on lung health among adults in rural areas.Geographic differences in asthma susceptibility exist around the world. The reason for the differences in asthma prevalence in rural and urban areas may be due to the fact that populations have different lifestyles and cultures, as well as different environmental exposures and different genetic backgrounds. Identifying geographic disparities in asthma hospitalizations is critical to implementing prevention strategies,reducing morbidity, and improving healthcare financing for clinical asthma treatment. Although evidence shows that differences in the prevalence of asthma do exist between urban and rural dwellers in many parts of the world, including in developed countries, data are inadequate to evaluate the extent to which different pollutant exposures contribute to asthma morbidity and severity of asthma between urban and rural areas.

Influenza vaccination in Turkey: prevalence of risk groups, current vaccination status, factors influencing vaccine uptake and steps taken to increase vaccination rate

Influenza infections cause considerable morbidity and mortality not only during the pandemics but also during annual epidemics. Vaccines are the most effective tools for preventing the infection. Although World Health Organization (WHO) and Ministry of Health (MoH) recommends vaccination for people at increased risk, sales data indicate that vaccination rate remains low in Turkey. Vaccine recommended groups are well defined and reimbursed in Turkey. However, the prevalence of people in risk groups, current vaccination rates and factors influencing vaccine uptake which are essential in order to develop and sustain effective strategies to increase vaccination rate are not documented. A thorough literature review was performed to determine the estimated number of people in risk groups, vaccination rates, factors influencing vaccine uptake in Turkey. Actions taken by the health authorities in order to increase the vaccine uptake among specified risk groups are also summarized. Based on the published prevalence rates, current study calculated that there are approximately 27 to 33 million people in risk groups. In addition, there are 428,000 health care providers serving in the public sector who are at increased risk for influenza infections. The lowest reported vaccination rate (5.9%) was in the elderly ≥65 years of age and the highest (27.3%) in patients with COPD. Finally, survey results indicated that leading factor negatively influencing vaccine uptake was disbelief in the effectiveness of vaccine. In order to increase vaccination coverage, vaccines are provided to health care providers free of charge and reimbursed for those in the risk groups. Realizing the fact that combating flu requires multidisciplinary collaboration, a stakeholder network, Grip Platformu, has been established in 2011 with the endorsement of the MoH to increase influenza awareness and vaccine coverage rates among risk groups in accordance with WHO recommendations.

The association of month of birth with atopy in adult patients with asthma and rhinitis in Anatolia, Turkey

BACKGROUND

Exposure to allergens in early life may predispose subjects to develop allergies and diseases related to allergic sensitisation.

OBJECTIVE

To determine the association between month of birth and atopic sensitisation in adult Turkish patients with rhinitis and/or asthma using the diagnostic method of skin prick tests.

METHODS

This prospective cross-sectional study included all adult patients who underwent skin prick testing with rhinitis and asthma from November 2009 to June 2010. Sensitisation was categorised as any sensitisation, pollen sensitisation, and house dust mite sensitisation. Multivariate logistic regression model was employed with the primary predictor being month of birth. Diagnosis (asthma, rhinitis and both), age, gender and family history of atopy were considered as potential confounders in the model. The associations were presented with both unadjusted and adjusted odds ratios (OR) and their 95% confidence interval (CI).

RESULTS

A total of 616 subjects were evaluated. Three-hundred and forty-one subjects had sensitisation to allergens according to skin prick tests. Analyses showed that subjects born in September were less likely to have documented skin test positively with pollen sensitisation [0.27 (0.09-0.84), p=0.023].

CONCLUSION

The results support the hypothesis that being born at the end of the pollen season may protect subjects from pollen sensitisation.

Allergy to hazelnut in adults: a two-step study

BACKGROUND

Although hazelnut consumption is very high in Turkey, the prevalence of hazelnut allergy is still unknown. This study's objective was to investigate the prevalence of hazelnut sensitisation and to verify its clinical importance using double-blind, placebo-controlled challenge (DBPCFC) in an adult population.

METHODS

Prick-to-prick skin tests were performed with fresh hazelnut in 904 patients admitted to the allergy department. Among the 904 subjects, 20 patients with a history of allergic reactions to hazelnut and/or positive skin tests were recalled for further evaluation. Specific IgE was measured in these subjects. Eleven (11/20) patients accepted to undergo DBPCFC with hazelnut.

RESULTS

Among the 904 individuals, the history of reactions to hazelnut was positive in 16 subjects (1.8%); prick-to-prick skin tests were positive in 13 (1.4%); prick tests with the commercial product were positive in nine (0.9%); and history plus skin tests were positive in 16 (1.8%). Specific IgE to hazelnut was positive in only three patients. DBPCFC was conducted in 11 subjects with a positivity rate of 63.6% (7/11). We observed six mild and one moderate systemic reactions during the DBPCFC. Among seven subjects with a positive DBPCFC, six (85.7%) had a history of hazelnut allergy, and five (71.4%) had both history and skin test positivity.

CONCLUSION

Skin test sensitisation to hazelnut was found to be 1.76% (16/904) which is similar to the sensitisation rate in previous reports. However, DBPCFC was positive in 63% of cases with a history of hazelnut allergy and/or positive skin tests in this study. These results indicate that the presence of history with a positive skin test can be suggestive of hazelnut allergy; however an oral food challenge is needed to confirm the diagnosis.

Global warming and allergy in Asia Minor

The earth is warming, and it is warming quickly. Epidemiological studies have demonstrated that global warming is correlated with the frequency of pollen-induced respiratory allergy and allergic diseases. There is a body of evidence suggesting that the prevalence of allergic diseases induced by pollens is increasing in developed countries, a trend that is also evident in the Mediterranean area. Because of its mild winters and sunny days with dry summers, the Mediterranean area is different from the areas of central and northern Europe. Classical examples of allergenic pollen-producing plants of the Mediterranean climate include Parietaria, Olea and Cupressaceae. Asia Minor is a Mediterranean region that connects Asia and Europe, and it includes considerable coastal areas. Gramineae pollens are the major cause of seasonal allergic rhinitis in Asia Minor, affecting 1.3-6.4 % of the population, in accordance with other European regions. This article emphasizes the importance of global climate change and anticipated increases in the prevalence and severity of allergic disease in Asia Minor, mediated through worsening air pollution and altered local and regional pollen production, from an otolaryngologic perspective.

Eczema among adults: prevalence, risk factors and relation to airway diseases. Results from a large-scale population survey in Sweden

BACKGROUND

In contrast to asthma and rhinitis, few studies among adults investigating the prevalence and risk factors of eczema have been published.

OBJECTIVES

To investigate the prevalence and risk factors of eczema among adults in West Sweden. A further aim was to study the associations between asthma, rhinitis and eczema.

METHODS

A questionnaire on respiratory health was mailed in 2008 to 30,000 randomly selected subjects in West Sweden aged 16-75 years; 62% responded. The questionnaire included questions about eczema, respiratory symptoms and diseases and their possible determinants. A subgroup of 669 subjects underwent skin prick testing against common airborne allergens.

RESULTS

'Eczema ever' was reported by 40·7% and 'current eczema' by 11·5%. Both conditions were significantly more common among women. The prevalence decreased with increasing age. The coexistence of both asthma and rhinitis with eczema was common. The main risk factors were family history of allergy and asthma. The dominant environmental risk factor was occupational exposure to gas, dust or fumes. Smoking increased the risk. Eczema was associated with urbanization, while growing up on a farm was associated with a decreased risk. Added one by one to the multivariate model, asthma, allergic rhinitis and any positive skin prick test were associated with eczema.

CONCLUSIONS

Eczema among adults is a common disease with more women than men having and having had eczema. Eczema is associated with other atopic diseases and with airway symptoms. Hereditary factors and exposure to gas, dust and fumes are associated with eczema.

Prevalence of self-reported asthma in urban and rural areas of Turkey

BACKGROUND AND PURPOSE

The risk factors for asthma in rural and urban population of Turkey are not well known. In this study we examined the effects of risk factors on the prevalence of asthma in adults living in rural and urban areas using data from a representative sample.

METHODS

Parents and grandparents of students from 20 randomly selected primary schools in urban and rural areas of Kirikkale, Turkey, were asked about respiratory diseases using the respiratory questionnaire, which were returned to us by their children.

RESULTS

Out of 13,225 parents and grandparents of primary school students 12,270 returned the questionnaires, for an overall response rate of 92.7%. The prevalence of asthma was more common in adults living in rural areas than in urban areas (10.8% vs. 6.2%, p < .0001, respectively). Asthma was more prevalent in women exposed to biomass smoke than those who were not exposed to it in rural areas (14.8% vs. 6.6%, p = .0001, respectively). Frequent childhood respiratory infections were more common in adults living in rural areas than in urban areas (18.2% vs. 10.9%, p < .0001, respectively). Exposure to biomass smoke and frequent childhood respiratory infections were associated with an increased risk of asthma, after adjusting for possible confounding factors in the logistic model for rural subjects. Chronic rhinitis (p = .0001) and frequent childhood respiratory infections (p = .0001) were associated with an increased risk of asthma, after adjusting for possible confounding factors in the logistic model for urban subjects.

CONCLUSIONS

The prevalence of asthma in adults living in the rural areas of the Kirikkale Region in Central Turkey was significantly higher than that in the urban population. Exposure to biomass smoke and childhood respiratory infections were more common in adults living in rural areas. The higher rate of asthma in adults living in rural areas may be due to a higher frequency of childhood respiratory infections and exposure to biomass smoke.

Immediate-type drug hypersensitivity and associated factors in a general population

BACKGROUND

Our aim was to assess the prevalence and associated risk factors of common hypersensitivity reactions to drugs in the adult population, for which limited data are available.

METHODS

The data consisted of 1052 questionnaires obtained from adults. The questionnaires consisted of questions on immediate-type hypersensitivity reactions induced by drugs (itching, skin rash/hives, angio-oedema, shortness of breath, hypotension, and loss of consciousness). The questionnaire added knowledge on physician's diagnosis of asthma, allergic rhinitis, eczema, and other chronic systemic diseases.

RESULTS

The prevalence of self-reported drug hypersensitivity reactions was 11.8% for all reactions. Hypersensitivity reactions to analgesics were the most common (37.2%) followed by antibiotics (24.2%). Multivariate analysis showed that female gender (Odds Ratio (OR) 95% Confidence Interval (CI) (2.00 (1.25-3.21)), physician-diagnosed allergic rhinitis (3.03 (1.64-5.59)), and eczema (3.22 (1.87-5.53)) were associated with any type of drug hypersensitivity reactions. Itching was associated with allergic rhinitis (4.50 (2.06-9.81)) and eczema diagnosis (4.24 (2.14-8.64)). Skin rash/hives were associated with female gender (2.67 (1.24-5.74)), allergic rhinitis (4.57 (1.99-10.05)), and eczema (5.36 (2.65-10.84)). Angio-oedema was higher in females (5.74 (1.69-18.5)). In addition, eczema (2.87 (1.12-7.32)) and systemic hypertension (2.60(1.03-6.10)) were associated with angio-oedema. Shortness of breath was only associated with ever asthma diagnosis (6.59 (2.09-20.83)). Factors associated with loss of consciousness were female gender (5.56 (1.27-24.30)), allergic rhinitis diagnosis (4.76 (1.73-13.14)), and systemic hypertension (2.74 (1.02-7.41)).

CONCLUSION

The study showed that females and subjects with allergic diseases and hypertension were more susceptible to drug hypersensitivity reactions.

The Asthma Insights and Reality in the Maghreb (AIRMAG) study: perspectives and lessons

Asthma is the most frequently encountered allergic respiratory disease, and one that has a potentially serious impact on patients' functioning and well-being. From a public health perspective, it is important to collect data on the prevalence, burden and management of asthma in order to improve understanding of the pathogenesis of asthma and to ensure that national healthcare policies are adapted and appropriate. In this respect, the different AIR surveys, which have collected standardised data on asthma in the general population of a large number of countries around the world, have made an important contribution. The latest of these surveys is the AIRMAG survey, performed in the three Maghreb countries of Algeria, Morocco and Tunisia. In these countries, the prevalence of asthma (3.4% to 3.9%) is in the low to moderate range. This is consistent with rates observed elsewhere in the Mediterranean basin. Nonetheless, the prevalence of asthma in the Maghreb may be expected to rise in the future as populations become more urbanized and adopt a more 'Westernized' lifestyle. Indeed the prevalence of asthma is already higher in the urban coastal regions of these countries than in the more rural mountainous and desert regions. Asthma control in the Maghreb is relatively poor compared to other regions evaluated in previous AIR studies, with control being unacceptable in around three-quarters of respondents. Although part of the explanation may reside in limited access to care, treatment rates for inhaled corticosteroids (26.1% of adults and 29.1% of children) were no worse than those reported in previous AIR studies. On the other hand, asthma monitoring through regular follow-up visits, home flow-meter use and preparation of individualised asthma management plans was in general unsatisfactory. In addition, awareness of asthma in the general population of the Maghreb countries was low. Education measures directed at the patient, together with programmes directed at the physician to ensure systematic monitoring and the use of a 'treat to target' approach to therapy, could do much to increase quality of life and minimise restrictions on activities in patients with asthma in the Maghreb.

Occupational exposures as risk factors for asthma and allergic diseases in a Turkish population

PURPOSE

There has been no community-based epidemiological study on the relation of occupational exposures with asthma, rhinitis, and eczema in Turkey. We examined the relationship between occupational exposures and adult-onset asthma, wheezing, allergic rhinitis, and eczema in a Turkish adult population.

METHODS

The data was collected from 1,047 adults, selected randomly from five distant family health centers. Questionnaires were filled by family practitioners with the help of interviews. The data included physician-diagnosed asthma, allergic rhinitis, eczema, wheezing, and occupational exposures.

RESULTS

Wheezing in all the subjects was associated with past exposure to irritants (OR: 1.7, 95%CI: 1.0-2.9), wood/coal smoke (OR: 2.3, 95%CI: 1.0-5.3), metal dust (OR: 2.6, 95%CI: 1.2-5.7), volatile fumes (OR: 2.5, 95%CI: 1.1-5.3), and paper dust (OR: 3.7, 95%CI: 1.5-8.9). Past exposure to dust (OR: 4.1, 95%CI: 1.2-14.2) and to irritants (OR: 6.5, 95%CI: 2.0-20.4) were associated with increased prevalence of wheezing in nonsmokers, whereas current exposure to irritants was associated with decreased prevalence of wheezing (OR: 0.1, 95%CI: 0.01-0.9) in these subjects. In subjects who were regular smokers, exposure to metal dust (OR: 2.8, 95%CI: 1.2-6.5), volatile fumes (OR: 2.3, 95%CI: 1.0-5.3), and paper dust (OR: 3.3, 95%CI: 1.3-8.6) were the main causes for wheezing. Physician-diagnosed eczema was associated with occupational exposure to chemical fumes (OR: 3.7, 95%CI: 1.3-10.6).

CONCLUSION

The present study showed that occupational exposures were associated with wheezing and eczema prevalence in the studied population. Nonsmokers could be more vulnerable to respiratory effects of occupational exposures due to healthy smokers effect.

Geo-climate effects on asthma and allergic diseases in adults in Turkey: results of PARFAIT study

The aim of the study was to evaluate the role of geo-climatic factors on the prevalence of allergic diseases in the adult population in Turkey. A total of 25,843 questionnaires using data from parents of 25,843 primary schoolchildren from 14 cities were evaluated. Mean annual temperature was significantly associated with the prevalence of asthma and wheezing in both sexes [respectively; OR: 1.008 (95% CI: 1.003-1.011) and OR: 1.012 (1.006-1.018 in males), OR: 1.007 (1.003-1.012) and OR: 1.01 (1.002-1.018) in females]. In addition, it was associated with eczema in females [OR: 1.007 (1.001-1.012)]. Asthma in females was associated with mean annual humidity in the air [OR: 1.001 (1.000-1.002)]. Annual number of days with snow is associated with wheezing in both sexes [respectively, OR: 1.001 (1.000-1.002) in males and OR: 1.002 (1.000-1.003) in females]. Protective measures could come into priority in certain areas of the country. Allergic diseases may increase as a cause of climate change in the future.

The frequency of self-reported allergic diseases in patients with crimean-congo haemorrhagic fever

BACKGROUND

Crimean-Congo haemorrhagic fever (CCHF) is an acute, tick-borne viral disease. In temperate areas, CCHF cases occur between spring and early autumn when tick activity is high. This period is also the pollen season during which symptoms of allergic diseases are exacerbated. Viruses induce inflammatory and antiviral responses by binding to specific receptors on the surface of airway epithelial cells, resulting in activation of innate immune responses; release of mediators such as cytokines and chemokines; and recruitment of neutrophils and mononuclear cells to the area.

AIM

We aimed to evaluate the frequency of self-reported allergic diseases and the effect on CCHF severity.

METHOD

Between June and August 2008, a questionnaire was applied to 114 CCHF (+) patients and 122 healthy control subjects, 16 to 88 years old who attended the Infectious Diseases clinic and were hospitalised with CCHF suspected, by face to face interview including history of allergic rhinitis (AR), asthma symptoms and nonspecific bronchial reactivity, doctor diagnosed AR and/or asthma, and familial allergic diseases history.

RESULTS

According to PCR and/or enzyme-linked immunoassay (ELISA) results, 51.7% of patients (n=114) had CCHF. There was no significant relation between CCHF and history of AR, asthma symptoms and nonspecific bronchial reactivity, doctor diagnosed AR and/or asthma, and familial allergic diseases history. The severity of CCHF has not affected these parameters (p>.05). Of patients with positive CCHF test, 2.6% (n=3) and 3.5% (n=4) had doctor diagnosed AR and asthma, respectively.

CONCLUSION

Self-reported allergic diseases and CCHF are not related with each other.