Introduction and objectives: As well as increased susceptibility to infections, autoimmune and in... more Introduction and objectives: As well as increased susceptibility to infections, autoimmune and inflammatory manifestations also eventuate due to dysregulation of immune system in a substantial proportion of patients with primary immunodeficiency (PID). Autoimmune and inflammatory manifestations can occur prior or after diagnosis of PID. This study aimed to evaluate autoimmune and inflammatory complications among all types of PID patients in childhood and to emphasize the importance of these findings as a warning sign to diagnose PIDs. Methods: Medical records of 1036 patients with PID, followed up between 2003 and 2019, were retrospectively screened for occurrence of autoimmunity and inflammation. During this time, demographic features, autoimmune/inflammatory findings and initial time, genetic mutations, laboratory and clinical follow up findings, treatment regimens and outcomes were recorded. Results: Autoimmune and inflammatory manifestations were observed in 83 patients (10.1%). The median age of autoimmunity initial time was 61.3 ± 53 months. Sixty-seven (80.7%) patients presented with autoimmune and inflammatory manifestations, and these findings had occurred during 16 patients' (19.3%) follow-up. The most common autoimmune manifestations were autoimmune hematologic (51.8%) and endocrine diseases (26.5%). Fifty patients (60.2%) had a single autoimmune/inflammatory manifestation, however 23 patients (27.7%
İzmir tepecik eğitim hastanesi dergisi, Dec 5, 2022
Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obs... more Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obstrüksiyonu ile karakterize enflamatuvar bir hastalıktır. Çalışmamızda astım tanısı kesinleştirilen çocukların ilk kez astım semptomlarının hangi yaşta başladığının ve ailelerin ilk kez çocuklarının tanısı ile ilgili ne zaman bilgilendirildiklerinin belirlenmesi, dolayısıyla hastaların kesin astım tanısı almaları için geçen sürenin tespit edilmesi amaçlanmıştır.
The Journal of Tepecik Education and Research Hospital
Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obs... more Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obstrüksiyonu ile karakterize enflamatuvar bir hastalıktır. Çalışmamızda astım tanısı kesinleştirilen çocukların ilk kez astım semptomlarının hangi yaşta başladığının ve ailelerin ilk kez çocuklarının tanısı ile ilgili ne zaman bilgilendirildiklerinin belirlenmesi, dolayısıyla hastaların kesin astım tanısı almaları için geçen sürenin tespit edilmesi amaçlanmıştır.
Acute asthma exacerbations (AAE) are episodes characterized by potentially life-threatening and r... more Acute asthma exacerbations (AAE) are episodes characterized by potentially life-threatening and rapidly deteriorating asthma symptoms. Viral respiratory infections are one of the major triggers in the pathophysiology of childhood asthma exacerbations. In this study, we aimed to determine the distribution of viral agents among pediatric AAE patients. One hundred and three AAE patients, aged 5 or older, hospitalized between from February 2017 through February 2020 at Pediatric Immunology and Allergic Diseases Unit were included in this study. Fifty patients (48.5%) were female, and the mean age of the patients was 108.2 months. Viruses were detected in 58 (%56.3) of the patients, in 5 of whom more than one virus type was detected. The most commonly detected virus was human rhinovirus (n=43, 67.1%). Other types included respiratory syncytial virus (n=8; 12.5%), influenza (n=6; 9.3%), human metapneumovirus (n=4; 6.2%), adenovirus (n=1; 1.5%), enterovirus (n=1; 1.5%), and parainfluenza (...
Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) -- JUN 01-05, 2019 --... more Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) -- JUN 01-05, 2019 -- Lisbon, PORTUGALWOS: 000480254003261European Acad Allergy & Clin Immuno
Background: Drug allergies are reactions within the context of drug hypersensitivity reactions, w... more Background: Drug allergies are reactions within the context of drug hypersensitivity reactions, which are caused by immunological mechanisms due to a previously sensitising drug. Beta-lactam antibiotics (BLA) are the leading agents causing drug hypersensitivity reactions in children. The aim of this study is to evaluate the diagnostic importance of in vivo and in vitro diagnostic tests in children with suspected immediate-type BLA hypersensitivity and to investigate the frequency of their use for the final diagnosis. Methods: Patients admitted to the Outpatient Clinic of Division of Paediatric Allergy and Immunology with suspicion of immediate-type BLA hypersensitivity between December 2014 and December 2018 were investigated. Patients with a history of immediate reactions to BLA were examined by performing drug specific IgE, skin prick tests, intradermal tests and drug provocation tests (DPT). Results: During the study period, 148 patients were admitted to our clinic with suspected immediate-type BLA hypersensitivity. Forty-eight patients completed all assessment steps and were enrolled in the study. It has been shown that 27 patients did not have drug allergy. BLA hypersensitivity was proven in 21 patients by using in vivo test algorithm. More than half of the patients were diagnosed via skin tests with culprit drug. Conclusion: Allergy work-up should be performed in patients with immediate reactions to BLA. A skin test can demonstrate BLA hypersensitivity in most patients. Thus, skin tests should be performed prior to the drug provocation test.
Journal of Pediatric Gastroenterology & Nutrition, 2020
Objective: Continued progress in our understanding of the food protein–induced allergic proctocol... more Objective: Continued progress in our understanding of the food protein–induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course since influencing parameters has not yet been established. Methods: Infants who were admitted with rectal bleeding and had a diagnosis of food protein–induced allergic proctocolitis in 5 different allergy or gastroenterology outpatient clinics were enrolled. Clinical features, laboratory tests, and prognosis were evaluated. Risk factors for persistent course were determined by logistic regression analyses. Results: Among the 257 infants, 50.2% (n = 129) were girls and cow's milk (99.2%) was the most common trigger. Twenty-four percent of the patients had multiple food allergies and had more common antibiotic use (41.9% vs...
Somekh and colleagues identify CD137, a member of the tumor necrosis factor superfamily, as a nov... more Somekh and colleagues identify CD137, a member of the tumor necrosis factor superfamily, as a novel cause of immunodeficiency associated with a risk of autoimmunity and lymphoid malignancy.
Background: It is known that platelets play an important role in inflammatory diseases. Atopic de... more Background: It is known that platelets play an important role in inflammatory diseases. Atopic dermatitis (AD) is a chronic, itchy, recurrent inflammatory skin disease that affects 2%-30% of the population, especially in childhood. Aims: We investigated the role of platelet count and mean platelet volume (MPV) as biomarkers in children with AD. Methods: This cross-sectional retrospective study examined the medical reports of patients who were referred to the Pediatric Allergy and Immunology Outpatient Clinic of the Medical Faculty Hospital, Istanbul Biruni University and the Pediatric Immunology and Allergy Diseases Outpatient Clinics of the Izmir S.B.U Tepecik Training and Research Hospital, for AD. A total of 167 children with AD and 170 healthy children were included in the study. Results: Among all participants, 36.5% (n = 61) and 31.8% (n = 54) were female in the patient and control groups, respectively. The mean age was 2.8 ± 2.8 and 3.3 ± 2.5 years in the patient and control groups, respectively. MPV was statistically significantly higher in the patient group than in the control group (P =0.003). Mean platelet to neutrophil ratio and mean absolute lymphocyte count values were significantly higher in the patient group (P <.0001 for both values). However, the mean absolute neutrophil count was lower in the patient group than in the control group and it was considered statistically significant (P <.0001). Conclusion: In conclusion, we found significantly higher platelet counts in patients with AD. The decrease in the neutrophil to lymphocyte ratio rate was remarkable. However, there was no significant difference in the MPV values between the patient and control groups.
Objective: In a large group of patients with primary immunodeficiency (PID), immunoglobulin repla... more Objective: In a large group of patients with primary immunodeficiency (PID), immunoglobulin replacement therapy is critical for infection control. There are two main methods of immunoglobulin replacement intravenous (IVIG) and subcutaneous (SCIG). The aim of this study was to determine the efficacy of SCIG by comparing IgG levels and frequency of infections obtained during SCIG replacements in patients with PID with those obtained during IVIG administration. Method: Immunoglobulin levels of 28 patients who were followed up in our clinic with a diagnosis of PID and who started IVIG replacement and switched to SCIG replacement after follow-up, were evaluated retrospectively. Serum IgG levels and frequency of infections before starting immunoglobulin treatment, the previous year of IVIG before starting SCIG replacement, and during the first six months, second six months, and second year of SCIG replacement were compared. Results: The mean age of all the patients that received SCIG was 10.5 years (min 15 months, max 23 years) and eleven of the patients were female. The mean serum IgG level of the patients before starting immunoglobulin replacement was 701±383 mg/dl, and for the final year they received IVIG replacement before switching to SCIG replacement it was calculated to be 900±342 mg/dl. The mean value was found to be 1082±312 mg/dl in the first six months after the initiation of SCIG, 1102±287 mg/dl in the second six months, and 1145±311 mg/dl in the second year. Serum IgG levels of the patients were significantly higher during IVIG and SCIG replacement than before treatment (p<0.05). Serum IgG levels during the first six months, second six months, and second year of SCIG treatment were significantly higher than levels during IVIG treatment (p=0.000, p=0.003, and p=0.002, respectively). Conclusion: Compared to IVIG replacement, significantly higher and more stable serum IgG levels can be obtained with SCIG replacement. This is expected to ensure improved outcomes in the management of infections in PID patients.
Introduction and objectives: The purpose of this study was to evaluate patients diagnosed with 22... more Introduction and objectives: The purpose of this study was to evaluate patients diagnosed with 22q11.2 deletion syndrome and determine the clues directing to diagnosis and evaluation of immunological findings for excellent management of the disease. Material and methods: Thirty-three pediatric patients with 22q11.2 deletion syndrome diag-nosed between 1998 and 2019 at Pediatric Immunology Division of Ege University Faculty of Medicine and SBU Izmir Dr Behcet Uz Children’s Education and Research Hospital were evaluated. Results: This study includes the largest case series reported from Turkey. Congenital car-diac anomalies were the most common pathology associated with the syndrome (90.9%). Hypocalcemic symptoms were observed in 13 patients (40%). Twenty-two of the 33 (66.6%) patients were diagnosed before two years of age. Autoimmune diseases, dysmorphic facial findings, recurrent infections, growth retardation, and speech impairment were other clues for diagnosis in older patients....
Journal of Dr. Behcet Uz Children s Hospital, 2021
Objective: Asthma is one of the most common chronic diseases of childhood. Many studies have show... more Objective: Asthma is one of the most common chronic diseases of childhood. Many studies have shown that education positively affects asthma control and patients’ quality of life. In this study, it was aimed to measure the awareness levels of children who have been under observation for a long time and who underwent Allergen Specific Immunotherapy (AIT). Methods: Patients with asthma, asthma & allergic rhinitis and/or rhinoconjunctivitis who received subcutaneous AIT between July 2019 and December 2019 were included in our prospective case-control study. A questionnaire was applied to each patient, in which both the levels of awareness related to their disease and AIT, as well as their knowledge of the allergens and prevention measures they were sensitive to were measured. The results were examined. Age, gender, type of allergic diseases, allergen type, AIT time were evaluated statistically. Results: 82 cases (48 boys and 34 girls) were included in the study. The number of patients w...
Introduction and objectives: As well as increased susceptibility to infections, autoimmune and in... more Introduction and objectives: As well as increased susceptibility to infections, autoimmune and inflammatory manifestations also eventuate due to dysregulation of immune system in a substantial proportion of patients with primary immunodeficiency (PID). Autoimmune and inflammatory manifestations can occur prior or after diagnosis of PID. This study aimed to evaluate autoimmune and inflammatory complications among all types of PID patients in childhood and to emphasize the importance of these findings as a warning sign to diagnose PIDs. Methods: Medical records of 1036 patients with PID, followed up between 2003 and 2019, were retrospectively screened for occurrence of autoimmunity and inflammation. During this time, demographic features, autoimmune/inflammatory findings and initial time, genetic mutations, laboratory and clinical follow up findings, treatment regimens and outcomes were recorded. Results: Autoimmune and inflammatory manifestations were observed in 83 patients (10.1%). The median age of autoimmunity initial time was 61.3 ± 53 months. Sixty-seven (80.7%) patients presented with autoimmune and inflammatory manifestations, and these findings had occurred during 16 patients' (19.3%) follow-up. The most common autoimmune manifestations were autoimmune hematologic (51.8%) and endocrine diseases (26.5%). Fifty patients (60.2%) had a single autoimmune/inflammatory manifestation, however 23 patients (27.7%
İzmir tepecik eğitim hastanesi dergisi, Dec 5, 2022
Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obs... more Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obstrüksiyonu ile karakterize enflamatuvar bir hastalıktır. Çalışmamızda astım tanısı kesinleştirilen çocukların ilk kez astım semptomlarının hangi yaşta başladığının ve ailelerin ilk kez çocuklarının tanısı ile ilgili ne zaman bilgilendirildiklerinin belirlenmesi, dolayısıyla hastaların kesin astım tanısı almaları için geçen sürenin tespit edilmesi amaçlanmıştır.
The Journal of Tepecik Education and Research Hospital
Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obs... more Amaç: Astım, çocukluk çağı kronik hastalıkları arasında en sık görülen ve reversibl hava yolu obstrüksiyonu ile karakterize enflamatuvar bir hastalıktır. Çalışmamızda astım tanısı kesinleştirilen çocukların ilk kez astım semptomlarının hangi yaşta başladığının ve ailelerin ilk kez çocuklarının tanısı ile ilgili ne zaman bilgilendirildiklerinin belirlenmesi, dolayısıyla hastaların kesin astım tanısı almaları için geçen sürenin tespit edilmesi amaçlanmıştır.
Acute asthma exacerbations (AAE) are episodes characterized by potentially life-threatening and r... more Acute asthma exacerbations (AAE) are episodes characterized by potentially life-threatening and rapidly deteriorating asthma symptoms. Viral respiratory infections are one of the major triggers in the pathophysiology of childhood asthma exacerbations. In this study, we aimed to determine the distribution of viral agents among pediatric AAE patients. One hundred and three AAE patients, aged 5 or older, hospitalized between from February 2017 through February 2020 at Pediatric Immunology and Allergic Diseases Unit were included in this study. Fifty patients (48.5%) were female, and the mean age of the patients was 108.2 months. Viruses were detected in 58 (%56.3) of the patients, in 5 of whom more than one virus type was detected. The most commonly detected virus was human rhinovirus (n=43, 67.1%). Other types included respiratory syncytial virus (n=8; 12.5%), influenza (n=6; 9.3%), human metapneumovirus (n=4; 6.2%), adenovirus (n=1; 1.5%), enterovirus (n=1; 1.5%), and parainfluenza (...
Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) -- JUN 01-05, 2019 --... more Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) -- JUN 01-05, 2019 -- Lisbon, PORTUGALWOS: 000480254003261European Acad Allergy & Clin Immuno
Background: Drug allergies are reactions within the context of drug hypersensitivity reactions, w... more Background: Drug allergies are reactions within the context of drug hypersensitivity reactions, which are caused by immunological mechanisms due to a previously sensitising drug. Beta-lactam antibiotics (BLA) are the leading agents causing drug hypersensitivity reactions in children. The aim of this study is to evaluate the diagnostic importance of in vivo and in vitro diagnostic tests in children with suspected immediate-type BLA hypersensitivity and to investigate the frequency of their use for the final diagnosis. Methods: Patients admitted to the Outpatient Clinic of Division of Paediatric Allergy and Immunology with suspicion of immediate-type BLA hypersensitivity between December 2014 and December 2018 were investigated. Patients with a history of immediate reactions to BLA were examined by performing drug specific IgE, skin prick tests, intradermal tests and drug provocation tests (DPT). Results: During the study period, 148 patients were admitted to our clinic with suspected immediate-type BLA hypersensitivity. Forty-eight patients completed all assessment steps and were enrolled in the study. It has been shown that 27 patients did not have drug allergy. BLA hypersensitivity was proven in 21 patients by using in vivo test algorithm. More than half of the patients were diagnosed via skin tests with culprit drug. Conclusion: Allergy work-up should be performed in patients with immediate reactions to BLA. A skin test can demonstrate BLA hypersensitivity in most patients. Thus, skin tests should be performed prior to the drug provocation test.
Journal of Pediatric Gastroenterology & Nutrition, 2020
Objective: Continued progress in our understanding of the food protein–induced allergic proctocol... more Objective: Continued progress in our understanding of the food protein–induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course since influencing parameters has not yet been established. Methods: Infants who were admitted with rectal bleeding and had a diagnosis of food protein–induced allergic proctocolitis in 5 different allergy or gastroenterology outpatient clinics were enrolled. Clinical features, laboratory tests, and prognosis were evaluated. Risk factors for persistent course were determined by logistic regression analyses. Results: Among the 257 infants, 50.2% (n = 129) were girls and cow's milk (99.2%) was the most common trigger. Twenty-four percent of the patients had multiple food allergies and had more common antibiotic use (41.9% vs...
Somekh and colleagues identify CD137, a member of the tumor necrosis factor superfamily, as a nov... more Somekh and colleagues identify CD137, a member of the tumor necrosis factor superfamily, as a novel cause of immunodeficiency associated with a risk of autoimmunity and lymphoid malignancy.
Background: It is known that platelets play an important role in inflammatory diseases. Atopic de... more Background: It is known that platelets play an important role in inflammatory diseases. Atopic dermatitis (AD) is a chronic, itchy, recurrent inflammatory skin disease that affects 2%-30% of the population, especially in childhood. Aims: We investigated the role of platelet count and mean platelet volume (MPV) as biomarkers in children with AD. Methods: This cross-sectional retrospective study examined the medical reports of patients who were referred to the Pediatric Allergy and Immunology Outpatient Clinic of the Medical Faculty Hospital, Istanbul Biruni University and the Pediatric Immunology and Allergy Diseases Outpatient Clinics of the Izmir S.B.U Tepecik Training and Research Hospital, for AD. A total of 167 children with AD and 170 healthy children were included in the study. Results: Among all participants, 36.5% (n = 61) and 31.8% (n = 54) were female in the patient and control groups, respectively. The mean age was 2.8 ± 2.8 and 3.3 ± 2.5 years in the patient and control groups, respectively. MPV was statistically significantly higher in the patient group than in the control group (P =0.003). Mean platelet to neutrophil ratio and mean absolute lymphocyte count values were significantly higher in the patient group (P <.0001 for both values). However, the mean absolute neutrophil count was lower in the patient group than in the control group and it was considered statistically significant (P <.0001). Conclusion: In conclusion, we found significantly higher platelet counts in patients with AD. The decrease in the neutrophil to lymphocyte ratio rate was remarkable. However, there was no significant difference in the MPV values between the patient and control groups.
Objective: In a large group of patients with primary immunodeficiency (PID), immunoglobulin repla... more Objective: In a large group of patients with primary immunodeficiency (PID), immunoglobulin replacement therapy is critical for infection control. There are two main methods of immunoglobulin replacement intravenous (IVIG) and subcutaneous (SCIG). The aim of this study was to determine the efficacy of SCIG by comparing IgG levels and frequency of infections obtained during SCIG replacements in patients with PID with those obtained during IVIG administration. Method: Immunoglobulin levels of 28 patients who were followed up in our clinic with a diagnosis of PID and who started IVIG replacement and switched to SCIG replacement after follow-up, were evaluated retrospectively. Serum IgG levels and frequency of infections before starting immunoglobulin treatment, the previous year of IVIG before starting SCIG replacement, and during the first six months, second six months, and second year of SCIG replacement were compared. Results: The mean age of all the patients that received SCIG was 10.5 years (min 15 months, max 23 years) and eleven of the patients were female. The mean serum IgG level of the patients before starting immunoglobulin replacement was 701±383 mg/dl, and for the final year they received IVIG replacement before switching to SCIG replacement it was calculated to be 900±342 mg/dl. The mean value was found to be 1082±312 mg/dl in the first six months after the initiation of SCIG, 1102±287 mg/dl in the second six months, and 1145±311 mg/dl in the second year. Serum IgG levels of the patients were significantly higher during IVIG and SCIG replacement than before treatment (p<0.05). Serum IgG levels during the first six months, second six months, and second year of SCIG treatment were significantly higher than levels during IVIG treatment (p=0.000, p=0.003, and p=0.002, respectively). Conclusion: Compared to IVIG replacement, significantly higher and more stable serum IgG levels can be obtained with SCIG replacement. This is expected to ensure improved outcomes in the management of infections in PID patients.
Introduction and objectives: The purpose of this study was to evaluate patients diagnosed with 22... more Introduction and objectives: The purpose of this study was to evaluate patients diagnosed with 22q11.2 deletion syndrome and determine the clues directing to diagnosis and evaluation of immunological findings for excellent management of the disease. Material and methods: Thirty-three pediatric patients with 22q11.2 deletion syndrome diag-nosed between 1998 and 2019 at Pediatric Immunology Division of Ege University Faculty of Medicine and SBU Izmir Dr Behcet Uz Children’s Education and Research Hospital were evaluated. Results: This study includes the largest case series reported from Turkey. Congenital car-diac anomalies were the most common pathology associated with the syndrome (90.9%). Hypocalcemic symptoms were observed in 13 patients (40%). Twenty-two of the 33 (66.6%) patients were diagnosed before two years of age. Autoimmune diseases, dysmorphic facial findings, recurrent infections, growth retardation, and speech impairment were other clues for diagnosis in older patients....
Journal of Dr. Behcet Uz Children s Hospital, 2021
Objective: Asthma is one of the most common chronic diseases of childhood. Many studies have show... more Objective: Asthma is one of the most common chronic diseases of childhood. Many studies have shown that education positively affects asthma control and patients’ quality of life. In this study, it was aimed to measure the awareness levels of children who have been under observation for a long time and who underwent Allergen Specific Immunotherapy (AIT). Methods: Patients with asthma, asthma & allergic rhinitis and/or rhinoconjunctivitis who received subcutaneous AIT between July 2019 and December 2019 were included in our prospective case-control study. A questionnaire was applied to each patient, in which both the levels of awareness related to their disease and AIT, as well as their knowledge of the allergens and prevention measures they were sensitive to were measured. The results were examined. Age, gender, type of allergic diseases, allergen type, AIT time were evaluated statistically. Results: 82 cases (48 boys and 34 girls) were included in the study. The number of patients w...
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Papers by Ömer AKÇAL