Chronic spontaneous urticaria (CSU) is a heterogeneous disease with incompletely defined immunological endotypes. Staphylococcus aureus enterotoxins have been implicated in disease pathogenesis, but their clinical relevance remains unclear. In this prospective study, we evaluated IgE sensitization to staphylococcal enterotoxins (SEA, SEB) in 91 CSU patients and 29 healthy controls, and investigated its association with clinical and immunological features. Enterotoxin-specific IgE sensitization was detected in 24.2% of CSU patients and in none of the controls. Sensitized patients exhibited significantly higher total IgE levels, eosinophil and basophil counts, consistent with a type-2 inflammatory profile. Sensitization was predominantly observed in the allergic phenotype and was least frequent in the autoimmune phenotype. Total IgE demonstrated acceptable discriminatory performance for predicting sensitization (AUC = 0.833), with an optimal cutoff of 134.5 IU/mL. In multivariable analysis, log-transformed total IgE independently predicted sensitization. These findings suggest that enterotoxin-specific IgE may serve as a marker of a microbial-associated type-2 inflammatory endotype in CSU. Importantly, total IgE may serve as a simple and clinically accessible surrogate biomarker to support biomarker-based patient stratification, although prospective validation in independent cohorts is warranted.

OBJECTIVE:Emerging evidence suggests that immune dysregulation may play a key role in the pathophysiology of psychosis. However, longitudinal studies integrating both innate and adaptive immune components in the same sample remain scarce. This study aimed to examine a broad spectrum of immunological parameters in first-episode psychosis (FEP) patients, both at onset and after treatment, in comparison to healthy controls. METHODS:Thirty-two minimally treated FEP patients (no lifetime psychotropic exposure >1 month) and 26 healthy controls were assessed at baseline. 20 patients completed a follow-up approximately one year later. Immunological markers – including complete blood count (leukocyte, neutrophil, lymphocyte, monocyte), C-reactive protein (CRP), SAA, complement components (C3, C4), and immunoglobulins (IgG, IgA, IgM, IgE) – were measured at both time points. First-episode psychosis was confirmed using SCID (DSM-IV). Symptom severity was evaluated using PANSS and BPRS. ROC and logistic regression analyses were performed to assess predictive value. RESULTS:Neutrophil, monocyte, C3, C4 levels and neutrophil-to-lymphocyte ratio (NLR) were significantly elevated in patients at both time points, with no change over time. CRP was elevated at T1 but normalised at follow-up. In contrast, immunoglobulin levels showed temporal and dimensional associations with symptom severity. NLR was correlated with negative symptoms during the acute phase, while IgG was associated with positive symptoms during remission. Elevated NLR and C4 predicted patient status in logistic regression analysis. CONCLUSION:This longitudinal study provides a system-level immunological profile across illness phases in FEP. The findings underscore distinct and dynamic contributions of innate and adaptive immunity to the onset and progression of psychosis.

Background:Biologic agents are widely used in clinical practice, but hypersensitivity reactions (HSRs) may limit their use. Rapid drug desensitization (RDD) allows patients to safely continue essential therapy by inducing temporary tolerance, but evidence on newer biologics such as daratumumab, brentuximab vedotin, and pertuzumab remains scarce. Methods:We retrospectively reviewed 11 patients who underwent RDD for biologic-induced HSRs between 2020 and 2024 at a tertiary allergy center. Each protocol was jointly designed by an experienced allergist and clinical pharmacist and carried out in the intensive care unit under close nurse and physician supervision. Demographic, clinical, and laboratory data, reaction grades, skin test results, premedication regimens, and breakthrough reactions (BTRs) were analyzed. Results:A total of 43 RDD cycles were performed for rituximab (n = 18), brentuximab vedotin (n = 13), daratumumab (n = 9), and pertuzumab (n = 3). Six patients underwent skin testing, two with positive results. Four patients (36%) experienced only mild cutaneous BTRs during their first RDD cycle, and no severe events occurred. The overall BTR rate per cycle was 9.3%. Extending premedication to more than 24 hours before desensitization reduced BTR frequency from 17% to 4%. Conclusion:RDD proved to be a safe and effective approach for managing HSRs to both common and less frequently used biologic agents. All patients completed treatment without discontinuation. Extended premedication period, multidisciplinary planning, and intensive care unit-based monitoring appear to enhance procedural safety and support the broader implementation of RDD in clinical allergy practice.

Objective: Nitroimidazoles, particularly metronidazole and ornidazole, are widely used in the treatment of anaerobic and protozoal infections. Although generally well tolerated, hypersensitivity reactions (HSRs) to nitroimidazoles have been increasingly recognized and may significantly limit antimicrobial options. The diagnosis of HSRs is often challenging due to overlapping clinical presentations, concomitant drug exposures, and the limited sensitivity of available diagnostic tests. This study aimed to characterize the clinical features, diagnostic methods, and causality assessment outcomes in patients evaluated for suspected nitroimidazole hypersensitivity. Materials and Methods: Among 1,570 patients tested for drug allergy between January 2019 and October 2025, 30 for whom diagnostic testing with nitroimidazoles was planned were included. Demographic data, clinical characteristics, and laboratory findings were systematically reviewed. Diagnostic procedures included skin prick testing (SPT), intradermal testing (IDT), and drug provocation testing (DPT). Causality was assessed using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo Adverse Drug Reaction Probability Scale. Results: Of the 30 patients, 23 had a history consistent with nitroimidazole hypersensitivity. Most were middle-aged women (mean age 43.8 years, 82.6% female), and two-thirds had an atopic background. Immediate-type reactions predominated (87%), most commonly urticaria, angioedema, or both. Allergy testing was performed in 20 patients: all SPTs were negative, IDT was positive in one (4.3%), and DPT confirmed hypersensitivity in two (8.7%). Overall, two patients had confirmed metronidazole allergy and one had ornidazole allergy, whereas most were reclassified as non-allergic after testing. Causality assessments categorized the majority as unclassified (WHO-UMC, 69.6%) or possible (Naranjo, 65.2%). Conclusion: Nitroimidazole hypersensitivity is rare but clinically important. Most reported allergies were unconfirmed upon systematic re-evaluation, underscoring the value of structured diagnostic algorithms. While causality tools aid interpretation, confirmatory DPT remains the cornerstone for accurate diagnosis and safe antimicrobial stewardship.

INTRODUCTION:Vitamin- and iron-containing medicinal preparations are widely perceived as safe; however, hypersensitivity reactions may pose diagnostic challenges. Standardized diagnostic pathways for suspected hypersensitivity are limited. This study aimed to compare pharmacovigilance-based causality assessment tools with allergist-defined clinical outcomes in patients evaluated for suspected hypersensitivity to vitamin- and iron-containing preparations. METHODS:A retrospective review was performed in 40 patients referred to a tertiary allergy center for suspected adverse reactions to vitamin- or iron-containing medicinal preparations. Demographic characteristics, index reaction features, diagnostic testing results, and clinical outcomes were collected. Causality classifications using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system and the Naranjo algorithm were compared with allergist-defined final evaluations. RESULTS:The cohort was predominantly female (97.5%) and atopic. Iron-containing products were most commonly implicated (40%), followed by B complex vitamins (27.5%) and combined formulations (12.5%). Most reactions reflected type B hypersensitivity (67.5% immediate; 10% delayed). Diagnostic testing was feasible in 82.5% of patients, and confirmed hypersensitivity was uncommon (10%), with most reactions classified as probable or nonallergic. In a subgroup analysis restricted to single-agent exposures, delayed or probable allergic reactions were more frequent with vitamin B preparations than iron (p = 0.03), and vitamin B complex products were also among the most frequently contraindicated or withheld pending diagnostic testing. WHO-UMC and Naranjo showed significant correlation (χ2 = 74.7, p < 0.001), with fair categorical agreement (κ = 0.28) and strong rank correlation (ρ = 0.78). Concordance with allergist-defined clinical outcomes was weak (WHO-UMC κ = 0.09; Naranjo κ = 0.18). CONCLUSION:Immunologically mediated hypersensitivity to vitamin and iron preparations appears uncommon in this tertiary allergy cohort. Pharmacovigilance-based causality assessment tools and allergist-led diagnostic evaluation demonstrate complementary but non-interchangeable roles, highlighting the importance of clinical verification in hypersensitivity reactions.

Introduction: Local anesthetics (LAs) are commonly used to provide regional insensitivity in dentistry, minor surgical procedures, and general anesthesia but may rarely cause allergic reactions. Methods: The file data of 101 patients who were referred to the Department of Allergy and Immunology, Ege University Faculty of Medicine, with a suspected LA allergy between February 2020 and August 2024 were retrospectively reviewed. Patients included in the study were contacted by phone and asked whether they had used LAs after the test and whether any reactions had developed. Results: Female patients comprised 81% (n = 82) of the study cohort. Patients were predominantly referred from the departments of dentistry (45% [n = 46]) and anesthesiology (22% [n = 22]). Patients were referred due to reactions related to LAs alone (n = 51) and both LAs and other drugs (n = 50). The severity of LA reactions was mild (n = 47), moderate (n = 36), or severe (n = 18), with dyspnea being the most common symptom (n = 47). Prick-intradermal (P-ID) and provocation tests were performed on all the patients (suspected LAs [n = 32], alternative LAs [n = 23], random [n = 46]). Only one patient tested positive in the P-ID test, and a provocation test was performed on this patient with an alternative agent, with a negative result. Of the 80 patients reached by phone, 41 received LAs based on test results and did not develop an allergic reaction, whereas the other 39 patients did not receive LAs. Conclusion: Immunologically mediated reactions to LAs were exceedingly rare in this study. These findings highlight that most suspected reactions are not attributable to confirmed allergic mechanisms and underscore the importance of a careful clinical history and guideline-based evaluation to avoid unnecessary drug avoidance.

Background/Objectives: Systemic mastocytosis (SM) is a rare clonal mast cell disorder associated with mediator-related symptoms and a broad range of neurocognitive and sleep-related complaints. Fatigue, insomnia, and brain fog are frequently reported in clinical practice, but objective polysomnographic data in this patient population remain limited. As overweight and obesity are established contributors to sleep-disordered breathing, polysomnography (PSG) findings in patients with SM should be interpreted with caution when a control group is not available. This study aimed to characterize sleep architecture, sleep continuity, and sleep-disordered breathing in adult patients with SM who underwent PSG. Methods: This single-center observational study included nine adult patients diagnosed with SM from the Ege University Mastocytosis Database between January 2023 and January 2024. No control group was included. All patients underwent overnight laboratory PSG after discontinuation of antihistamine therapy for at least seven days. Demographic characteristics, SM subtype, baseline serum tryptase levels, Epworth Sleepiness Scale (ESS) scores, and brain fog-like cognitive complaints were recorded. PSG parameters included total sleep time, sleep efficiency, sleep onset latency, wake after sleep onset, rapid eye movement (REM) latency, sleep stage distribution, arousal burden, apnea-hypopnea index (AHI), oxygenation parameters, and periodic limb movements. Results: The study included four women and five men, with a median age of 50 years. Eight patients had a body mass index (BMI) ≥ 25 kg/m2, indicating that the cohort was predominantly overweight or obese. The most common SM subtype was indolent SM. The median baseline serum tryptase level was 55.9 ng/mL, and the median ESS score was 9. Only two patients had excessive daytime sleepiness according to ESS > 10, whereas six patients reported brain fog-like complaints. Median sleep efficiency was 91.4%, total sleep time was 344 min, sleep onset latency was 9 min, and wake after sleep onset was 11 min. Median REM latency was 128.5 min. Sleep stage distribution showed median N1, N2, N3, and REM sleep proportions of 3%, 54%, 26%, and 16.7%, respectively. One patient had no observed REM sleep, and two patients had no measurable N3 sleep. The median number of arousals was 55. The median AHI was 8.2 events/hour. Although eight of nine patients met PSG criteria for obstructive sleep apnea (OSA), including five with mild and three with severe disease, this finding should be interpreted in the context of the high prevalence of overweight/obesity in the cohort. All patients with BMI ≥ 25 kg/m2 had OSA, whereas the only normal-weight patient did not. Conclusions: In this single- center observational study, PSG demonstrated frequent sleep-disordered breathing, REM-related changes, and variable arousal burden in patients with SM; however, these findings cannot be separated from the predominance of overweight/obesity and the absence of a control group. Brain fog-like complaints were common, although excessive daytime sleepiness was present in only a minority of patients. Because most patients were overweight or obese and no control group was included, these findings cannot be attributed directly to SM. However, the results suggest that objective sleep assessment may be useful in selected patients with SM, particularly when fatigue, non-restorative sleep, or cognitive complaints are present. Larger controlled studies with BMI-matched groups are needed to clarify the relationship between SM, mast cell mediator activity, and sleep abnormalities.

Reduced serum IgM is increasingly encountered in adults evaluated for inborn errors of immunity (IEI), yet its clinical relevance and diagnostic utility remain uncertain. While some patients meet criteria for selective IgM deficiency (SIgMD), others remain unclassified, reflecting significant diagnostic heterogeneity. This study aimed to characterize adult IEI patients with low serum IgM and to assess the prognostic value of IgM levels for clinical outcomes. Among 378 adult IEI patients followed at a tertiary immunology center, 43 individuals (11.4

Background and Objectives: Systemic mastocytosis (SM) is a clonal mast cell disorder characterized by abnormal mast cell accumulation and activation in multiple organs, leading to mediator-related symptoms, including anaphylaxis. Drug hypersensitivity reactions (DHRs) are a major clinical challenge in SM, but their frequency and characteristics remain undefined. This study aimed to evaluate the frequency of drug allergy, identify high-risk drug groups, investigate reaction characteristics, and examine the relationship between drug reactions, baseline serum tryptase levels, and SM subtypes in patients with SM. Materials and Methods: We retrospectively analyzed 34 patients diagnosed with SM between 2009 and 2024 at Ege University Faculty of Medicine. Clinical features, SM subtypes, baseline serum tryptase levels, and DHR characteristics were recorded. Reactions to antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, anesthetics, radiocontrast media (RCM), and COVID-19 vaccines were graded using the Ring and Messmer anaphylaxis classification. Results: Among 34 patients, the mean age was 48.6 ± 13.3 years, 53% were male, and 10 (29.4%) had DHRs. The most common culprit drugs were NSAIDs (17.6%) and β-lactam antibiotics (14.7%). Anaphylaxis was the predominant reaction, frequently associated with hypotension. In 5 patients (14.7%), drug-induced anaphylaxis was the initial and only manifestation of SM. No hypersensitivity reactions occurred to quinolones, general anesthetics, or COVID-19 vaccines. Median baseline tryptase was 50.25 µg/L (min–max: 8.59–200.00) overall, and 41.85 µg/L (min–max: 19.00–200.00) among those with DHRs. Conclusions: Patients with SM are at increased risk of severe DHRs, particularly to NSAIDs and beta-lactam antibiotics. In some patients, drug allergy may be the first and only manifestation of SM. Measurement of baseline serum tryptase is essential in patients with drug-induced anaphylaxis. A comprehensive allergy assessment, including tolerance testing and individualized counseling, is crucial to ensure safe pharmacological management.

Background/Objectives: Immediate-type hypersensitivity reactions (HSRs) to proton pump inhibitors (PPIs) represent a clinically relevant adverse drug reaction and pose diagnostic and management challenges, including variable cross-reactivity (CR). Drug provocation testing (DPT) is the diagnostic gold standard, but real-life use after testing remains uncertain. This study aimed to describe clinical features, diagnostic outcomes, CR profiles, and real-life PPI use in patients with immediate-type PPI hypersensitivity. Methods: Single-center ambispective study of 40 patients evaluated for immediate-type PPI HSRs (2014-2023). Index reactions, culprit PPI, and skin test/DPT results were recorded retrospectively. Patients tolerating an alternative PPI on DPT were followed prospectively; real-life tolerance and use were assessed by structured telephone interview. Results: Among 40 patients (87.5% female; mean age 48 years), lansoprazole was the most frequent culprit (50%); anaphylaxis occurred in 65%. Skin tests were positive in 25% (n = 9), and a shorter interval from reaction to testing was associated with positivity (p = 0.025). CR was detected in 25% (n = 10), most often between lansoprazole and pantoprazole. All 29 patients undergoing DPT tolerated at least one alternative PPI. In real-life follow-up (n = 27), 11 (40.7%) restarted PPIs without recurrence; 1 (3.7%) developed a mild cutaneous reaction despite negative testing. Fifteen (55.6%) did not restart therapy; 4 (14.8%) cited drug-related anxiety or physician-advised avoidance. Conclusions: In immediate-type PPI hypersensitivity, skin test sensitivity appears time-dependent, supporting early evaluation. DPT identifies safe alternatives, yet behavioral and clinician-related barriers limit real-life implementation; addressing these barriers is essential to optimize PPI allergy management.

Drug desensitization enables essential treatment in patients with drug hypersensitivity when alternatives are unavailable. We describe an 81-year-old woman with chronic renal failure and malignancies who developed a Klebsiella pneumoniae infection. She had a remote, unconfirmed history of a penicillin-associated adverse reaction and experienced an immediate hypersensitivity reaction to meropenem. Given her age and comorbidities, direct 12-step meropenem desensitization was performed without prior testing. During the final step, urticaria occurred but was controlled, and therapy was completed after adding an intermediate step. The patient tolerated the full dose without further reaction. This case illustrates the safety and effectiveness of individualized meropenem desensitization in high-risk elderly patients.

BACKGROUND:Hereditary angioedema (HAE) is characterized by recurrent, potentially life-threatening attacks often triggered by surgical procedures. Standard risk assessments frequently overlook the invasiveness of procedures and tissue trauma, limiting individualized perioperative management. OBJECTIVE:To evaluate the procedure-specific risk of acute HAE attacks and assess the effectiveness of prophylactic strategies across diverse surgical and interventional categories. METHODS:This retrospective cohort study analyzed 410 procedures in 58 patients with C1-inhibitor-deficient HAE. Interventions were categorized as major surgery, minor surgery, diagnostic, obstetric, or minimally invasive cosmetic procedures based on invasiveness and airway involvement. Attacks within 72 hours postprocedure were recorded. RESULTS:Overall, procedure-related attacks occurred in 12.9% (53 of 410) of cases. Major surgery carried the highest risk (34.7%, 17 of 49), with attack rates reaching 47.8% (11 of 23) without prophylaxis vs 23.1% (6 of 26) with prophylaxis. Minor surgery showed an 8.9% (4 of 45) attack rate; notably, no attacks occurred in patients receiving prophylaxis (0 of 12) compared with 13.0% (3 of 23) without it. For circumcision, the rate was 13.3% overall. Diagnostic procedures had an 18.18% (2 of 11) attack rate, occurring only without prophylaxis. Minimally invasive cosmetic procedures posed the lowest risk (1.94%, 5 of 258). Statistical analysis confirmed that the risk with major surgery significantly exceeded that with minor surgery (P = .023) and cosmetic procedures (P < .001). In addition, cosmetic procedures carried a lower risk than minor (P = .046) and diagnostic interventions (P = .043). CONCLUSION:The HAE attack risk follows an invasiveness-dependent gradient. Major surgeries and obstetric procedures carry the highest risk, whereas minor and aesthetic interventions demonstrate significantly lower rates, emphasizing the need for stratified prophylactic protocols.

Background/Objectives: Quinolones are among the most frequently implicated antibiotics in immediate hypersensitivity reactions, yet diagnostic evaluation remains challenging and the real-world behaviour of patients after de-labeling has received little attention. We examined the diagnostic work-up, outcomes, and post-de-labeling drug-use behaviour of patients with suspected quinolone hypersensitivity. Methods: This single-centre ambispective study included 29 patients evaluated between January 2020 and April 2024. Clinical, demographic, skin test, and drug provocation test (DPT) data were extracted retrospectively. Patients in whom allergy had been excluded or a safe alternative identified were contacted by structured telephone interview between May and June 2025. Results: Anaphylaxis was the most common index reaction (42.9%), and ciprofloxacin was the most frequently implicated agent (57.1% of drug instances). Skin tests were positive in 84.2% of cases, but the positive predictive value in the DPT-tested subset was only 20.0%. Of the 12 reached patients, 11 had quinolone allergy excluded; among these, only 4 (36.4%) had reused the de-labeled quinolone, while 7 (63.6%) had avoided it, including 4 who declined it when clinically indicated. Conclusions: Quinolone skin tests show limited specificity, and successful de-labeling does not guarantee real-world drug use. Patient anxiety and counselling are central to effective management.

Objective: Type D personality, characterized by negative affectivity and social inhibition, has been associated with increased psychological distress and reduced quality of life in individuals with chronic illnesses. This study aimed to determine the prevalence of Type D personality and examine its psychosocial correlates in adults diagnosed with inborn errors of immunity (IEI). Materials and Methods: This descriptive, cross-sectional study included 53 adult patients with IEI. Sociodemographic, clinical, and psychosocial data were collected using a structured patient identification form. Type D personality was assessed using the validated Turkish version of the Type D Scale-14 (DS14). Group comparisons were performed using appropriate statistical tests. Results: Type D personality was identified in 22.6% of participants (n = 12). It was more prevalent among women (27.6%) than men (16.7%) (p = 0.344). Higher rates were observed among divorced (42.9%) and single (35.3%) participants compared to married individuals (10.3%) (p = 0.062), among unemployed (32.1%) versus employed participants (12.0%) (p = 0.080), and among those reporting nicotine and/or alcohol use (33.3%) compared to non-users (11.5%) (p = 0.099). Participants with a psychiatric diagnosis had significantly higher rates of Type D personality compared to those without (57.1% vs. 17.4%, p = 0.039). No significant associations were identified with clinical parameters. Conclusion: In this cohort of adult patients with IEI, the prevalence of Type D personality was comparable to that reported in general population samples, but significantly higher among individuals with a psychiatric diagnosis, suggesting a potential link between Type D traits and psychological vulnerability in this group.

Inborn Errors of Immunity (IEI) often lead to recurrent infections, immune dysregulation, and an increased risk of malignancies. Due to the heterogeneity in IEI presentations, personalized monitoring is essential for early detection of non-infectious complications. This study aims to document the characteristics and prevalence of malignancies in IEI patients. A retrospective review of 355 patients diagnosed with IEI at the Adult Allergy and Immunology Clinic of Ege University was conducted. Data on demographics, clinical presentations, laboratory results, and immunological and genetic profiles of patients with malignancies were analyzed. A total of 40 patients with neoplasia (F/M: 18/22; median age: 51.58 years, range: 18–91) were evaluated. The median ages at IEI symptom onset, diagnosis, and neoplasm diagnosis were 16.5, 45, and 39.5 years, respectively. Malignancy was diagnosed in 60

BACKGROUND:Histamine plays a central role in CSU pathogenesis and may contribute to extracutaneous symptoms such as dysmenorrhea, but this relationship has not been fully examined. METHODS:In this prospective, cross-sectional multicenter study, 425 female CSU patients and 370 age-matched controls were recruited from 19 UCARE centers in Türkiye. Dysmenorrhea prevalence and severity were assessed using a numerical scale and symptom scores. Histamine skin prick testing (SPT) was performed to evaluate histamine clearance capacity. Associations between dysmenorrhea, CSU phenotype, antihistamine use, and SPT kinetics were analyzed. RESULTS:The prevalence and severity of dysmenorrhea were comparable between CSU patients and controls (81.6% vs. 79.5%, p = 0.244). However, 95/418 (22.7%) of CSU patients reported increased menstrual pain following CSU onset, and 20/95 (21.1%) of these reported partial relief with antihistamines. CSU patients with worsened dysmenorrhea exhibited significantly shorter histamine SPT positivity durations than those without symptom change (35 vs. 45 min; p = 0.015). No correlation was observed between dysmenorrhea severity and total IgE, anti-TPO levels, or urticaria control/activity scores. A moderate negative correlation was found between UAS7 and elapsed time to histamine SPT negativity (r = -0.389, p < 0.001). CONCLUSIONS:Although overall prevalence and severity of dysmenorrhea were similar in CSU patients and healthy controls, about one in five patients with CSU experienced worsening menstrual pain after disease onset, and only a subset of these patients reported partial improvement with antihistamines. A distinct CSU subgroup with heightened menstrual pain may be characterized by altered histamine dynamics. Whether these patients may benefit from more intensive antihistamine treatment remains uncertain and requires confirmation in future studies; further studies should explore neuroimmune and hormonal mechanisms underlying this overlap.

Case Report Over the last two decades, new anticoagulants have been developed to prevent and manage thromboembolic diseases, including direct-acting anticoagulants like rivaroxaban, which is used for venous thromboembolism prevention, stroke prevention in atrial fibrillation, and ischemic heart disease. Here, we present the experience of a case with a history of multiple thromboses and an anaphylactoid reaction to anticoagulants, who was able to continue prophylaxis without allergic reactions after rivaroxaban desensitization.A 42-year-old female patient visited the hematology outpatient clinic to obtain a prescription for a new anticoagulant due to a supply issue with her current medication, fondaparinux.. Her medical history included thrombosis in both upper and lower extremities ten years earlier, along with heterozygous mutations for factor V Leiden and MTHFR, necessitating lifelong anticoagulant therapy. She had previously experienced anaphylactic shock from enoxaparin, warfarin, tinzaparin, and rivaroxaban, which led her to use fondaparinux without issues. When faced with a supply problem prescribed apixaban, she suffered anaphylactic shock thirty minutes after administration, requiring epinephrine treatment. Following this, the allergy and immunology department recommended a desensitization protocol for rivaroxaban, crucial for her ongoing anticoagulation. After a one-day desensitization, she successfully continued treatment with 20 mg of rivaroxaban without any allergic reactions during follow-up visits.Desensitization is a technique that allows patients with drug hypersensitivity reactions to safely maintain drug therapy by creating temporary tolerance, especially for IgE-mediated reactions. It works by inhibiting mast cell activation and reducing the release of inflammatory mediators, often resulting in decreased skin sensitivity and potentially negative skin test results after the procedure. In this case, the patient had a grade 3 early-type drug allergy, and while literature on desensitization for new-generation oral anticoagulants is scarce, the successful desensitization to rivaroxaban suggests that it may be an effective option for similar patients in the future.

Background: β-Lactams are the most widely used antibiotic family in the world. Nevertheless, they also stand out as the primary culprits for inducing drug hypersensitivity reactions (HSR). Methods: Between May 2018 and March 2023, patients with suspected HSRs to β-lactams, who underwent skin tests (ST), were retrospectively screened. The determinants of allergenic penicillin (DAP) tests, which include penicillin minor and major determinants, clavulanic acid, and amoxicillin, along with ampicillin, sulbactam, the identified culprit drugs, and alternative cephalosporins, which include cefuroxime, ceftriaxone prick and/or intradermal tests, were administered. The analysis focused on identifying positive ST results and determining the true HSRs rates in this patient cohort. Results: Of the 147 patients, 78.9% (n = 116) were women and the median (minimum-maximum) age was 41 years (18-71 years). Mild HSRs (grades 1-2) were observed in 72.78% (n = 107), whereas 24.4% (n = 36) had severe reactions (grades 3-4) and 2.7% (n = 4) had an unknown grade. Of the patients, 64% (n = 94) experienced HSRs within the first hour after the last dose of the identified culprit drug. The overall positivity rate for all STs was 26.5% (n = 39). ST positivity rates were notably higher in individuals who had experienced HSRs within the past 6 months (p = 0.02) and those with severe anaphylaxis (p < 0.001). Conclusion: β-Lactam ST positivity is higher, especially in those with grades 3-4 reactions and consulted a physician within the first 6 months after their HSRs.

Background and Objectives: Hereditary angioedema (HAE) is characterized by unpredictable skin and mucosal angioedema attacks. We aimed to find the frequency of sexual-activity-triggered attacks (STAs) and understand how the sexual life of HAE with C1-inhibitor deficiency (HAE-C1INH) patients is affected. Materials and Methods: Adult HAE-C1INH patients were included in this cross-sectional study, which started in March 2020. Demographic information, marriage properties, gender-specific sexual life characteristics, and the HAE-specific histories of the patients were collected. The Hospital Anxiety and Depression Scale (HADS) and the Turkish version of the New Sexual Satisfaction Scale (NSSS) were applied to all participants. Results: Among 42 symptomatic HAE patients, 33 (78.57%) had genital attacks and 17 (42.5%) had STAs. Ten (58.8%) had genital pain, tenderness, or swelling, and five (29.4%) had isolated abdominal and groin pain. Eight (47.1%) patients with STAs experienced a HAE attack during their first time engaging in sexual intercourse. Anxiety/depression scales, NSSS scores, and distribution of other HAE attack localizations were similar in patients with and without STAs, and no gender differences were observed. Compared to the patients without STAs, the ratio of patients who stated that their sexual lives were negatively affected and that they lost their sexual desire was higher in patients with STAs. Conclusions: Genital or abdominal attacks triggered by sexual activity may be more common than thought. Sexual activity should also be questioned for evaluating attack triggers. There is a possibility of triggering an attack with the first and ongoing sexual intercourse, and patients should be informed to keep their attack treatment medications ready in advance.