Background:We aimed to assess knowledge of emergency department (ED) physicians regarding the classification and treatment of angioedema and to evaluate the impact of a training program on this knowledge base. Methods:A total of 11 questions about angioedema and its types were posed to ED physicians from various hospitals, either in person or via e-mail, before the implementation of an educational module on the subject (pre-test). Following a brief training period, the ED physicians were presented with the same set of questions once again (post-test). The reliability between the repeated tests were estimated using intraclass correlation coefficients (ICC). Item difficulty was calculated separately for each question in both the pre-test and post-test. Results:A total of 541 ED physicians participated in the pre-test survey, and 162 of them declined to participate in the post-test survey. The remaining 379 participated in the post-test survey as well. The ICC between the repeated tests indicated a moderate level of reliability (mean ICC = 0.5; 0.42-0.57; lower and upper 95% confidence intervals). The mean item difficulty was 0.36 in the pre-test, indicating that the items had an appropriate level of difficulty. In the post-test, the mean item difficulty increased to 0.57, suggesting that the items were generally easier, likely reflecting improved knowledge or skills following the intervention. The level of knowledge regarding the clinical features of different types of angioedema was found to be inadequate. Following the training period, there was a notable increase in the number of correct answers, with a statistically significant difference (p = 0.002). Similarly, a remarkable increase was observed in the number of respondents who indicated that bradykinin-mediated-angioedema should be considered in cases of unresponsiveness to antihistamine and-corticosteroid treatment (p < 0.001). Regarding queries about hereditary angioedema (HAE), the majority of ED physicians had no prior experience in treating a patient with HAE, and only a small number were familiar with the symptoms of HAE. Following the training ED physicians demonstrated enhanced knowledge of HAE symptoms and diagnostic criteria (p < 0.001). Similarly, a notable enhancement in familiarity with HAE attack treatments was observed when the inquiries related to these treatments were compared between the pre-test and post-test phases (p < 0.001). Conclusion:In light of the potential lethality of attacks mediated by bradykinin, a training program should include the recognition of rare types of angioedema, with a particular emphasis on HAE disease.

Introduction: The clinical efficacy of allergen immunotherapy is well documented, but the treatment always involves a risk of adverse reactions. Although premedication is not routinely performed, it has been shown to reduce the adverse reactions. Aim: To evaluate the contribution of premedication to prevent hypersensitivity reactions during cluster im-munotherapy. Material and methods: 253 patients receiving a total of 290 cluster immunotherapy protocols to house dust mites, pollens, and venoms were recruited in the study. Patients were randomized into 5 groups according to the premedication status as follows: daily antihistamine, antihistamine only 2 h prior to injections, daily montelukast, combination of montelukast and antihistamine and the control group including patients without premedication. Patients were followed during up-dosing and maintenance phases of immunotherapy. Systemic and local reactions were reported. Results: Most of the patients were female (61.7%), the most frequent allergen was house dust mites (56.9%). 67.2% of patients had premedication and 20.6% of patients had reactions during the up-dosing phase. Reac-tions were more frequent in patients who received pollen immunotherapy. The total frequency of the hyper-sensitivity reaction was significantly higher in the control group. When evaluated seperately, local reactions were more frequently observed in the control group, while no difference in the frequency of systemic reactions was detected. Conclusions: Our study suggests that the reaction risk is increased in pollen immunotherapy. Premedication does not seem to prevent the frequency or severity of systemic reactions. However premedication, daily AH intake in particular, decreases the frequency of local reactions.

Background: The clinical effects of intranasal corticosteroids (INC) on nasal symptoms and the clinical course of coronavirus disease 2019 (COVID-19) in subjects with chronic rhinitis (CR) seem unclear. Objective: To evaluate the clinical effects of INCs on nasal symptoms in subjects with CR and with COVID-19. Methods: In subjects with CR and diagnosed with COVID-19 at four tertiary centers, quality of life and nasal symptoms were assessed by using the 22-item Sino-Nasal Outcome Test (SNOT-22) and the visual analog scale (VAS), respectively. In subjects with allergic rhinitis, nasal symptoms were also assessed on the total symptom score-6 (TSS-6) scale. The subjects were then allocated into two groups according to whether or not they used INCs while infected with the severe acute respiratory syndrome coronavirus 2 (group 1 and group 2, respectively). The subjects in group 2 were divided into two subgroups according to the use of antihistamines and/or leukotriene receptor antagonist or not (group 2a and group 2b, respectively). All the scores were compared before and during COVID-19 among the three groups. Results: A total of 71 subjects (21 in group 1, 24 in group 2a, and 26 in group 2b) were enrolled. The total scores of the SNOT-22 increased remarkably in all the groups during the infection when compared with the pre-COVID-19 scores (p < 0.001 in each group). However, the difference between the pre-COVID-19 and COVID-19 values revealed a lower decrease in the senses of smell and/or taste in group 1 than in group 2a and group 2b (p = 0.015, adjusted p = 0.045; and p = 0.001, adjusted p = 0.002, respectively). There were no significant differences in other COVID-19 findings, VAS, and TSS-6 scores among the groups (all p > 0.05). Conclusion: INCs in subjects with CR seemed protective against the decrease in smell and/or taste observed during COVID-19 and do not aggravate the clinical course of COVID-19.

Background: The success of subcutaneous immunotherapy (SCIT) mostly depends on regular injections. Our aim was to investigate adherence to SCIT with aeroallergens during the COVID-19 pandemic and demonstrate clinical consequences of treatment disruptions in real-life. Methods: Visual analogue scale for quality of life (VAS-QoL), VAS for symptom scores (VAS-symptom), medication scores (MSs) and total symptom scores (TSS-6) were recorded during the pandemic in 327 adult allergic rhinitis and/or asthmatic patients receiving maintenance SCIT and these scores were compared with the pre-pandemic data. Patients were grouped according to SCIT administration intervals; no delay (Group 1), <2 months (Group 2), and ≥2 month intervals (Group 3). Results: 104 (31.8%) patients (Group 3) were considered as non-adherent which was mostly related to receiving SCIT with HDMs and using public transportation for reaching the hospital. Median MS, VAS-symptom and TSS-6 scores of Group 3 patients during the pandemic were higher than the pre-pandemic scores (p=0.005, p<0.001, p<0.001, respectively) whereas median VAS-QoL scores of Group 3 during the pandemic were lower than the pre-pandemic scores (p<0.001). Median TSS-6 and VAS-symptom scores were the highest in Group 3 compared to other groups (p<0.001 for each comparison). Median VAS-QoL scores were the lowest in Group 3 compared to Group 1 and Group 2 (p<0.001, p=0.043, respectively). Conclusion: When precautions in allergy clinics are carefully applied, adherence to SCIT can be high during a pandemic. Patients must be warned about adhering to SCIT injections since delays in SCIT administration can deteriorate clinical symptoms.

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A 27-year-old woman experiencing angioedema attacks without concomitant urticaria since the age of 7 years was diagnosed as having hereditary angioedema (HAE) type II in our clinic in 2014. She did not have any siblings. Her mother was also diagnosed as having type II HAE in our clinic. On admission, she was complaining of frequent recurrent angioedema of her extremities and lips and episodic abdominal pain with nausea and vomiting, which was occasionally concomitant.