Objective: This study aimed to evaluate patients who developed hypersensitivity reactions (HSRs) during rituximab treatment and report the outcomes of desensitization protocols implemented to allow treatment continuation. Methods: We retrospectively reviewed the institutional data of 76 patients who received rituximab therapy at the Adult Hematology Department between January 2022 and September 2023. Among these, 11 patients who experienced immediate hypersensitivity reactions during infusion were analyzed. The overall frequency of rituximab-associated HSRs was 14.47% (11 out of 76 patients). Demographic data, underlying diseases, timing and type of HSRs, and details of the desensitization protocols were recorded. Results: The overall frequency of rituximab-associated HSRs was 14.47% (11 out of 76 patients). Among the 11 patients, eight were male and three were female, with a median age of 56 years (range: 19-72). Eight patients had CD20-positive non-Hodgkin lymphoma (NHL) and three had acute B-lymphoblastic leukemia (B-ALL). HSRs occurred during the first rituximab exposure in nine patients, at the fourth dose in one patient, and at the eighth dose in another. Symptoms included widespread rash, pruritus, flushing, chills, shivering, dyspnea, dysphagia, back pain, dizziness, syncope, and throat discomfort. All the patients were consulted by the Allergy and Immunology Clinic. Based on prick and intradermal test (IDT) results and the planned rituximab dose, desensitization protocols consisting of a three-dilution/12-step and a four-dilution/16-step regimen were prepared. Overall, 46 desensitization procedures were successfully completed in 11 patients. Notably, no severe anaphylactic events or treatment discontinuations due to drug toxicity occurred during the implementation of the protocols. Conclusions: Although the number of patients was limited, our findings indicate that in patients with hematologic malignancies receiving rituximab who develop early HSRs, desensitization represents a safe and effective strategy before considering treatment modification. These results support that, in appropriately selected patients, desensitization protocols are an important approach to continue therapy without interruption while minimizing adverse reactions.

Background/Objectives: In recent years, the concept of clinical remission under treatment in asthma has gained increasing attention. It is defined as the absence of exacerbations, asthma symptoms, and oral corticosteroid use for at least 12 months, together with improved or stable lung function. This study aimed to evaluate the clinical remission rates and associated factors in patients with severe asthma receiving biologic therapy with either omalizumab (anti-IgE) or mepolizumab (anti-IL-5). Methods: Adult patients with severe asthma and type 2 inflammation who started omalizumab or mepolizumab between January 2009 and December 2023 in our allergy clinic were retrospectively analyzed. Sociodemographic and clinical characteristics were reviewed. Clinical remission rates were assessed at the first and most recent years of maintenance therapy. Independent markers were identified using multivariable analyses. Results: A total of 160 patients were included (mean age 53.8 ± 14.6 years; 81.9% female). Of these, 85.6% received omalizumab and 14.4% mepolizumab. Remission rates at one year and at the latest follow-up were 60.0% and 43.7%, respectively. Patients achieving remission had higher total IgE levels. Psychiatric comorbidity negatively affected remission. The one-year remission rates were 91.3% in the mepolizumab group and 54.7% in the omalizumab group. Higher baseline blood eosinophil counts and Asthma Control Test (ACT) scores were positive markers, while psychiatric disease was inversely associated. Conclusions: Omalizumab and mepolizumab achieved meaningful clinical remission rates in severe asthma. Elevated ACT scores and eosinophil counts and absence of psychiatric comorbidities were independent markers, underscoring the need for individualized biologic therapy to achieve sustained remission.

BACKGROUND:Anaphylaxis is classically framed around IgE-FcεRI, yet a subset of severe reactions engages an IgG-FcγR-mediated arm whose consequences for mucosal barrier integrity and epithelial repair remain undefined under recurrence. We propose that mucosal surfaces sustain function during severe anaphylaxis through coordinated operation of immunological composition, structural integrity and reparative capacity-which we term mucosal allostasis-and asked whether the two pathways diverge along this framework. METHODS:BALB/c mice were resolved into IgE- and IgG-mediated arms using a hybrid active/passive (ASA-PSA) sensitisation model and subjected to acute or recurrent severe anaphylaxis, with pharmacological reversal enabling matched rechallenge. Lung, small intestine, colon and serum were profiled across cytokine, mediator, junctional, repair and bacterial 16S rDNA panels; ILC subsets and junctional integrity were resolved by flow cytometry and immunohistochemistry. RESULTS:Despite comparable systemic clinical severity, the two pathways diverged sharply at the mucosal level. IgE-mediated recurrence preserved junctional expression and mounted a coordinated AREG/EGF/periostin/TFF3/MUC2 repair programme, whereas IgG-mediated recurrence dismantled both: Claudin-1, Occludin, ZO-1 and E-cadherin declined in tissue and rose reciprocally in serum, repair mediators failed to engage where junctional injury was greatest, and bacterial DNA translocation rose 48-fold, alongside a type 2/regulatory to inflammatory shift and an ILC2 to ILC1/NCR+ ILC3 reorganisation. CONCLUSION:Recurrent IgE- and IgG-mediated severe anaphylaxis diverge into two mechanistically opposite allostatic phenotypes. IgG-mediated recurrence produces an allostatic collapse in which structural failure proceeds uncoupled from reparative engagement, identifying barrier-repair coupling as a candidate axis for intervention in refractory anaphylaxis.

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.

Background: Rituximab, a chimeric monoclonal anti-CD20 antibody, is widely used in various malignant and benign conditions, including leukemia, lymphoma, rheumatoid arthritis, and systemic lupus erythematosus. However, some patients may develop early or delayed hypersensitivity reactions (HSRs) following rituximab infusion, which can limit therapy continuation. Objective: This study aimed to evaluate patients who developed HSRs during rituximab treatment and report the outcomes of desensitization protocols implemented to allow treatment continuation. Methods: We retrospectively analyzed 11 patients who experienced allergic reactions or anaphylaxis during rituximab therapy at the Adult Hematology Department between 2022 and 2024. Demographic data, underlying diseases, timing and type of HSRs, and details of the desensitization protocols were recorded. Results: Among the 11 patients, 8 were male and 3 were female, with a median age of 56 years (range: 19–72). Eight patients had CD20-positive non-Hodgkin lymphoma (NHL) and three had acute B-lymphoblastic leukemia (B-ALL). HSRs occurred during the first rituximab exposure in 9 patients, at the fourth dose in 1 patient, and at the eighth dose in another. Symptoms included widespread rash, pruritus, flushing, chills, shivering, dyspnea, dysphagia, back pain, dizziness, syncope, and throat discomfort. All patients were consulted by the Allergy and Immunology Clinic. Based on prick and intradermal test (IDT) results and the planned rituximab dose, desensitization protocols consisting of a 3-dilution/12-step and a 4-dilution/16-step regimen were prepared. Premedication with 40 mg methylprednisolone and 1 ampoule of pheniramine maleate was administered prior to all procedures. In one patient, despite the 12-step protocol, HSR (chest pain and dyspnea) occurred, and the 16-step/4-dilution protocol was successfully applied. Overall, 46 desensitization procedures were successfully completed in 11 patients. Conclusion: Although the number of patients was limited, our findings indicate that in patients with hematologic malignancies receiving rituximab who develop early HSRs, desensitization represents a safe and effective strategy before considering treatment modification. These results support that, in appropriately selected patients, desensitization protocols are an important approach to continue therapy without interruption while minimizing adverse reactions.

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.

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.

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.

Aim: Elderly people encounter COVID-19 more frequently due to physiological changes associated with aging and underlying potential health conditions.The study aims to evaluate the impact of baseline patient characteristics on short- and long-term mortality in elderly patients aged 65 and over, classified as youngest-old, middle-aged, or oldest-old, who applied to the pandemic outpatient clinic and had not yet been vaccinated. Materials and Methods: Symptomatic patients who attended the emergency department were enrolled in the study. Demographic data, symptoms, comorbidities, thoracic computed tomography (CT), and laboratory results were recorded at admission. The primary outcomes were all-cause short-term (within six months) and long-term (within four years) mortality. Results: The study consists of 393 participants, with a mean age of 67.4 ± 9.8 years and 52.2% male. Considering the death rates in the last four years, it was determined that 72 (18.3%) cases died in the short term, and 104 (26.5%) cases died in the long term. It was found that chronic renal failure (CRF), coronary artery disease (CAD), middle-old and oldest-old-aged patients compared to the 50-64 age group were independent predictors of overall short-term mortality. It was determined that the following factors independently predicted overall long-term mortality: male gender, CAD, malignancy, CRF, fever, and dyspnea symptoms, and the patients of the youngest-old, middle-old, and oldest-old relative to the 50–64 age group. Conclusion: Advanced age, male gender, symptoms of shortness of breath and fever, high D-dimer levels, the presence of CAD, malignancy, and CRF were related to a higher risk of death from COVID-19 infection in the elderly.

Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluateasthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderlyasthma) years of age.Materials and methods: The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item MoriskyMedication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed.Results: A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%)were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), hadhigher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities(p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controllermedications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatmentcompliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlledasthma (odds ratio = 1.61, CI = 1.04–2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48–4.0) were associated withbeing in the elderly asthma group.Conclusion: The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age ofasthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better.Patients diagnosed ≥60 years of age did not have more severe disease.

Can omalizumab be an alternative treatment for non-atopic severe asthma? A real-life experience with omalizumabIntroduction: Omalizumab, a humanized monoclonal anti-IgE antibody, has largely demonstrated its efficacy in severe allergic asthma. There are limited data about the effectiveness of omalizumab in patients with non-atopic severe persistent asthma. In this study, we aimed to determine the effect of omalizumab in patients with non-atopic severe asthma and compare the data obtained with those in patients with allergic severe asthma.Materials and Methods: This study was an observational, retrospective, tertiary single-center study that assessed and compared the clinical outcome of adult patients with severe asthma (165 atopic and 41 non-atopic) who have been on omalizumab for one year or longer between January 2008 and January 2020. Effectiveness was assessed by considering symptom scores (GINA symptom control score), daily systemic corticosteroids (SCS) dosage, blood eosinophil counts, pulmonary function, and number of severe exacerbations and hospitalizations within the last one year.Results: Omalizumab exhibited significant improvement in the clinical status of non-atopic asthma patients as measured by GINA symptom score [decreased from 3.77 +/- 0.63 to 1.36 +/- 1.27 (p< 0.001)], the number of emergency room visits for asthma [decreased from 11.25 +/- 14.69 to 0.25 +/- 0.55 (p< 0.001)], and the number of hospitalizations [decreased from 1.17 +/- 2.87 to 0.14 +/- 0.36 (p= 0.036)]. These results were not significantly different from those obtained in allergic asthma patients. FEV1 improved significantly from 2.08 +/- 0.86 to 2.14 +/- 0.84 (p= 0.041) and oral corticosteroid doses decreased significantly from 1.67 +/- 7.49 to 0.46 +/- 2.74 (p= 0.015) in the only atopic group.Conclusion: Omalizumab, which is a proven and effective treatment option for allergic asthma, may also be an efficacious alternative option in non-atopic severe asthma.

This study was aimed to examine the pulmonary gas exchange and ventilation dynamics in chronic lung diseases. Since chronic lung diseases are the most common in the society, patients with Chronic Obstructive Pulmonary Disease (COPD), changes when lung cancer accompanies, and cases with idiopathic pulmonary fibrosis, which is one of the prototypes of interstitial lung disease that causes respiratory failure in a restrictive pattern, perform both pulmonary function tests and cardiopulmonary exercise. evaluated with tests. It was investigated whether there was a difference in the three disease states in relation to ventilation volumes and anaerobic threshold. Ten patients with COPD (Group 1) and 9 patients with lung cancer (Group 2) who applied to the Bursa Uludag University Chest Diseases outpatient clinic were included in the study. The mean age of Groups were 65.00 ± 3.17; 66.67 ± 2.70 and 62.50 ± 3.25 years. Group 1 and 2 had obstructive respiratory failure; Group 3 had restrictive respiratory failure. Cardiopulmonary exercise tests (CPET) were performed with a standard protocol. Maximum oxygen consumption (VO2max) was 14.29 ± 1.17 in Group 1, while it was 13.31 ± 1.31 in Group 2 and 12.50 ± 1.76 in Group 3 (Figure 1) (Figure 2). Anaerobic threshold values were found to be 0.70 ± 0.04; 0.68 ± 0.03; 0.71 ± 0.12 in Groups 1, 2 and 3. When the pulmonary function test was evaluated, the FEV1, FEV1/FVC values of Group 3 were higher than the other two groups (p<0.05). A measurement indicator was also detected between the expected value of the oxygen pulse and the RQ (p<0.05). As a result, ventilation dynamics deteriorates in chronic lung diseases.

Objective: The objective of this study was to evaluate and compare knowledge, attitude, and practice patterns between pulmonologists and allergists for adult asthma in Turkey. Methods: Questionnaire-based data were gathered from 236 pulmonologists and 62 allergists, who had been members of the Turkish Thoracic Society and Turkish National Society of Allergy and Clinical Immunology in January-March 2021. Univariate and multivariate statistics were used to determine the factors associated with primary reliever preferences. Results: Of the 298 physicians, 39% encountered at least five asthma patients daily. Spirometer was used frequently by both the allergists (82.3%) and pulmonologists (77.5%) for asthma diagnosis. Budesonide was the most preferred inhaler corticosteroid. Formoterol/budesonide was the most preferred ICS/LABA combination, followed by beclomethasone/formoterol and fluticasone/salmeterol for asthma treatment. For mild asthmatics, formoterol/ICS was the most preferred (72.6%) reliever among allergists, whereas salbutamol was the most preferred (66.1%) among pulmonologists (p < 0.001). Age and workplace were associated with salbutamol preference of doctors for mild asthmatics. Age, specialty, and patient examination time were significantly associated with salbutamol preference for severe asthmatics. Conclusions: The use of diagnostic tools, such as a spirometer, for asthma diagnosis was compatible with the guidelines. While recent updates of the guidelines indicate that salbutamol should not be used solely in mild asthmatics due to its harmful effects in long-term use, it still was the most preferred drug by pulmonologists. Postgraduate education programs are needed to improve compliance with the guidelines.

Objective: Local anesthetics are broadly used in various health care settings with high probability of lifetime exposure.The main aim of this study was to determine the characteristics and risk factors of the patients presenting to our allergy outpatient clinic due to suspected hypersensitivity to local anesthetics. Materials and Methods:We retrospectively evaluated the clinical data and test results obtained from patients who had presented to our allergy outpatient clinic for allergological work-up of local anesthetics from 2015 to 2020.Results: A total of 289 subjects were included.The most common referral reason was a history of non-local anesthetic drug hypersensitivity reaction (65.7%, n=190).Twenty-five out of 289 (8.65%) patients had positivity for at least one of the tested drugs in skin prick test/ intradermal test/ subcutaneous drug provocation test.Of these 25 patients, 4 (16%) had a history of DHR to LA and 9 (36%) had a history of multiple drug hypersensitivity (MDH).Allergy to local anesthetics was observed in only 13 (18.6%) of 70 patients with a history of local anesthetic hypersensitivity reaction.Patients with atopy were 5.3 times more likely to have local anesthetic hypersensitivity (odds ratio: 5.254; 95% CI: 1.316-20.974;p=0.019).Cross-reactivity among amide-local anesthetics without a distinct predictive pattern has also been demonstrated in 3 patients. Conclusion:Most patients who report local anesthetic allergy can tolerate local anesthetics without having a hypersensitivity reaction.Atopic status is associated with increased risk of a hypersensitivity reaction to local anesthetics.Atopic patients are candidates for performing allergy tests to local anesthetics to enable appropriate counseling.

Introduction of inhaled corticosteroids (ICS) has been the cornerstone of the long-term management of asthma. ICSs either alone or in combination with long-acting beta-2 agonists have been shown to be associated with favorable asthma outcomes. However, asthma control is still reported to be below expectations all around the world. Research in the last decades focusing on the use of ICS/formoterol both as maintenance and as needed (maintenance and reliever therapy approach) showed improved asthma outcomes. As a result of recent developments, Turkish Asthma Guidelines group aimed to revise asthma treatment recommendations. In general, we recommend physicians to consider the risk factors for poor asthma outcomes, patients' compliance and expectations and then to determine "a personalized treatment plan." Importantly, the use of short-acting beta-2 agonists alone as a symptom reliever in asthma patients not using regular ICS is no longer recommended. In stepwise treatment approach, we primarily recommend to use ICS-based controllers and initiate ICS as soon as possible. We define 2 different treatment tracks in stepwise approaches as maintenance and reliever therapy or fixed-dose therapy and equally recommend each track depending on the patient's risks as well as decision of physicians in a personalized manner. For both tracks, a strong recommendation was made in favor of using add-on treatments before initiating phenotype-specific treatment in step 5. A strong recommendation was also made in favor of using biologic agents and/or aspirin treatment after desensitization in severe asthma when indicated.

Background: Hypersensitivity reactions (HSRs) to nonsteroidal anti-inflammatory drugs (NSAIDs) are a significant clinical issue. Several classifications have been proposed to categorize these reactions, including the current European Academy of Allergy and Clinical Immunology/ European Network for Drug Allergy (EAACI/ENDA) classification. This study aimed to evaluate the applicability of this classification in a real-world clinical setting. Methods: We conducted a national multicenter study involving patients from nine hospitals in four major urban centers in Turkey. All patients had a suggestive clinical history of hypersen-sitivity reactions to NSAIDs. Researchers collected data using a structured form and classified reactions based on the EAACI/ENDA classification. Oral provocation tests with several NSAIDs were performed using a single-blind challenge per EAACI/ENDA guidelines. Results: Our retrospective study included 966 adult patients with a history of hypersensitivity to NSAIDs. The most common triggers were Acetylsalicylic Acid (ASA), paracetamol, and metamizole. The most prevalent acute NSAID hypersensitivity group was NSAID-induced urticaria/angioedema (NIUA) (34.3%). However, 17.3% of patients did not fit neatly into the current EAACI/ENDA classification. Notably, patients with underlying asthma or allergic rhinoconjunctivitis exhibited unusual reactions, such as urticaria and/or angioedema induced by multiple chemical groups of NSAIDs, blended mixed reactions, and isolated periorbital angioedema in response to multiple chemical groups of NSAIDs. Conclusions: While the EAACI/ENDA classification system stratifies NSAID-induced hypersensitivity reactions into five distinct endotypes or phenotypes, it may not fully capture the diversity of these reactions. Our findings suggest a need for further research to refine this classification system and better accommodate patients with atypical presentations.

Introduction: In a resource-constrained situation, a clinical risk stratification system can assist in identifying individuals who are at higher risk and should be tested for COVID-19. This study aims to find a predictive scoring model to estimate the COVID-19 diagnosis. Materials and Methods: Patients who applied to the emergency pandemic clinic between April 2020 and March 2021 were enrolled in this retrospective study. At admission, demographic characteristics, symptoms, comorbid diseases, chest computed tomography (CT), and laboratory findings were all recorded. Development and validation datasets were created. The scoring system was performed using the coefficients of the odds ratios obtained from the multivariable logistic regression analysis. Results: Among 1187 patients admitted to the hospital, the median age was 58 years old (22-96), and 52.7% were male. In a multivariable analysis, typical radiological findings (OR= 8.47, CI= 5.48-13.10, p< 0.001) and dyspnea (OR= 2.85, CI= 1.71-4.74, p< 0.001) were found to be the two important risk factors for COVID-19 diagnosis, followed by myalgia (OR= 1.80, CI= 1.082.99, p= 0.023), cough (OR= 1.65, CI= 1.16-2.26, p= 0.006) and fatigue symptoms (OR= 1.57, CI= 1.06-2.30, p= 0.023). In our scoring system, dyspnea was scored as 2 points, cough as 1 point, fatigue as 1 point, myalgia as 1 point, and typical radiological findings were scored as 5 points. This scoring system had a sensitivity of 71% and a specificity of 76.3% for a cut-off value of >2, with a total score of 10 (p< 0.001). Conclusion: The predictive scoring system could accurately predict the diagnosis of COVID-19 infection, which gave clinicians a theoretical basis for devising immediate treatment options. An evaluation of the predictive