A New Method of Oral Drug Provocation Testing for Determining Safe Alternatives for Patients with Non-Steroidal Anti-Inflammatory Drug Intolerance: The Triple Test

BACKGROUND

Although some of the non-steroidal anti-inflammatory drugs (NSAIDs) are reported to be safe for NSAID-intolerant patients, they should not be suggested before confirming the safety by single-blind oral drug provocation tests. Various test protocols are used in different allergy centers. The aim of this survey was to find out if testing three drugs a day could be a safe, time-saving and cost-effective method.

METHODS

We have enrolled 84 patients into this survey between September 1, 2002, and July 31, 2004.

RESULTS

Their mean age was 37.3+/-11.0 years; 63 (75%) patients were female. By reliable history, the NSAID most commonly causing intolerance was aspirin (46.4%), and the most common reaction to analgesic intolerance was angioedema (60.7%). Eighty-seven tests were performed with meloxicam, rofecoxib, celecoxib, benzydamine, azapropazone, codeine and paracetamol in various triple combinations. Seventeen of the triple tests were positive, and one of them was suspiciously positive. After repeating these 18 tests with the same analgesics in the same order on 54 separate days, we have determined the responsible analgesics for 14 of the triple tests. There were no reactions when four of the triple tests were repeated on separate days (two of the triple tests demonstrated urticaria and the other two angioedema). Five patients had nausea and vomiting, and 2 had abdominal pain and other dyspeptic complaints during the tests. If we had performed the tests by the classical method, 264 days would have elapsed instead of 148 days (including the extra tests that we have performed after positive triple tests and gastrointestinal symptoms).

CONCLUSION

The triple oral drug provocation testing seems to be a safe, time-/manpower-saving and cost-effective method for determining safe alternatives for NSAID-intolerant patients.

Asthma and allergy in Turkish university students: Two cross-sectional surveys 5 years apart

BACKGROUND

prevalence of asthma and allergic diseases is increasing worldwide. We investigated the first-year university students to a) determine prevalence of asthma, and allergic diseases, b) compare prevalence with a similar study conducted in 1994, and c) investigate determinants of asthma, current wheeze and seasonal rhinitis.

METHODS

an ECRHS based questionnaire was distributed to 5,406 students and completed by 4,639 (response: 85.3 %) in september 1999. Information from the students residing in Turkey was used in the analyses (1,800 boys, 2,712 girls).

RESULTS

prevalence % of asthma (symptom and/or medicine), current wheeze and seasonal rhinitis were 2.1, 6.9 and 12.7 in boys, and 2.5, 7.2 and 14.5 in girls. Current smoking, pet ownership and family atopy was reported more frecuently in 1999 than 1994. Cough and seasonal rhinitis increased almost twofold. Asthma diagnosis and attack rate was similar in 1999 and 1994. Family atopy, pet in childhood, smoking and passive smoking in childhood increased the risk of asthma, and current wheeze. Family atopy, passive smoking and current pet ownership increased the risk of seasonal rhinitis.

CONCLUSION

increased rate of smoking and pet ownership could contribute to the increased prevalence of asthma and allergic diseases in the last 5 years.

Experience of 10 years with Churg-Strauss syndrome: An accompaniment to or a transition from aspirin-induced asthma?

Churg-Strauss syndrome is a rare, idiopathic, eosinophilic vasculitis appearing in concurrence with asthma which is often severe. Aspirin-induced asthma is a special clinical syndrome existing in nearly 10 % of adult asthmatics. After leukotriene antagonists had been marketed there has been marked increase in Churg-Strauss syndrome reports among the patients who had been followed up with asthma. This syndrome seems to be more frequent among the patients with aspirin-induced asthma. The role of leukotriene antagonists on the conversion from aspirin-induced asthma to Churg-Strauss syndrome has aroused attention and been questioned. Here we report 7 cases of Churg-Strauss syndrome where three had aspirin induced asthma which we have diagnosed in the last 10 years and where only one of them seems to be related to antileukotriene drug use.

Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the last 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6-13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months' prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09-2.98 and 1.01-2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13-3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5-year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.

Tuberculosis-associated haemophagocytic syndrome: a report of two cases and a review of the literature

The haemophagocytic syndrome (HS) is an uncommon reactive proliferation of mature histiocytes, and is more frequently but not exclusively associated with infections in individuals with pre-existing immunologic abnormalities. As far as we know, only 13 cases of tuberculosis-associated HS have previously been reported. We present here two cases of disseminated tuberculosis-associated HS. Both of the cases recovered with antituberculosis therapy. High-dose methylprednisolone and intravenous immunoglobulin were added in one case because of the extremely severe clinical presentation. This therapy seemed to contribute to the favourable outcome of the patient. The similarities in HLA phenotypes of this patient and others reported in the literature may provide evidence for an underlying immune dysregulation in some cases of infection-associated HS.

Occult papillary carcinoma of the thyroid presenting as an intratracheal tumour

A case of occult papillary carcinoma of the thyroid presenting as an intratracheal tumor in a 64-year-old woman is reported. No lymph node metastases were observed. The patient had an 11-year history of hoarseness, dyspnea and productive cough, and was found at bronchoscopy to have a large intratracheal tumor occupying half of the lumen. It was histologically a papillary carcinoma with immunoreactivity of thyroglobulin. No primary tumor was found in the thyroid gland. By reviewing the English literature, no similar case was encountered.

Myelodysplastic syndrome in a patient with Werner's syndrome

Werner's syndrome is a relatively rare autosomal recessive disorder characterized by several features generally associated with aging. This syndrome is classified in the group of chromosome instability syndromes and there is an increased incidence of neoplasia. Hematologic malignancies associated with this syndrome are, however, unusual. Herein we report a case of Werner's syndrome with myelodysplastic syndrome, a clonal preleukemic disorder of hemopoietic stem cells. Such an association, to the best of our knowledge, has not been reported in the English literature so far.

Incidental lung adenocarcinoma in a 20-year-old woman with bronchiectasis

A case of lung adenocarcinoma in a 20-year-old woman with bronchiectasis is presented. The patient showed no clinical and radiological findings in regard to the carcinoma. The tumor was discovered incidentally in the parenchyma of the lung specimen resected due to chronic bronchiectasis.

Localised fibrous mesothelioma arising in an intralobar pulmonary sequestration

A localised fibrous mesothelioma arising from an intralobar lung sequestration occurred in a 64 year old Turkish woman. This appears to be the first report of a mesothelioma occurring within a pulmonary sequestration.

Endobronchial tuberculosis. A report on 15 cases

Fifteen patients were diagnosed between 1973 and 1987 at Hacettepe University Hospital as having endobronchial tuberculosis. They were subjected to bronchoscopy because of provisional diagnoses of primary bronchogenic carcinoma in 7 cases, bronchial asthma in 3 cases, tuberculosis in 2 cases and hydatid cyst, foreign body aspiration and bronchiectasis in 1 case each. In those patients in whom the initial clinical diagnosis was primary bronchogenic carcinoma, it was difficult to differentiate endobronchial tuberculosis either by radiography or bronchoscopy.

An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos

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Epidemiological and environmental evidence of the health effects of exposure to erionite fibres: a four-year study in the Cappadocian region of Turkey

An environmental and epidemiological study has been carried out in Central Cappadocia, Turkey, aiming at investigating the relationship between exposure to naturally occurring erionite fibres and the reported high incidence of malignant mesotheliomas. Airborne fibre levels are generally low but show a higher proportion of erionite fibres in the villages affected by malignant disease than in a control village. The same pattern is confirmed by analysis of the fibre content in lung tissues of sheep from several villages, both affected and unaffected by malignant disease. The 3 villages with the highest proportion of erionite fibres have high rates of malignant pleural mesothelioma, malignant peritoneal mesothelioma and lung cancer. No case of malignancy for the same sites has been reported during the study period from the control village. The relationships between these findings and their consistency with the results from experimental studies indicate erionite fibres as a carcinogenic agent, although some aspects of the exposure are not fully clarified.

Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study

This study was designed to determine the prevalence of pleural mesothelioma and other malignancies in the Anatolian village of Tuzköy, where neither asbestos nor any environmental carcinogen has been detected. Another village (Kizilköy) located 12 km from Tuzköy was selected as a control. Three hundred twelve subjects from Tuzköy who were at least 25 yr of age and 95 subjects from Kizilköy were studied. Analysis of X-rays of the Tuzköy group revealed that subjects had calcified pleural plaques (17%), pleural thickening (10.5%), obscured costophrenic angles (15%), and diffuse interstitial pulmonary fibrosis (12.1%). Sixty-seven deaths were records in Tuzköy during the previous 3 yr, 41 of which resulted from malignant diseases. There were no X-ray abnormalities or deaths resulting from malignancies in the control group. Because of the high incidence of mesothelioma and lung cancer which usually results from asbestos exposure, the presence of asbestos in Tuzköy was investigated, but none was detected in spite to Tuzköy's volcanic location. Nevertheless, zeolite, an asbestiform mineral, was detected in the stones of buildings and in the village soil, as well as in the lung and pleura of the patients during biopsy. Thus, this mineral was considered to be responsible for the fiber-induced pleuro-pulmonary diseases in Tuzköy. No zeolite was found in the soil and stones of the control village.

Malignant mesothelioma and radiological chest abnormalities in two villages in Central Turkey. An epidemiological and environmental investigation

A comparative epidemiological and environmental study in two neighbouring villages, Karain and Karlin, in Central Turkey showed an excess adult mortality, shortening of life expectancy, and an excess of pleural radiological abnormalities in Karain. This supports an earlier report of an endemic of pleural mesothelioma in the village. Concentrations of airborne respirable fibres were uniformly very low in Karlik and higher in some of the air samples from Karain, the fibres being similar in composition to those of erionite-a mineral of the zeolite family and the major contributor to the Karain clouds. This is compatible with the hypothesis of a causal association between endemic mesothelioma and inhalation of erionite fibres, but the fibre concentrations in all samples are so low as to leave in question the aetiological role of erionite. In addition to their local importance these results may have relevance for the wider scientific and public-health issue of long-term inhalation of mineral fibres at low concentrations.

[Occurrence of pleural mesothelioma. Chronic fibrosing pleurisy and calcified pleural plaques in Turkey in relation with environmental pollution by mineral fibers (author's transl)]

The incidence of pleural mesothelioma (PM), chronic fibrosing pleurisy (CFP) and calcified pleural plaques (CPP) has been studied in Anatolia (Turkey) in relation with environmental pollution by mineral fibers: 1) In central Anatolia, where asbestos deposits have been described, the frequency of CFP and CPP was in the range 2-25%; several cases of PM have been encountered. 2) One area (Cappadoce) is free of asbestos, but contains another kind of mineral fiber: zeolite. In this area, an outbreak of PM has been described in some villages. Among the 600 inhabitants of Karain, 28 cases of PM occurred for the period January 1975-June 1979.

Malignant mesotheliomas in a small village in the Anatolian region of Turkey: an epidemiologic study

An epidemiologic and cause-related study was done in Tuzköy, a small village in the city of Nevşehir, in the Anatolian region of Turkey. The neighboring village of Kizilböy was used as a control. People 25 years of age or older were studied: 312 persons (145 males and 167 females) from Tuzköy and 95 persons (45 males and 50 females) from the control village. The annual incidence of malignant pleural mesothelioma (MPM) was found to be 6.5 cases (22 cases per 10,000 people) in Tuzköy. Several other respiratory disorders were detected as well. Although no type of asbestos could be found in Tuzköy and its vicinity, the asbestiform mineral zeolite was found in soil samples from the roads and fields of Tuzköy, in its building stones, and in lung tissues of the villagers. Chest X-rays revealed no cases of MPM or other respiratory abnormalities in the control group. No zeolite could be found in the control village. Therefore, zeolite was thought to be the cause of MPM and the other respiratory disorders in Tuzköy.

[Drug fever due to isoniazid]

Drug fever is an uncommon manifestation of isoniazid intolerance. A patient with tuberculous peritonitis is presented with a diagnostic problem, because of continuous and spiking fever, while she was on isoniazid. The fever disappeared after discontinuation of the drug. For confirmation of the drug fever, isoniazid was given on two occasions. Fever respond was demonstrated on rechallenge. This case calls attention to uncommon adverse reaction of isoniazid in patients who are treated with isoniazid.

Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease

Forty-four patients with airway obstruction and 18 with pulmonary infiltration were studied in an attempt to correlate exercise tolerance, as assessed by a simple walking test, with basic respiratory function values and differing subjective assessments of exercise performance. The distance walked in 12 minutes was significantly correlated with the response to a structured questionnaire and with the patients' assessment of performance using an oxygen-cost diagram. The distance walked did not agree well with simple subjective estimates obtained in the clinical history. It was better correlated with forced vital capacity than with forced expiratory volume in one second in both groups of patients, and was well correlated with carbon monoxide transfer factor in those with pulmonary infiltration. The scatter of results, however, was such that exercise performance could not usefully be predicted from the respiratory function values or from subjective assessments. Simple exercise tests are an essential part of assessing disability and response to treatment in patients with respiratory impairment.