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Öğe Anaphylaxis: Turkish National Guideline 2018(Bilimsel Tip Yayinevi, 2018) Orhan, Fazil; Civelek, Ersoy; Sahiner, Umit Murat; Arga, Mustafa; Can, Demet; Calikaner, Ahmet Zafer; Cetinkaya, FeyzullahAnaphylaxis is an acute and potentially fatal systemic reaction that sould be recognized and managed by all helthcare professionals. This is the first national guideline of Turkish National Society of Allergy and Clinical Immunology on diagnosis and management of anaphylaxis. The guideline is prepared by Anaphylaxis Interest Group with the incorporation of 20 allergy/immunology specialists and the epidemiology, etiology, pathophysiology, symptoms and signs, diagnosis/differentials, and acute and long-term management of anaphylaxis are reviewed in detail.Öğe Demographics and clinical characteristic of patients diagnosed with hen’s egg allergy(2019) Topal, Erdem; Arga, Mustafa; Celiksoy, Mehmet Halil; Kaynak, Mustafa Sinan; Duman, Yücel; Demirtas, Semih; Alatas, Cem; Tonbul, Hayrettin; Dalkilic, Huri MaralAim: To assess the demographics, clinical characteristics and natural course of patients diagnosed with hen’s egg allergy.Material and Methods: Patients who were diagnosed with hen’s egg allergy were included in this study. The patients’ medical records were analyzed to collect demographic and clinical data.Result: 88 patients diagnosed with hen’s egg allergy were included in the study. 46 (52.3%) of the patients were male, their median age was 33 months and their median follow-up period was 18 months. 44 (50%) of the patients had comorbid atopic disease. 49 (55.7%) of the children’s parents had a diagnosis of atopic disease, while 5 (5.7 %) had a diagnosis of food allergy. In terms of the patients’ clinical symptoms, 86 (97.7%) had cutaneous symptoms, 16 (18.2%) had gastrointestinal system symptoms, 13 (14.8%) had respiratory system symptoms. In the follow-up, 43 (48.9%) of the patients were found to develop tolerance. When the patients allergic to egg white and those allergic to egg yolk were compared in terms of clinical findings, atopic eczema exacerbation was found to be more frequent (p=0.012) in patients allergic to egg white; while urticaria (p=0.005) and cough (p=0.012) were found to be more frequent in patients allergic to egg yolk.Conclusion: In clinical presentations that develop as a result of egg allergy, the most frequent symptoms are dermatological, gastrointestinal system and respiratory system symptoms, respectively. However, while atopic eczema exacerbations are more frequent in patients allergic to egg white, symptoms related with respiratory tract are more common in patients allergic to egg yolk. Keywords: Allergy; Cow’s Milk; Persistence; Predictive Factors; Tolerance.Öğe Demographics and clinical characteristic of patients diagnosed with hen’s egg allergy(2019) Topal, Erdem; Arga, Mustafa; Çeliksoy, Mehmet Halil; Kaynak, Mustafa Sinan; Duman, Yücel; Demirtaş, Hasan; Alataş, Cem; Tonbul, Hayrettin; Maral Dalkılıc, HuriAbstract: Aim: To assess the demographics, clinical characteristics and natural course of patients diagnosed with hen’s egg allergy. Material and Methods: Patients who were diagnosed with hen’s egg allergy were included in this study. The patients’ medical records were analyzed to collect demographic and clinical data. Result: 88 patients diagnosed with hen’s egg allergy were included in the study. 46 (52.3%) of the patients were male, their median age was 33 months and their median follow-up period was 18 months. 44 (50%) of the patients had comorbid atopic disease. 49 (55.7%) of the children’s parents had a diagnosis of atopic disease, while 5 (5.7 %) had a diagnosis of food allergy. In terms of the patients’ clinical symptoms, 86 (97.7%) had cutaneous symptoms, 16 (18.2%) had gastrointestinal system symptoms, 13 (14.8%) had respiratory system symptoms. In the follow-up, 43 (48.9%) of the patients were found to develop tolerance. When the patients allergic to egg white and those allergic to egg yolk were compared in terms of clinical findings, atopic eczema exacerbation was found to be more frequent (p=0.012) in patients allergic to egg white; while urticaria (p=0.005) and cough (p=0.012) were found to be more frequent in patients allergic to egg yolk. Conclusion: In clinical presentations that develop as a result of egg allergy, the most frequent symptoms are dermatological, gastrointestinal system and respiratory system symptoms, respectively. However, while atopic eczema exacerbations are more frequent in patients allergic to egg white, symptoms related with respiratory tract are more common in patients allergic to egg yolk.Öğe Effects of modifying visual inhaler spacer usage instructions on correct usage rate of untrained users(Wiley, 2020) Topal, Erdem; Arga, Mustafa; Ozmen, Hakan; Dogru, Mahmut; Alatas, Cem; Mustu, Elif Busra; Celiksoy, Mehmet HalilBackground Pressurized metered-dose inhalers (pMDIs) used with spacers are considered the method of choice for delivery of inhaled drugs in preschool-age children. The aim of this study was to determine the effects of modifying the visual inhaler spacer usage guidelines on the correct usage rate. Methods The parents and caregivers of patients <6 years old who were prescribed inhalers with spacers for the first time were included in our study. The participants were randomly divided into a modified visual inhaler spacer usage guidelines group and an unmodified visual inhaler spacer usage guidelines group. All study participants underwent face-to-face interviews and completed questionnaires. Results A total of 510 participants with a median age of 31 (range, 20-46) years were included in this study. The modified visual guidelines group included 254 (49.6%) participants, and the unmodified visual guidelines group included 256 (50.4%) participants. One hundred sixty-five (65.2%) of the 254 participants in the modified visual guidelines group correctly demonstrated the inhaler spacer technique. In contrast, only 21 (8.2%) of the 256 participants in the unmodified visual guidelines group correctly demonstrated the inhaler spacer technique (p < 0.001). When comparing the inhaler spacer usage steps between the 2 groups, the modified visual guidelines group demonstrated the steps more correctly and more quickly (p < 0.001). Conclusion The current visual inhaler spacer usage guidelines are insufficient. We believe that improving the visual inhaler spacer usage guidelines, in particular, will increase the correct usage rate and decrease the number of usage errors.Öğe Experiences and attitudes of parents of children with cow's milk and other food-allergy(Codon Publications, 2022) Karakurt, Tuba; Bozkurt, Hayrunnisa Bekis; Kaplan, Fatih; Aksit, Anil; Cavkaytar, Ozlem; Topal, Erdem; Arga, MustafaIntroduction and objective: The attitude and behaviors of parents are important in the management of children with food allergy (FA). The aim of this study is to evaluate the experiences and attitudes of parents of children with allergy to cow's milk and other FA. Materials and methods: The parents of children with FA were asked to complete an 18-item questionnaire to evaluate the FA history and experiences during diagnosis, treatment, and follow up. Results: The data from 558 (91.2%) survey questionnaire that were filled completely were analyzed. The mean age of the parents was 33.4+4.9. It was found that most common food allergen was cow's milk (85.3%). The mean time to diagnosis from the onset of symptoms was 10.9 +/- 18.4 months. Around 229 parents (41.6%) admitted to at least four different physicians and 68 (12.3%) parents admitted to at least five different physicians before diagnosis. The median time to diagnosis from the onset of symptoms was five (1-108) months in the patients admitted to four or more physicians, but it was one (1.48) month in the patients that admitted to less physicians (p<0.001). The most common symptoms were dermatitis and mucus-bloody stool, the least common ones were cardiovascular symptoms. Only 21.1% of the patients were able to use hypoallergenic formulas (HAF) in accordance with the recommendation of the physician. Conclusions: Delayed diagnosis of FA is a major concern, and during this period the patients admit many physicians. A majority of the patients with CMPA experience difficulties while using HAFs, and only one-fifth of them is able to use formula regularly. (C) 2022 Codon Publications. Published by Codon Publications.Öğe Factors affecting formula compliance of infants with IgE mediated cow's milk protein allergy during the pandemic(Frontiers Media Sa, 2023) Uygun, Dilara Kocacik; Karaatmaca, Betul; Topal, Erdem; Arga, Mustafa; Sancakli, Ozlem; Ozcan, Dilek; Igde, MahirIntroductionCow's milk protein allergy (CMPA) is the most commonly encountered food allergy in the world, usually seen in infants under the age of 2 years. This study aims to determine the factors including COVID-19 affecting formula compliance of CMPA patients.MethodsThis study is a prospective, observational study based on 10 different Paediatric Allergy-Immunology clinics in Turkey. Patients aged between 6 months and 2 years, who were followed up with IgE-mediated CMPA treatment or newly diagnosed and using breast milk and/or formula were included in the study. The sociodemographic characteristics of the patients, their symptoms, the treatments they received, and the effects of the COVID-19 pandemic on adherence to formula were evaluated with a questionnaire administered to the parents.ResultsThe compliance rate for formula-based treatment was 30.8% (IQR: 28.3, SD: 21.86). The number of patients with a single and multiple food allergy was 127 (51.6%) and 71 (28.9%), respectively. Breastfeeding duration, daily amount of prescribed formula and addition of sweetener to the formula were found to reduce compliance (p = 0.010, p = 0.003, and p = 0.004, respectively). However, it was determined that the patient's height, weight, age at diagnosis, and age of formula onset did not have a significant effect on compliance.ConclusionIt was found that the duration of breastfeeding, the increase in the daily amount of formula requirement, and the addition of sweeteners had adverse effects on formula compliance. There was no significant correlation between the formula adherence of CMPA patients and the pandemic.Öğe Food-induced anaphylaxis in early childhood and factors associated with its severity(Ocean Side Publications Inc, 2021) Aydogan, Metin; Topal, Erdem; Yakici, Nalan; Acar, Hazal Cansu; Demirkale, Zeynep Hizli; Arga, Mustafa; Uysal, PinarBackground: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (inter quartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.Öğe Healthcare workers' knowledge level regarding anaphylaxis and usage of epinephrine auto-injectors(Turkish J Pediatrics, 2021) Arga, Mustafa; Topal, Erdem; Yilmaz, Sila; Erdemli, Pinar Canizci; Bicakci, Kubra; Bakirtas, ArzuBackground. Inadequate practices in diagnosis and management of anaphylaxis in parallel with an increase in its prevalence may cause serious public health problems today. This is the first study aiming to assess the theoretical knowledge of professional and non-professional healthcare workers from different lines of the healthcare service chain about anaphylaxis management, and their practice approaches for epinephrine autoinjectors (EAIs) together. Methods. The study included 697 participants comprising physicians, dentists, pharmacists, and school staff. In face-to-face interviews, each participant was asked to fill out the questionnaire forms prepared for assessing their demographic characteristics, experience with a case of anaphylaxis and EAI and theoretical knowledge about the diagnosis and treatment of anaphylaxis, and to demonstrate how to use EAI in practice with trainer device. Results. The rates of 391 physicians, 98 dentists, 102 pharmacists and 105 school staff of knowing the diagnosis criteria of anaphylaxis were 47.6%, 31.6%, 31.1%, 19%, and knowing the first and life-saving treatment of anaphylaxis were 87.2%, 79.6%, 47.6%,15.2%, respectively. Predictors that affected physicians in knowing the first and life-saving treatment of anaphylaxis were having experience with EAIs [OR:5.5, (%95a1.330-23.351, p=0.015)1 and a case of anaphylaxis [OR:2.4, (%95CI:1.442-4.020, p=0.001)1, and knowing the administration route of epinephrine correctly [OR:1.9, (%95CI:1.191-3.314, 1,1008)]. 31.1% of the participants demonstrated the EAI usage correctly. The EAI usage steps with the most errors were Place the appropriate injection tip into outer thigh/Press the trigger so it 'clicks' and Turn the trigger to arrow direction (60.3% and 34.9%, respectively). Conclusions. Healthcare workers' knowledge level regarding anaphylaxis management and ability to use EAIs correctly are not adequate. That most errors were made in the same steps of EAI usage indicates that the industry should continue to strive for developing the ideal life-saving device.Öğe Independent predictive factors for the persistence and tolerance of cow's milk allergy(Wiley, 2019) Topal, Erdem; Celiksoy, Mehmet Halil; Arga, Mustafa; Kaynak, Mustafa Sinan; Duman, Yucel; Demirtas, Semih; Alatas, CemBackground Cow's milk protein allergy (CMPA) is usually transient, with most children tolerating ingested cow's milk by 3 years of age. This study aimed to determine factors that promote or hindering the development of tolerance to CMPA. Methods A logistic regression model was used to determine independent risk factors associated with tolerance and persistence of CMPA. Result A total of 178 children diagnosed with CMPA were included in the study. The patients' median age was 32 months (minimum-maximum, 14 to 144 months), and their median follow-up period was 30 months (minimum-maximum, 12 to 54 months). In the follow-up, CMPA persisted in 62 (34.8%) patients. The patients were divided into 2 groups according to patient's age. Group I was <3 years old and group II was >= 3 years old. The factors independently associated with the persistence of CMPA for group I were as follows: comorbid food allergies (p = 0.021), the presence of an immunoglobulin E (IgE)-mediated reaction (p = 0.001), and respiratory system symptoms (ie, tachypnea) (p = 0.036). The presence of gastrointestinal-related discomfort (p = 0.001) was an independent risk factor associated with the development of tolerance. The presence of comorbid food allergies (p = 0.03) was the only independent predictive factor for CMPA persistence for group II. Conclusion The prognosis in cases of CMPA, a food allergy, is good, with tolerance developing over time. The presence of IgE-mediated CMPA, respiratory-related symptoms (ie, tachypnea), and the presence of comorbid food allergies have negative effects on tolerance.Öğe The pharmacists' ability to use pressurized metered-dose inhalers with a spacer device and factors affecting it(Taylor & Francis Ltd, 2021) Topal, Erdem; Arga, Mustafa; Ozmen, Abdullah Hakan; Kursun, Muhammet Arif; Ilhan, Omer Adil; Alici, MustafaObjective: The aim of this study is to evaluate the pharmacists' ability to use pMDIs with a spacer device and the factors that affect this ability. Method: Face to face interviews were conducted with the pharmacists. A nine item questionnaire was completed and the checklist for how to use pMDIs with a spacer device was filled out. Results: A total of 307 pharmacists voluntarily participated in this study. Fifty-six (18.2%) of the pharmacists stated that they did not know how to use pMDIs with a spacer device. These pharmacists were excluded and remaining 251 pharmacists included in the study. Only 100 (39.8%) pharmacists demonstrated all of the inhaler spacer device usage steps correctly. The step in which pharmacists made the most mistakes was take 5-6 deep and slow breaths, hold for 10 s and slow breaths. Those pharmacists who were more likely to correctly use pMDIs with a spacer device were younger (p = 0.023), had dispensed more asthma medications per day (p < 0.001), had dispensed more asthma medications per day for patients younger than six years of age (p = 0.016), and sold inhaler spacer devices at their pharmacy (p = 0.042). Conclusion: Approximately one third of the pharmacists in the current study were able to correctly demonstrate all of the steps for proper usage of pMDIs with a spacer device, which indicates that pharmacists should be included in the training program and be provided continuous training on the use of pMDIs with a spacer device.Öğe Subcutaneous allergen-specific immunotherapy with Gramineae pollen in children with allergic rhinoconjunctivitis(2023) Yılmaz, Ercan; Topal, Erdem; Karagol, Hacer Ilbilge Ertoy; Ozbey, Mehmet Yavuz; Cavkaytar, Ozlem; Arga, MustafaAim: Patients experiencing persistent complaints of moderate-severe allergic rhinoconjunctivitis despite symptomatic treatment are considered candidates for Allergen Specific Immunotherapy (ASIT). The present study aims to assess the effectiveness and safety of ASIT using Gramineae pollen in children afflicted by allergic rhinoconjunctivitis. Materials and Methods: The study involved participants between 5 and 18 years of age who had allergic rhinoconjunctivitis. These participants were divided into two distinct groups. The initial group underwent ASIT, while the other constituted the control group that refrained from it. The control group comprised participants with akin ages and equivalent disease durations. Visual analog scores (VAS), daily symptom scores (dSS), daily medication scores (dMS), and combined symptom and medication scores (CSMS) were assessed at three specific time junctures: Baseline, post the initial year of ASIT, and after the second year of ASIT. Results: The study encompassed 188 children who had been diagnosed with allergic rhinoconjunctivitis. Among these, 94 patients had undergone immunotherapy. Of the total cases, 105 (55.9%) were male, with a median age of 14 years (range: 7-18 years). Among the patients who had received ASIT, there were statistically significant reductions in VAS, dSS, dMS, and CSMS after one and two years of therapy when compared to the baseline values (p<0.001). Upon comparing the group receiving ASIT with the control group after a two-year follow-up, notable reductions were observed in VAS, dSS, dMS, and CSMS (p<0.001). Five patients (5.3%) experienced systemic reactions. Conclusion: The current study demonstrated that ASIT with Gramineae pollen is clinically effective in patients with Graminae pollen-induced allergic rhinoconjunctivitis.
