OBJECTIVE: Rhinitis is a common upper airway disorder, classified as either allergic rhinitis (AR) or non-allergic rhinitis (NAR). While the association between air pollution and AR airway diseases has been well documented, its specific effects on NAR remain poorly understood. This study aimed to evaluate the seasonal impact of air pollution on pulmonary function, oxidative stress biomarkers, and bronchial hyperresponsiveness in patients with AR, patients with NAR, and healthy controls. MATERIAL AND METHODS: In this prospective case-control study, 58 participants (23 AR, 22 NAR, 13 controls) were evaluated during periods of low pollution (summer) and high pollution (winter). Assessments included symptom questionnaires, pulmonary function tests, bronchial provocation tests (BPT), serum total antioxidant status (TAS), and total oxidative status. RESULTS: In the high pollution period, the NAR group exhibited significantly lower TAS levels compared to summer (1.51±0.15, 1.60±0.2, P = 0.041), indicating an increased oxidative stress. A significant decrease in post-bronchodilator forced expiratory volume in 1 second (FEV)1 was also observed in the NAR group, suggesting heightened airway reactivity. The AR group demonstrated a higher frequency of BPT reactivity. Pulmonary function declined across all groups in winter, with the greatest reduction observed in AR patients. Within-group analyses revealed seasonal reductions in both FEV1 and post-BPT FEV1 in AR and NAR groups. CONCLUSION: Seasonal air pollution exerts phenotype-specific effects on oxidative stress and airway reactivity in rhinitis. AR patients exhibited increased bronchial hyperresponsiveness, whereas NAR individuals showed a marked decline in antioxidant capacity. These findings highlight the importance of phenotype-based monitoring and management during periods of high environmental exposure.

Background: Chronic urticaria (CU) is characterized by recurrent wheals and/or angioedema persisting for more than six weeks. While disease triggers are often unidentified, seasonal and environmental factors may modulate disease activity; however, evidence regarding their clinical impact remains limited. Objective: This study aimed to evaluate the effects of seasonal, meteorological, and pollutant-specific environmental factors on urticaria control using the Urticaria Control Test (UCT), and to compare these effects between chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIU) in relation to inflammatory serum biomarkers. Materials and Methods: This prospective observational study was conducted at the Allergy and Clinical Immunology outpatient clinic of Kirikkale University Faculty of Medicine between 1 June 2023 and 1 April 2024. Patients with CU were classified as CSU or CIU according to international guidelines. Each participant was evaluated during summer and winter seasons. Area-level air pollution data and meteorological parameters were obtained from national monitoring systems. Disease control was assessed using the UCT, and inflammatory biomarkers were analyzed. Results: Urticaria control showed significant seasonal variation, with lower UCT scores during summer and higher scores during winter in both CSU and CIU patients. Among environmental factors, ozone (O3) was the only pollutant consistently associated with poorer urticaria control, whereas particulate matter and traffic-related pollutants, despite being higher in winter, showed no clinically relevant association. Summer months were characterized by increased inflammatory activity, including elevated leukocyte counts, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and D-dimer levels, particularly in CSU patients. D-dimer emerged as an independent marker associated with poor disease control during summer. Conclusions: CU demonstrates marked seasonal variation, with disease worsening during summer months. Pollutant-specific effects, particularly O3 exposure, rather than overall air pollution burden, appear to be clinically relevant in urticaria control. Inflammatory and coagulation-related biomarkers may provide additional insight into disease activity. These findings support a season-aware and individualized management approach and highlight the need for future studies incorporating individual-level exposure assessment and biomarker-guided strategies.

Montelukast, a leukotriene receptor antagonist (LTRA) approved for the treatment of asthma and allergic rhinitis, is widely used, though real-world data on its application in asthma management remain limited. This registry-based study evaluated the use of montelukast in adult asthma patients, examining demographic and disease characteristics, asthma control status, asthma phenotypes, presence of atopy, and treatment regimens. Among 2053 patients analyzed, 61.76% (n = 1268; mean age: 46.2 ± 14.3 years), predominantly females (~76%), received montelukast. Montelukast users showed higher rates of allergic rhinitis (P < 0.001), hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (P = 0.008), and chronic rhinosinusitis (P = 0.008). Montelukast group also had higher atopy and total IgE levels and tended to be more eosinophilic. Montelukast was commonly preferred in allergic, eosinophilic, NSAID-exacerbated respiratory disease, and severe asthma phenotypes (P < 0.001). Patients receiving Steps 4 and 5 treatments are more likely to be prescribed montelukast (P < 0.001). Montelukast usage was higher among patients with uncontrolled asthma [ACT< 20 (OR:1.29, 95%CI:1.052–1.582, P = 0.014)]. In addition, logistic regression analyses identified the main factors associated with increased montelukast use as; female gender (OR:1.33, 95%CI:1.041–1.713, P = 0.02), presence of atopy (OR:1.46, 95%CI:1.157–1.864, P = 0.002), comorbid allergic rhinitis (OR:2.12, 95%CI:1.679–2.293, P < 0.001), and severe asthma (OR:2.18, 95%CI:1.712–2.784, P < 0.001). These findings reveal that montelukast use is prevalent among asthma patients, particularly in females, middle-aged adults, and those with comorbid allergic rhinitis, uncontrolled asthma, or specific asthma phenotypes, underscoring the factors that influence its prescription in asthma management.

Objective: The obese-asthma phenotype has gradually increased in the last few years. We aimed to assess the differences between obese and non-obese patients with asthma. Methods: This research is a subanalysis of the Turkish Adult Asthma Registry (TAAR). Clinical presentation, disease control, severity, and demographics of obese and non-obese (normal-weight, overweight) patients were compared. Results: The obesity rate in TAAR was 32.2% (n=619/1919; 18-83years; 527F/92 M). Patients with asthma and obesity had higher rates of childhood obesity, longer symptom duration, later onset of asthma, and more severe asthma. These patients were more likely to be female, older, less educated, and live in rural areas. Patients with obesity had more scheduled visits and emergency visits compared with non-obese patients, but similar asthma control, oral corticosteroid use, hospitalizations, intensive care unit admissions, and unscheduled visits. They also had a higher frequency of T2-high but lower frequency of possible T2-low phenotypes compared with normal-weight asthmatics. The risk of severe asthma in patients with obesity was 6.04 times higher for allergic than non-allergic patients and 3.58 times higher for the T2-high phenotype than for possible T2-low phenotypes. A one-unit increase in the asthma control test reduced the risk of severe asthma by 22%. Conclusions: A good definition of this phenotype is important to ensure that appropriate treatment strategies are implemented to achieve the control goal. We also believe that prevention of childhood obesity is an effective and pivotal strategy to achieve the goal of asthma control.

OBJECTIVE:Risk factors associated with asthma symptom control is crucial for disease management. This study aimed to determine the risk factors of patients with uncontrolled asthma and to examine the relationship with their geographical patterns. METHODS:This cross-sectional study was conducted at 36 centers across Turkey. Future risk factors (FRFs) such as exposure to triggers/allergens and inadequate or poor inhalation technique, etc., were identified based on the Global Initiative for Asthma (GINA) guidelines. The associations between FRFs and demographic and clinical characteristics, geographical regions, and levels of asthma control were analyzed. RESULTS:The study included 2,053 adult asthma patients. At least one FRF was identified in 1576(76.8%) patients. The most common FRFs were exposure to allergens/triggers (n: 664; 32.3%), impaired asthma symptom control (n: 540; 26.3%), and eosinophilia (n: 526; 25.6%). Regarding regional differences, the most prevalent FRFs in the Marmara region were exposure to allergens/triggers and frequent use of short-acting beta-2 agonists (>3 boxes/year). In contrast, eosinophilia was more common in the Southeastern region, while inadequate or poor inhalation technique, noncompliance with treatment, and psychosocial or socioeconomic problems were more frequently observed in the Eastern Anatolia region. Asthma control was achieved in 79.5% of patients without any FRFs; however, this rate decreased significantly to 25% among patients with more than four FRFs. CONCLUSIONS:This study demonstrates that FRFs in asthma vary according to demographic and disease characteristics, as well as geographical distribution. An increased number of FRFs was associated with asthma control. However, an individualized approach remains essential for achieving optimal asthma management.

Allergies to vegetables and fruits develop as a primary sensitization to pollen allergens followed by cross-reactive secondary sensitization to foods or as a direct sensitization to foods via the gastrointestinal tract. Although much focus has been placed on food hypersensitivity reactions following oral ingestion, reactions resulting from skin contact and inhalation are slowly gaining attention. A 34-year-old female patient, who had no known history of chronic disease and was a teacher by profession, applied to our outpatient clinic with airway symptoms (dyspnea and cough) triggered by apple odor for 5 years. In our test room, where there are equipment that can intervene in a possible anaphylaxis, the patient was provoked with the smell of an apple. The patient was made to smell the apple cut in half for 10 seconds. The patient developed a dry cough that started as mild and then gradually became more severe, and mild urticarial lesions on the anterior chest wall. The patient was diagnosed with inhalation fruit hypersensitivity. An epinephrine auto-injectorwas prescribed and an IKS-LABA dry powder inhaler was prescribed for use when necessary. She was told to stay away from apples.

AbstractBackgroundAsthma is one of the most common causes of chronic respiratory disease, and countries with low socioeconomic status have both a high prevalence of asthma and asthma‐related death.ObjectiveIn this study, we aimed to determine socioeconomic levels of asthmatic patients according to a national database and investigate the effects of social markers on disease control in our region.MethodsThis is an analysis of data from 2053 adult asthma patients from a multicentre chart study in Turkey. Socioeconomic status (SES) data were collected from questionnaires and this form was sent to the patients via e‐mail. Parameters related to social status and poor disease control were analyzed.ResultsIlliteracy (OR:2.687 [95% CI: 1.235–5.848]; p = 0.013) and lower household income (OR:1,76 [95% CI: 1.002–3.09]; p = 0.049) were found as independent risk factors for hospitalization in the multivariate logistic regression analysis. Therewithal, being aged between 40 and 60 (OR: 1.435 [95% CI: 1.074–1.917]; p = 0.015), illiteracy (OR: 2.188 [95% CI: 1.262–3.795]; p = 0.005) and being employed (OR: 1.466 [95% CI: 1.085–1.847]; p = 0.011) were considered as independent risk factors for systemic corticosteroid use at least 3 days within last 1 year.ConclusionAs a result of our national database, education level, household income and working status briefly socioeconomic status have impacts on asthma control. Identification of social markers in asthma and better recognition of risk factors based on the population gives us clues to provide better asthma control in the future.

Aims: Tryptase is a serine protease released from mast cells during an acute allergic reaction. Levels of serum tryptase vary among healthy individuals, and there has been a growing debate about the normal and abnormal ranges of tryptase depending on the numbers of mast cells, basal secretion rate, and renal function. To adress this point, serum tryptase levels were analysed in subjects with a prediagnosis or absolute diagnosis of anaphylaxis. Methods: This was a retrospective, one-centered study performed in a Tertiary Hospital in Turkey. Patient recruiment criteria was that files of patients with tryptase levels between 2020 and 2023 were evaluated detailly. Serum tryptase levels that is moment at reaction (RT) and as basal (BT) were analyzed with the same method with ImmunoCAP (Pharmacia, Uppsala, Sweden). The age, gender and reasons for admission of the patients were examined one by one. Results: Out of approximately 400 test entries, there were valid results of 300. A ratio of 62% of the patients were female (n: 186) and 38% were male (n: 114). The mean age was 18-89 (41.5±14.7)/year. Serum levels of tryptase was measured at the time of reaction in 12.7% of the patients, 4.3% had both reaction and baseline tryptase levels, and the rest had only baseline tryptase analyses. A statistically significant difference was found between the tryptase levels during the reaction in males and females (p: 0.02, Female/Male: 7.26±4.91/16.93±11.11 µg/L). We found that approximately 90.3% of the patients had serum tryptase levels lower than 11.5 µg/L. There was a statistically significant difference between reaction time (RT) and baseline tryptase (BT) in drug-induced hypersensitivity reactions (p: 0.02), but no difference was found in venom hypersensitivity reactions (p: 0.47). There was no correlation between age and tryptase during reaction, but a positive correlation was found between baseline tryptase (p: 0.01 r: 0.162). Conclusion: There may be many reasons for high serum tryptase levels. For doctors, it is important to quickly recognize anaphylaxis and manage the treatment process quickly. In this study, we reviewed all tryptase results retrospectively and addressed the etiology of the cases we encountered in our center. We showed that age is a baseline variable in determining tryptase levels. Tryptase can be used as a useful biomarker in diagnosis.

Current guidelines recommend adding long-acting muscarinic antagonists (LAMAs) in patients with uncontrolled asthma, despite the use of moderate to high doses of inhaled steroid-long-acting beta agonists (ICS/LABA). This study aims to analyze the factors related to the prescription of add-on LAMA in clinical practice for asthma patients, shedding light on physicians’ preferences.This study included adult asthma patients on add-on LAMA and ICS/LABA monitored for at least one year in a national registry comprising 2053 asthmatics. Patients’ characteristics and disease profiles were analyzed to identify factors associated with the prescription of add-on LAMA across the entire cohort. A comparative analysis was performed among three groups: MART (ICS/formoterol as a maintenance and reliever therapy) plus LAMA, Conventional (ICS/LABA as a maintenance and short-acting beta agonist as reliever) plus LAMA and Triple (ICS/LABA/LAMA single inhaler).LAMAs were added to ICS/LABA in 11.7% of patients in the national registry. Logistic regression analysis revealed that older age, low FEV1 (%), Asthma Control Test (ACT) scores less than 20, and severe exacerbation were the main factors influencing the initiation of LAMA in our registry. However, demographic characteristics of asthma, control status, pulmonary function test results were similar among the three groups of LAMA users (p>0.05). Physicians used LAMAs without phenotyping based on allergic status or eosinophil levels (p>0.05). Mepolizumab was added after LAMA in all patients, while omalizumab was initiated before LAMA in 16.9% of the patients receiving LAMA along with biologics.Add-on LAMAs were predominantly prescribed for older, uncontrolled, and exacerbated asthma patients with low FEV1.

BackgroundMicroplastics are increasingly prevalent in daily life. While their adverse effects on health are well-known, their specific role in rhinitis has not been fully established.ObjectiveIt is known that microplastics suspended in the air have toxic effects on cells through inhalation. The primary aim of this study was to investigate the presence of microplastics in nasal lavage samples from patients in both allergic rhinitis (AR) and nonallergic rhinitis (NAR) groups.MethodsDemographic data, allergy test results, respiratory function tests, mini-Rhinoconjunctivitis Quality of Life Questionnaire and Total Nasal Symptom Score of patients aged 18 to 65 years who applied to the allergy clinic were recorded. Nasal lavage fluid (NLF) samples were collected with physiological serum and placed in glass tubes for all cases. After the filtration process of the samples, microplastic counting was performed under a Stereomicroscope.ResultsA total of 90 subjects (AR: 30, NAR: 30, controls: 30), 64.4% females, within the mean age of 30.27 ± 10.53 years were investigated. Microplastic density in NLF was higher in all rhinitis patients (n: 60) with no difference between AR and NAR than controls (all rhinitis = 3.10 ± 1.00 particles/mL, AR = 3.23 ± 1.29 particles/mL, NAR = 2.97 ± 0.57 particles/mL, controls = 1.18 ± 0.52 particles/mL, P < .001). Microplastic density was higher in young subjects than in older ones (values are "years; particles/mL"; 18-30; 2.79 ± 1.22, 31-45; 2.18 ± 1.13, 46-60; 1.5 ± 1.09, P < .05). In logistic procedures, microplastic density of NLF (OR = 2.20, 95% CI [1.02 to 4.75], P = .04) determine the likelihood of sneezing.ConclusionsIn this study, regardless of allergy or nonallergy, higher microplastic density was found in NLF of rhinitis patients than healthy individuals. We also found quantifiable and noteworthy concentrations of microplastics in the nasal lavage of control group. These results support the idea that microplastics cause inflammation in the upper airways.

BackgroundUp to 30% of chronic spontaneous urticaria (CSU) patients and 24% of children with CSU may have an NSAIDs-exacerbated cutaneous disease (NECD). Some vegetables and fruits are rich in salicylate. Salicylates in food can exacerbate symptoms in CSU patients.AimOur aim is to investigate the effect of a low salicylate diet on urticaria severity, quality of life, blood salicylate level and urine arachidonic acid pathway metabolites.MethodsPatients followed a fourweek low salicylate diet. Chronic urticaria quality of life questionnaire (CU-Q2oL) and 4 Days-Urticaria Activity Scores (UAS4) were recorded and blood and urine samples were collected at baseline and after the low salicylate diet. Urine Leukotriene-E4, Prostaglandin-E2, Prostaglandin-F2α, Thromboxane-A2, and creatinine levels were measured via ELISA. Blood salicylate level was determined by LC-MS/MS.ResultsA total of 36 CSU patients were included in the study. The CU-Q2oL scores significantly decreased from 33.7 to 20.7 (p < 0.001) and the UAS4 significantly decreased from 14 to 8 (p < 0.001) after low salicylate diet when compared to baseline (low scores mean less complaints). The blood salicylate level was significantly lower after the low salicylate diet compared to the baseline (p = 0.042). However, there was no significant effect of the diet on urinary LTE4, PGDE2, PGDF2α and TXA2 levels.ConclusionOur findings suggest that a low salicylate diet may help to reduce the severity of urticaria and improve quality of life by lowering blood salicylate levels. However, the diet had no impact on urinary LTE4, PGDE2, PGDF2α, and TXA2 levels.

Objectives It is aimed to assess how physicians use chest imaging in asthma and the relationship between the pathological findings and related disease characteristics in the radiological imaging of asthmatic patients. Background The daily practice of imaging and its contribution to the management of asthma are not well defined. It is common to use radiological imaging to investigate pathologies that cause respiratory symptoms and to evaluate differential diagnoses in asthma patients. In this study, as a subanalysis of the Turkish Adult Asthma Registry, radiological findings and outcomes of asthmatic patients were examined. Methods Between March 2018 and March 2022, the data of asthma patients in 36 secondary and tertiary health care centers was recorded using a web-based application. Patients with chest X-ray, computed thorax tomography, and paranasal sinus tomography data in the asthma database were statistically evaluated for sub-analysis. Results The study included 2053 patients. Chest X-rays were taken in the majority of the cases (n:1739; 84.7%). Computed thorax tomography was performed in 869 (42.3%) patients and paranasal sinus tomography in 388 (18.9%) patients. The most common pathological findings on chest X-rays of asthmatic patients were increased bronchovascular branching and dirty lung appearance, whereas they were linear atelectasis, and bronchial wall thickening on computed thorax tomography bronchiectasis. Soft tissue in the sinuses and nasal polyps were the most common pathological findings in paranasal sinus tomography. Pathological findings were much more common in the radiological evaluations of patients with eosinophilic and allergic phenotypes and in patients with severe asthma. Conclusion The radiological findings of asthma vary depending on the phenotype and severity of the disease. Patients with asthma, particularly those in the high-risk group, should be evaluated from a radiological perspective.

INTRODUCTION:Considerable overlaps exist between asthma phenotypes and the clinical significance of these overlaps remains undetermined. The objective of this study is to analyze the characteristics of asthma overlap phenotypes using data from the Turkish Adult Asthma Registry (TAAR). METHODS:This cross-sectional registry study included 2053 adult patients (74.8% female) with asthma. RESULTS:Overall, 39.3% (n = 697) had allergic-eosinophilic (AE), 26.0% (n = 461) had allergic-non-eosinophilic (ANE), 21.3% (n = 377) had non-allergic-eosinophilic (NAE), and 13.4% (n = 237) had non-allergic-non-eosinophilic (NANE) asthma. Severe asthma exacerbations and emergency department (ED) visits were more frequent in the AE (28.3%, 31.2%, respectively) and NAE groups (36.0%, 34.0%, respectively) than in the ANE (14.3%, 20.6%, respectively) and NANE groups (12.6%, 16.7%, respectively) (p < 0.001). FEV1 values were significantly lower in the AE group than in the ANE and NANE groups (p < 0.001, p = 0.048, respectively) and in the NAE group than in the ANE group (p < 0.001). Risk factors for poor asthma control included living in rural areas, asthma-related ED visits, FEV1 < 60% in the NAE; being overweight, chronic rhinosinusitis, oral corticosteroids use, age < 40 years in the NANE; FEV1 < 80% in the AE; and severe asthma exacerbations, ED visits for AE and ANE groups. CONCLUSION:The considerable overlap between allergic and eosinophilic asthma phenotypes has clinical implications as increased rates of asthma exacerbations and healthcare utilization. The clinical heterogeneity among asthma phenotypes based on a single biomarker highlights the importance of multidimensional asthma phenotyping.

Severe asthma (SA) is defined as asthma that is uncontrolled under high-dose ICS+LABA treatment or can only be controlled with this high-dose treatment, with a differential diagnosis from difficult asthma. It has been known that severe asthmatics with poor symptom control were reported as 3.7% (range between 3.6-6.1%). Although SA constitutes a very small proportion of all asthmatics, it causes a significant social and psychological burden on patients and on social reimbursement systems. The Turkish Severe Asthma Program (TSAP) was established by stakeholders that include the Turkish National Society of Allergy and Clinical Immunology (TNSACI), representatives from national severe asthma centers, and those from the pharmaceutical industry to develop standards to diagnose and treat patients with SA and to monitor their treatments at the national level. Here we present the TSAP organization and vision.

ObjectiveThe older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey.MethodsThe data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire.ResultsOf the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma.ConclusionsHerein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors.

Background: Rhinitis affects the majority of the population. It may generate localized nasal mucosal inflammation via allergic (AR) or nonallergic (NAR) processes, but it is unknown if this might also result in systemic inflammation, which can raise morbidity and death. Using current serum inflammatory markers, we sought to investigate systemic inflammation in patients with chronic rhinitis. Methods: In this retrospective case-control study, we included 439 patients with newly diagnosed AR (n = 179), NAR (n = 157), and 103 healthy individuals. Inflammation-related blood parameters were collected as lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), eosinophil/neutrophil ratio (ELR), and systemic immune inflammation index (SII). Results: All groups were similar in terms of age, gender, and body mass index. Neutrophil counts were significantly higher both in AR and NAR groups compared to controls (4.51 ± 0.09, 4.54 ± 0.1 vs. 3.73 ± 0.1, p < 0.001). NLR (1.91 ± 0.56, 1.89 ± 0.61, 1.61 ± 0.59, p < 0.001), LMR (5.76 ± 0.17, 5.93 ± 0.17, 5.1 ± 0.15, p = 0.005), ELR (0.1335 ± 0.007, 0.0999 ± 0.006, 0.12 ± 0.009, p = 0.003), SII (533.3 ± 16.6, 558.1 ± 20.9, 479.9 ± 22.2, p = 0.035), and CRP (1.44 ± 0.09, 1.67 ± 0.09, 0.87 ± 0.04, p < 0.001) were significantly higher in AR and NAR groups than the controls, respectively. SII (r = 0.146, p = 0.007) and ELR (r = 0.254, p < 0.001) were correlated with the presence of asthma. Conclusion: We found that systemic circulation of inflammatory cells was significantly increased in rhinitis with/without allergy compared to the control group. This study showed that not only AR, but also NAR triggers a systemic increase of inflammation which supports the link between rhinitis and comorbid conditions such as asthma. Therefore, effective treatment may be suggested for local inflammation and its systemic manifestations. Cite this as Yalim SA, Kalpaklıoglu AF, Baccıoglu A, Poyraz M, Alpagat G, Dumanoglu B. Evaluation of systemic inflammation markers in patients with rhinitis. Allergo J Int 2024;33: 24-31 https://doi.org/10.1007/s40629-023-00277-2

β-Lactams, particularly penicillins, may cause several allergic reactions. We described symmetric drug-related intertriginous and flexural exanthema (SDRIFE) illness in this case, a rare instance of systemic contact dermatitis caused by amoxicillin/clavulanic acid that needs to be considered in the differential diagnosis. A 65-year-old male patient was admitted to our Allergy Outpatient Clinic because of increased blue-purple pigmentation on the flexural surfaces of the hip, forearm, axilla, and posterior face of the neck. The patient was receiving a combination of angiotensin receptor blocker (ARB) and hydrochlorothiazide diuretic medication for hypertension. The patient used an antibiotic containing amoxicillin three months ago; As a result, there was localized redness, itching, and black spotting without any systemic symptoms. Similarly, the patient reported that when he used amoxicillin for an upper respiratory tract infection eight months ago, he experienced similar side effects within 20 days and recovered when he applied corticosteroid ointment. Due to the symmetrical site involvement following the consumption of penicillin group antibiotics with a five-month gap and subsequent comparable reactions in our patient, SDRIFE was taken into consideration. The results of the skin punch biopsy identified Baboon Syndrome (SDRIFE). Treatment with topical corticosteroids and antihistamines began. Clinically speaking, SDRIFE is distinguished by significant erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area, symmetric involvement of at least one other intertriginous or flexural area, and the absence of systemic signs or symptoms. The possibility that the medication may have contributed to the patient's erythematous eruption in the flexural regions should be taken into account, and the patient should be advised to stop taking the medication and not use it again.

The COVID-19 pandemic has affected people worldwide with varying clinical presentations ranging from mild to severe or fatal, and studies have found that age, gender, and some comorbidities can influence the severity of the disease. It would be valuable to have genetic markers that might help predict the likely outcome of infection. For this objective, genes encoding VEGFR-2 (rs1870377), CCR5Δ32 (rs333), and TLR3 (rs5743313) were analyzed for polymorphisms in the peripheral blood of 160 COVID-19 patients before COVID-19 vaccine was available in Türkiye. We observed that possession of the VEGFR-2 rs1870377 mutant allele increased the risk of severe/moderate disease in females and subjects ≥65 years of age, but was protective in males <65 years of age. Other significant results were that the CCR5Δ32 allele was protective against severe disease in subjects ≥65 years of age, while TLR3 rs5743313 polymorphism was found to be protective against severe/moderate illness in males <65 years of age. The VEGFR-2 rs1870377 mutant allele was a risk factor for severe/moderate disease, particularly in females over the age of 65. These findings suggest that genetic polymorphisms have an age- and sex-dependent influence on the severity of COVID-19, and the VEGFR-2 rs1870377 mutant allele could be a potential predictor of disease severity.