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Can Bostan O, Karakaya G, Kalyoncu AF, Damadoglu E. Dual biologics therapy in a patient with severe asthma and chronic urticaria: a case report and review of the literature. J Asthma 2024; 61:260-264. [PMID: 37715663 DOI: 10.1080/02770903.2023.2260884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION The data on the use of dual biologics are scant, but a topic of current interest. CASE STUDY In this report, the treatment regimen of a patient with two T helper 2 pathway-related comorbidities, severe asthma, and chronic spontaneous urticaria, was presented. RESULTS Both urticaria and asthma symptoms of the patient could not be controlled entirely with monotherapy while both diseases could be controlled after omalizumab-mepolizumab dual treatment. No adverse events were observed after 6 months of dual biologics use. CONCLUSION This report supports other publications in the literature involving the use of dual biologics and provides a summary of the literature.
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Affiliation(s)
- Ozge Can Bostan
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gul Karakaya
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ebru Damadoglu
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
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Can Bostan O, Damadoglu E, Sarac BE, Kilic B, Sahiner UM, Karaaslan C, Karakaya G, Kalyoncu AF. Cytokine Profiles of Chronic Urticaria Patients and The Effect of Omalizumab Treatment. Dermatol Pract Concept 2023; 13:dpc.1304a272. [PMID: 37992372 PMCID: PMC10656130 DOI: 10.5826/dpc.1304a272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Cytokines are key mediators in immunological and inflammatory conditions, including chronic spontaneous urticaria (CSU). OBJECTIVES To investigate Th1, Th2, and Th17 cytokine profiles in CSU and to evaluate the possible effect of omalizumab treatment. METHODS Patients who were followed up for CSU, as well as healthy volunteers, were included in the study. To assess urticaria activity, the 7-day-Urticaria Activity Score (UAS-7), the Urticaria Control Test (UCT), and the Chronic Urticaria Quality of Life Questionnaire (CU-QoL) were filled. Serum levels of IL-6, IL-17, IL-31, eotaxin, RANTES, TNF-α, and TSLP were analyzed by ELISA and compared in CSU and control groups. The patients were analyzed in two groups as the omalizumab group and the non-omalizumab group based on their treatment status. RESULTS Total IgE, ESR, CRP, RANTES, and TNF-a were significantly different in the overall comparison of the three groups: CSU-receiving omalizumab, CSU-not receiving omalizumab, and control groups (P <0.01, 0.015, <0.01, <0.01 and <0.01 respectively). Total IgE, CRP, RANTES, and TNF-α values were similar in those who received and did not receive omalizumab, yet these biomarkers were significantly higher in both groups than in the control group (P < 0.05). Statistical significance in ESR was observed only between the CSU-receiving omalizumab group and the control group (P = 0.01). Within the CSU patients, there was a slight but significant correlation between UCT and TNF-α (P = 0.008, r = 0.32) and IL-17 (P = 0.06, r = 0.33) levels. CONCLUSIONS The investigated cytokine profile in CSU patients may differ from healthy controls, particularly with the higher levels of RANTES and TNF-α, and omalizumab treatment does not seem to affect that profile in CSU patients.
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Affiliation(s)
- Ozge Can Bostan
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
| | - Ebru Damadoglu
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
| | - Basak Ezgi Sarac
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Busra Kilic
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Umit Murat Sahiner
- Hacettepe University Faculty of Medicine, Department of Pediatric Allergy and Asthma, Ankara, Turkey
| | - Cagatay Karaaslan
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Gul Karakaya
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
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Cihanbeylerden M, Can Bostan O, Tuncay G, Safak C, Damadoglu E, Karakaya G, Kalyoncu AF. Evaluation of disease control after SARS-CoV-2 infection or vaccination in patients with NSAID-exacerbated airway disease. Allergy Asthma Proc 2023; 44:e3-e10. [PMID: 37480202 DOI: 10.2500/aap.2023.44.230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Background: There are insufficient data on changes in disease control after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection or vaccination in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease (N-ERD). Objective: This study aimed to investigate the history of coronavirus disease 2019 (COVID-19) in patients with N-ERD, determine whether they experienced exacerbations of asthma or rhinitis after COVID-19, and evaluate their postvaccination asthma and rhinitis control data. Methods: The demographic characteristics of patients with N-ERD and whether they had had symptoms of asthma, changes in nasal symptom scores Sino-nasal outcome test (SNOT-22), Asthma Control Test (ACT) within 1 month after SARS-CoV-2 vaccination or infection were recorded. The prevalence of COVID-19 in patients with N-ERD and in healthy controls was estimated. Results: A total of 103 patients with N-ERD and 100 healthy controls were included in the study. Thirty seven of the patients (35.9%) and 65 of the controls (65%) had a history of COVID-19. There were no significant differences in changes in the ACT and SNOT-22 scores after SARS-CoV-2 vaccination (p = 0.999). Although, the change in ACT score after infection was significant (p = 0.017; r = 0.39), there was no significant change in level of asthma control (p < 0.001). Conclusion: The history of COVID-19 was less frequent in the N-ERD group. There was no deterioration in asthma and rhinitis controls after SARS-CoV-2 vaccination. Although a significant decrease was observed in the ACT scores after COVID-19, there was no deterioration in the level of asthma control.
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Affiliation(s)
- Melek Cihanbeylerden
- From the Division of Allergy and Clinical Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozge Can Bostan
- From the Division of Allergy and Clinical Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gulseren Tuncay
- From the Division of Allergy and Clinical Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cagla Safak
- Department of Biostatistics, Ankara University Medical School, Ankara, Turkey
| | - Ebru Damadoglu
- From the Division of Allergy and Clinical Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gul Karakaya
- From the Division of Allergy and Clinical Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- From the Division of Allergy and Clinical Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
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Goktas P, Can Bostan O, Gulseren D, Cakmak ME, Kaya SB, Damadoglu E, Karakaya G, Kalyoncu AF. Thermo-SPT: A new skin prick test evaluation framework based on low-cost, portable smartphone thermography. Clin Exp Allergy 2023. [PMID: 37013254 DOI: 10.1111/cea.14310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Although the skin prick test (SPT) is a reliable procedure to confirm IgE-dependent allergic sensitization in patients, the interpretation of the test is still performed manually, resulting in an error-prone procedure for the diagnosis of allergic diseases. OBJECTIVE To design and implement an innovative SPT evaluation framework using a low-cost, portable smartphone thermography, named Thermo-SPT, to significantly improve the accuracy and reliability of SPT outcomes. METHODS Thermographical images were captured every 60 s for a duration of 0 to 15 min using the FLIR One app, and then analysed with the FLIR Tool® . The definition of 'Skin Sensitization Region' area was introduced to analyse the time-lapse thermal changes in skin reactions over several time periods during the SPT. The Allergic Sensitization Index (ASI) and Min-Max Scaler Index (MMS) formulae were also developed to optimize the identification of the peak allergic response time point through the thermal assessment (TA) of allergic rhinitis patients. RESULTS In these experimental trials, a statistically significant increase in temperature was detected from the fifth minute of TA for all tested aeroallergens (all p $$ p $$ values < .001 $$ <.001 $$ ). An increase was observed in the number of false-positive cases, where patients with clinical symptoms not consistent with SPT were evaluated as positive on TA assessment, specifically for patients diagnosed with Phleum pratense and Dermatophagoides pteronyssinus. Our proposed technique, the MMS, has demonstrated improved accuracy in identifying P. pratense and D. pteronyssinus compared with other SPT evaluation metrics, specifically starting from the fifth minute. For patients diagnosed with Cat epithelium, although not statistically significant initially, an increasing trend was determined in the results at the 15 min (ΔT (T15 - T0 ), p = .07 $$ p=.07 $$ ; ASIT15 , p < .001 $$ p<.001 $$ ). CONCLUSIONS This proposed SPT evaluation framework utilizing a low-cost, smartphone-based thermographical imaging technique can enhance the interpretability of allergic responses during the SPT, potentially reducing the need for extensive manual interpretation experience as standard SPTs.
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Affiliation(s)
- Polat Goktas
- UCD School of Computer Science, University College Dublin, Dublin, Ireland
- CeADAR: Centre for Applied Data Analytics Research, Dublin, Ireland
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey
| | - Ozge Can Bostan
- School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Duygu Gulseren
- School of Medicine, Department of Dermatology, Hacettepe University, Ankara, Turkey
| | - Mehmet Erdem Cakmak
- School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Saltuk Bugra Kaya
- School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoglu
- School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gul Karakaya
- School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
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Tuncay G, Damadoglu E, Cihanbeylerden M, Can Bostan O, Kayıkcı H, Özer S, Karakaya G, Kalyoncu AF. Comparison of the clinical outcomes of patients with NSAID-exacerbated respiratory disease receiving aspirin or biologicals. J Asthma 2023:1-10. [PMID: 36971076 DOI: 10.1080/02770903.2023.2196567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE NSAID-exacerbated respiratory disease (NERD) is characterized by exacerbation of respiratory symptoms after NSAID intake. While research for specific treatment options continues in patients who cannot tolerate or are unresponsive to aspirin treatment after aspirin desensitization (ATAD), biologicals have emerged as a new therapeutic option in NERD patients. The aim of this study was to compare the quality of life, and the sinonasal and respiratory outcomes of NERD patients treated with ATAD or biologicals. METHODS Patients who have been followed up at a tertiary care allergy center and who have been receiving at least one of ATAD, mepolizumab or omalizumab for at least six months were included. Evaluations were made using sinonasal outcome test (SNOT-22), asthma control test (ACT), short form-36 (SF-36), blood eosinophil counts, need for recurrent functional endoscopic sinus surgeries (FESS), and asthma or rhinitis exacerbations requiring oral corticosteroids (OCS). RESULTS A total of 59 patients comprised of 35 (59%) females and 24 (41%) males with a mean age of 46.1 (min-max, 20-70) years were included. The baseline blood eosinophil count was higher, and a significant decrease in blood eosinophil counts was observed in the mepolizumab group compared to ATAD group (p = 0.001, p < 0.001, respectively). At follow-up, the rate of recurrent FESS was lower in the group that received mepolizumab (p = 0.02). CONCLUSIONS In NERD patients, mepolizumab significantly decreased blood eosinophil counts and recurrent FESS. There was no significant difference between the patients receiving ATAD or mepolizumab regarding other clinical parameters.
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Can Bostan O, Duran E, Tuncay G, Cihanbeylerden M, Karadag O, Damadoglu E, Karakaya G, Kalyoncu AF. Sinonasal and respiratory outcomes of eosinophilic granulomatosis with polyangiitis patients receiving 100 mg mepolizumab in real-life clinical practice: 1-year follow up study. J Asthma 2022; 60:931-937. [PMID: 35912568 DOI: 10.1080/02770903.2022.2109165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background: Mepolizumab 300 mg is an approved treatment option for patients with eosinophilic granulomatosis with polyangiitis (EGPA), yet, the adequacy of 100 mg of mepolizumab in disease control is controversial.Objective: To evaluate the sinonasal and respiratory outcomes of EGPA patients treated with 100 mg mepolizumab for one year.Methods: Evaluations of 11 patients were made of the sinonasal outcome test (SNOT-22) (nasal, otologic, sleep, and emotional domains), asthma control test (ACT), forced expiratory volume in 1s (FEV1), blood eosinophil counts and oral steroid doses before mepolizumab treatment (T0) and at the 6th (T6) and 12th (T12) months.Results: A significant decrease was observed in the total SNOT-22 scores in the 6th month, after which the scores continued to be stable until the 12th month. (SNOT-22 median (IQR); T0: 70(53-82); T6: 19(4-35); T12: 11(6-40); T0-T6, p = 0.02; T6-T12, p = 0.85). In the subdomains of SNOT-22, nasal and sleep-related domains improved significantly in the first 6 months, and the otologic and emotional domains only improved from baseline in the 12th month. There was a significant decrease in blood eosinophil counts in the 6th month and oral steroid dose in the 12th month (eosinophils, median(IQR), T0: 1000(700-1800), T6: 100(0-200), p = 0.02; OCS dose, median(IQR), T0: 16(8-16); T6: 4(0-4); T12: 0(0-4); T0-T12, p = 0.002). A significant improvement was observed in ACT values in the 6th month (ACT median (IQR); T0:16(8-18); T6: 22(21-25); p = 0.01).Conclusion: Mepolizumab 100 mg provided a significant decrease in SNOT-22 values, especially in nasal and sleep domains, eosinophil counts and OCS dose in the 6th month.
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Affiliation(s)
- Ozge Can Bostan
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Emine Duran
- Hacettepe University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.,Hacettepe University School of Medicine, Vasculitis Research Centre, Ankara, Turkey
| | - Gulseren Tuncay
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Melek Cihanbeylerden
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Omer Karadag
- Hacettepe University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.,Hacettepe University School of Medicine, Vasculitis Research Centre, Ankara, Turkey
| | - Ebru Damadoglu
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Gul Karakaya
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Ali F Kalyoncu
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
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Tuncay G, Bostan OC, Damadoglu E, Karakaya G, Kalyoncu AF. SARS-CoV-2 vaccines are well tolerated in patients with mastocytosis. Ann Allergy Asthma Immunol 2022; 128:733-734. [PMID: 35257871 PMCID: PMC8894735 DOI: 10.1016/j.anai.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Gülseren Tuncay
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ozge Can Bostan
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoglu
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gül Karakaya
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Can Bostan O, Cakmak ME, Kaya SB, Tuncay G, Damadoglu E, Karakaya G, Kalyoncu AF. The association of timothy grass allergy and cat ownership on cat sensitization. Allergy Asthma Proc 2022; 43:220-225. [PMID: 35524353 DOI: 10.2500/aap.2022.43.220012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Pollen hypersensitivity might be a determining factor for other nonseasonal allergens because it may indicate deviation of the immune system toward T-helper type 2 activity and immunoglobulin E sensitivity. Objective: To investigate whether timothy grass pollen allergy may be a predictive factor for cat sensitization and whether there is an association between sensitivity to both allergens. Method: A retrospective review was made of patients with symptoms of rhinitis. The skin-prick test results and cat ownership status of the patients were analyzed. On the basis of the skin-prick test results with Phleum pratense (timothy grass) and other pollens, the patients were analyzed in two groups: "timothy allergic" and "non-timothy allergic." Results: A total of 383 patients with the diagnosis of rhinitis were included in the study, which comprised 213 (55.6%) in the timothy allergic group and 170 (44.4%) in the non-timothy allergic group. The frequency of cat sensitization was significantly higher in the patients in the timothy allergic group compared with those without timothy grass allergy (33.8% versus 12.3%; p < 0.001). No significant difference was determined between the two groups in terms of cat ownership (p = 0.63). In the logistic regression analysis, cat ownership (adjusted odds ratio [OR] 23.07 [95% confidence interval {CI}, 7.72-68.91]) and timothy allergy (adjusted OR 7.72 [95% CI, 3.16-18.86]) were associated with an increased risk of cat sensitization. Conclusion: Timothy grass allergy may play a role in the development of cat sensitization; however, further research is needed to clarify these associations and the underlying mechanisms.
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Affiliation(s)
- Ozge Can Bostan
- From the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Erdem Cakmak
- Department of Allergy and Clinical Immunology, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey; and
| | - Saltuk Bugra Kaya
- Department of Allergy and Clinical Immunology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Gulseren Tuncay
- From the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ebru Damadoglu
- From the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gul Karakaya
- From the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- From the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
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Duran E, Bostan OC, Bilgin E, Kaya SB, Bolek EC, Ozer S, Damadoğlu E, Bilgen SA, Karakaya G, Karadag O. The clinical features and treatment of eosinophilic granulomatosis with polyangiitis (EGPA) in Turkey: one or two distinct diseases? Intern Emerg Med 2022; 17:743-751. [PMID: 34628561 DOI: 10.1007/s11739-021-02863-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is defined the disease as having two subgroups, ANCA (+) and ANCA (-). We aimed to compare EGPA subgroups in terms of clinical features, outcomes, and treatments. A multidisciplinary team was established under our vasculitis centre since October 2014. Totally 50 EGPA patients were enrolled. Clinical features, treatments, and outcomes (FFS, VDI, relapse) were reviewed. For relapse-free survival analysis, time to first relapse was compared according to ANCA phenotype by Kaplan-Meier survival analysis and log-rank test. 17 (34%) patients were in ANCA (+), 33 (66%) patients were in ANCA (-) group. ANCA (-) patients were significantly younger at the diagnosis time (37.9 ± 14.3 vs 53.8 ± 16.3; p = 0.001) and had more nasal polyposis (45.5% vs 11.8%; p = 0.017). ANCA (+) patients had higher BVAS (17[13] vs 9[4]; p = 0.002), renal involvement and peripheral neuropathy were more common in this group, while cardiac involvement was seen only in ANCA (-) group (n = 3). Biological agents (mepolizumab or rituximab) were prescribed to nine patients in ANCA (-) and two patients in ANCA (+) group. The median duration of follow-up was 47 (IQR 69.9) months. ~ 40% of patients had at least one relapse, but relapse-free survival rate was similar between the groups. However, the predictor of first relapse was elevated Ig E level [OR (95% CI): 6.5 (1.09-38.63) p = 0.04]. Consequently, both clinical features, disease activity, and treatments appear to be significantly different between EGPA subgroups. The relapse risk was similar although clinical features and treatment strategies were different. Also, elevated Ig E levels may be a precursor for the relapse.
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Affiliation(s)
- Emine Duran
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe University Vasculitis Research Centre, Ankara, Turkey
| | - Ozge Can Bostan
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emre Bilgin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe University Vasculitis Research Centre, Ankara, Turkey
| | - Saltuk Bugra Kaya
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ertugrul Cagri Bolek
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe University Vasculitis Research Centre, Ankara, Turkey
| | - Serdar Ozer
- Department of Otolaryngology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoğlu
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sule Apras Bilgen
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe University Vasculitis Research Centre, Ankara, Turkey
| | - Gul Karakaya
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
- Hacettepe University Vasculitis Research Centre, Ankara, Turkey.
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Tuncay G, Cakmak ME, Can Bostan O, Kaya SB, Damadoglu E, Karakaya G, Kalyoncu AF. The course of COVID-19 in patients with severe asthma receiving biological treatment. J Asthma 2021; 59:2174-2180. [PMID: 34669544 DOI: 10.1080/02770903.2021.1996599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In order to decrease the use of systemic corticosteroids and prevent asthma exacerbations, EAACI and GINA made recommendations in favor of severe asthma patients continuing the use of biologicals during the pandemic. However, the course of SARS-CoV-2 infection remains uncertain, especially in patients taking biological therapy for severe asthma. The aim of this study was to demonstrate the clinical course of COVID-19 in severe asthmatic patients receiving biological treatment. METHODS A total of 75 patients under the care of a tertiary level allergy clinic and receiving omalizumab or mepolizumab, which are the approved biologicals for severe asthma in Turkey, were included in the survey between April 1 and December 31, 2020. A questionnaire was administered via a telephone call by one of the treating physicians. RESULTS Of the total patients, 46 (61%) were receiving mepolizumab and 29 (39%) omalizumab. Of the patients, 14 (19%) had COVID-19, 9 (64%) had pneumonia, 4 (29%) were hospitalized. A total of 12 (16%) patients interrupted biological treatments because they did not want to attend hospital for injections during the pandemic. The incidence of COVID-19 was higher in patients who have interrupted biological treatment (p < 0.001). In addition, the risk of having COVID-19 was higher in the ones who have interrupted their biological treatment (Relative risk:2.71; 95% Confidence interval:1.21-6.06). Asthma control was better in patients attending regular injections (p = 0.006). CONCLUSION Severe asthma itself seems to be a risk factor for COVID-19, whether biological treatment has a role in the disease course needs further research.
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Affiliation(s)
- Gülseren Tuncay
- Faculty of Medicine, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Mehmet Erdem Cakmak
- Faculty of Medicine, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Ozge Can Bostan
- Faculty of Medicine, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Saltuk Bugra Kaya
- Faculty of Medicine, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoglu
- Faculty of Medicine, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gül Karakaya
- Faculty of Medicine, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Faculty of Medicine, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
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Can Bostan O, Tuncay G, Damadoglu E, Karakaya G, Kalyoncu AF. Effect of COVID-19 on hereditary angioedema activity and quality of life. Allergy Asthma Proc 2021; 42:403-408. [PMID: 34474710 DOI: 10.2500/aap.2021.42.210066] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: The demonstration that severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) enters the cell via the angiotensin-converting enzyme 2 receptor has raised concerns that, in hereditary angioedema (HAE), a disease characterized by bradykinin-mediated angioedema attacks, coronavirus disease 2019 (COVID-19) may trigger angioedema attacks, increase the frequency and/or severity of attacks, or cause more severe symptoms of COVID-19. Objective: The objective was to evaluate the severity of COVID-19 in patients with HAE, the course of HAE attacks, angioedema activity, and the quality-of-life scores during COVID-19 pandemic. Methods: Patients diagnosed with HAE for at least 6 months were included in the study. The 7-day Angioedema Activity Score and the Angioedema Quality of Life (AE-QoL) Questionnaire were first completed at the onset of the pandemic between March 12 and June 1, 2020, then during SARS-CoV-2 infection, and in the third month after recovering from COVID-19. Results: Ten of 67 patients with HAE (14.9%) were diagnosed with COVID-19. The median (interquartile range) age of the 10 patients diagnosed with COVID-19 was 35.5 years (28.0-55.0 years). Six of the 10 patients (60%) were women. During COVID-19, five of the 10 patients (50%) had no angioedema attack. Two patients with severe HAE experienced a significant increase in angioedema activity during COVID-19 compared with their basal activity scores. The remaining three patients had a similar or lower attack frequency than their basal level. Four (40%) of the 10 patients had a relative increase in their attacks during the convalescence period. There was no statistically significant difference among pre-COVID-19, during COVID-19 and post-COVID-19 periods in function, mood, fear and/or shame, nutrition, and total scores of the AE-QoL Questionnaire although the fear dimension was relatively more affected (p = 0.06). Conclusion: Although the sample size was small, analysis of our data supported that the symptoms of COVID-19 were not more severe in HAE. Also, there was no significant difference in the AE-QoL Questionnaire scores, the frequency, and severity of angioedema attacks during the course of COVID-19 in the patients with HAE.
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Abstract
Objective Obstructive sleep apnea (OSA) is more common in men than in women. In this study, we aimed to address the impact of gender on symptoms and comorbidities in patients with OSA. Materials and Methods This cross-sectional study was conducted among 1,317 consecutive patients, who were admitted to the Sleep Apnea Clinic of the Marmara University Hospital between November 2015 and October 2018, and who completed questionnaires and a sleep study with cardiorespiratory polygraphy. OSA was defined as Apnea Hypopnea Index (AHI) ≥15/hour. Results In all, 1,042 patients (334 women) fulfilled the inclusion criteria. OSA was observed in 589 patients (56.5%). Women were older than men (50.2±12.5 versus 45.6±15.1 years) and had lower AHI (22.1±20.1 versus 26.8±21.9 events/h). In the OSA group, women were older (53.7±11.5 versus 47.8±12.8 years) and more obese (BMI 34.6 versus 31.8 kg/m2). Symptoms were categorized as frequent/very frequent, and women with OSA complained more about daytime fatigue (74.6% versus 63.7%), nocturia (69.7% versus 51.8%), headache in the morning (50.0% versus 28.4%), depressive mood (49.0% versus 19.5%), and restless legs symptoms (43.1% versus 17.2%), than did men (all p values <0.05). Comorbidities were observed more in women than in men (lung disease [25.4% versus 13.7%], hypertension [29.6% versus 15.0%], diabetes [20.3% versus 11.3%], and hypothyroidism [14.0 % versus 4.1%]). In regression analysis, age (OR 1.03, p<0.001), BMI (OR 1.13, p<0.001), and male sex (OR 2.08, p<0.001) were significantly predictive for OSA while history of tonsillectomy was protective (OR 0.48, p=0.033). Conclusion Fatigue, nocturia, headache, depressive mood, restless leg, and comorbidities were observed more in women. OSA-related symptoms develop late and/or the referral of women for diagnostic evaluation of OSA is delayed. Symptoms and comorbidities in women should be evaluated more attentively for earlier referral and diagnosis of OSA.
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Affiliation(s)
- Ozge Can Bostan
- Department of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey.,Department of Pulmonary Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Beyza Akcan
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Cihan Durmus Saydam
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Muhammet Tekin
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Omur Dascı
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Baran Balcan
- Department of Pulmonary Medicine, Marmara University School of Medicine, Istanbul, Turkey
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Can Bostan O, Ozben B, Bayram T, Sayar N, Eryuksel E. The effect of smoking on atrial and ventricular functions in healthy subjects: A speckle tracking echocardiography study. J Clin Ultrasound 2020; 48:462-469. [PMID: 32350877 DOI: 10.1002/jcu.22854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Smoking is a well-known risk factor for coronary artery diseases. It is also associated with nicotine-induced myocardial dysfunction. The aim of this study was to evaluate the right and left atrial and ventricular functions in apparently healthy smokers. METHODS We included consecutively 80 healthy smokers (56 males, mean age:35.5 ± 8.4 years) and 70 healthy nonsmokers (44 males, mean age:33.9 ± 9.5 years). None of the subjects had any additional cardiovascular risk factor other than smoking. The right and left atrial and ventricular functions were assessed by both conventional and speckle tracking echocardiography. RESULTS Although there was no significant difference in left ventricular ejection fraction, the smokers had significantly lower ventricular global longitudinal strain than controls (-19.9 ± 2.0% vs -21.2 ± 1.9%, P < .001 and -18.4 ± 2.1% vs -21.8 ± 2.2%, P < .001, respectively, for the left and right ventricle). Smokers had also lower atrial reservoir and conduit strains: 35.9 ± 11.1% vs 40.2 ± 11.2%, P = .022 and 16.7 ± 6.8% vs 19.4 ± 6.8%, P = .016, respectively, for the left atrium, and 33.0 ± 10.6% vs 37.6 ± 11.2%, P = .011 and 15.2 ± 5.6% vs 18.0 ± 6.3%, P = .004, respectively, for the right atrium). CONCLUSION Even in apparently healthy people with no other cardiovascular risk factors, smoking is associated with impaired atrial and ventricular functions.
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Affiliation(s)
- Ozge Can Bostan
- Department of Chest Diseases and Critical Care, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Beste Ozben
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Tuba Bayram
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Emel Eryuksel
- Department of Chest Diseases and Critical Care, Marmara University Faculty of Medicine, Istanbul, Turkey
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Bostan OC, Cakmak ME, Kaya SB, Celebioglu E, Karakaya G, Kalyoncu AF. Anaphylaxis to lidocaine and cross-reactivity to articaine and prilocaine with tolerance to bupivacaine. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40629-020-00132-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bostan OC, Kocakaya D, Ahiskali R, Cimsit C, Eryuksel E. “Desquamative Interstitial Pneumonia” with Early Diagnosis. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Can Bostan O, Akcan B, Balcan B, Peker Y. Impact of Gender on Symptoms and Comorbidities in Obstructive Sleep Apnea. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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