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    Allergic Diseases as a Clinical Phenotype Marker in Patients with Common Variable Immunodeficiency
    (Karger, 2023) Yildiz, Eray; Colkesen, Fatih; Arslan, Sevket; Evcen, Recep; Aykan, Filiz Sadi; Kilinc, Mehmet
    Introduction: Patients with common variable immunodeficiency (CVID) have been shown to be more predisposed to develop allergic diseases because of mucosal immune defects and immune dysregulation. The aim of this study was to determine the prevalence, and clinical and laboratory characteristics of various allergic diseases in patients with CVID. Methods: The study included patients aged & GE;18 years who were followed up for a diagnosis of CVID. Patients were separated into 5 groups according to the clinical phenotypic characteristics of lymphoproliferation, autoimmunity, gastrointestinal diseases, allergic diseases, and malignancy. Atopic dermatitis (AD), drug hypersensitivity reaction (DHR), allergic rhinitis (AR), and asthma were accepted as allergic diseases. Results: The most commonly seen clinical phenotypes were lymphoproliferation in 41 (48.8%) patients and allergic diseases in 31 (37%). AD was determined in 2 (2.4%) patient, DHR in 5 (6%), AR in 7 (8.3%), and asthma in 21 (25%). The delay in diagnosis of patients with allergic disease was determined to be shorter compared to those without allergic disease (p = 0.042). Serum total immunoglobulin E level, CD19(+) B cell, switched memory B cell, and natural killer cell counts were determined to be higher in the CVID patients with allergic disease compared to those without (p = 0.007, p = 0.022, p = 0.023, p = 0.017, respectively). Conclusion: Allergic diseases should be considered as a marker of clinical phenotype in CVID because of the clinical and immunological differences. Early diagnosis and treatment of allergic diseases in patients with CVID can improve quality of life.
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    Anaphylaxis in older adult patients: a 10-year retrospective experience
    (Elsevier, 2022) Yildiz, Eray; Arslan, Sevket; Coelkesen, Fatih; Evcen, Recep; Aykan, Filiz Sadi; Kilinc, Mehmet
    Background: Despite the worldwide increase in life expectancy and the elderly population, very little is known about the characteristics of anaphylaxis in older adults.Methods: A retrospective scan was made of the files of patients who presented at the Allergy Unit of our clinic between October 2011 and October 2021. The study included 971 patients aged >18 years who met the criteria for diagnosis of anaphylaxis. The patients were separated into 2 groups of adults (18-64 years) and older adults (>65 years).Results: The adult group included 887 (91.3%) patients and the older adult group, 84 (8.7%) patients. Comorbid diseases were seen more frequently in the older adults than in the adult group (p < 0.001). Drugs were seen to be the most common trigger of anaphylaxis in both groups, and this was more common in the older adult group (p = 0.039). Food was a more common trigger of anaphylaxis in the adult group than in the older adult group (p = 0.017). In both groups, the skin was the organ most affected, and was less affected in the older adults than in the adults (p = 0.020). Cardiovascular symptoms were seen significantly more and respiratory symptoms significantly less in the older adult group (p < 0.001, p = 0.002, respectively). Admission to the hospital and the intensive care unit was more frequent in the older adult group and rates of adrenalin administration were higher compared to the adult group (p < 0.001 for all).Conclusion: Anaphylaxis in the older adults is generally caused by drugs. Older adults were found to have more cardiovascular symptoms and more frequent adrenalin injections, hospitalizations and intensive care unit admissions.
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    Evaluation of malnutrition risk and nutrition status in adult patients with common variable immunodeficiency
    (Wiley, 2022) Yildiz, Eray; Arslan, Sevket; Colkesen, Fatih; Aykan, Filiz Sadi; Evcen, Recep; Kilinc, Mehmet; Aytekin, Gokhan
    Background The aim of this study is to determine the prevalence of malnutrition in outpatients with common variable immunodeficiency (CVID) and the utility of nutrition screening tools to detect malnutrition in these patients. Methods Fifty outpatients with CVID were included in the study. Nutrition risk for each patient was evaluated using four nutrition screening tools: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), and Nutritional Risk Screening 2002 (NRS-2002). Results According to MUST, MST, SNAQ, and NRS-2002, malnutrition risk was determined to be 48% (n = 24), 26% (n = 13), 20% (n = 10), and 20% (n = 10), respectively. Malnutrition was detected in 54% (n = 27) of the patients. It was found that MUST showed a better correlation in detecting malnutrition in outpatients with CVID (kappa = 0.482, P = 0.001). MUST has a higher positive and negative predictive value than other nutrition screening tools (79% and 70%, respectively). In the multivariate logistic regression analysis, it was found that low serum immunoglobulin A (IgA) levels at diagnosis increased the risk of malnutrition by similar to 15 times, and low CD19(+) B-cell counts increased the risk by approximately eight times. Conclusion The prevalence of malnutrition in patients with CVID was found to be quite high, and there was a strong correlation between malnutrition and low CD19(+) B-cell counts and low serum IgA levels. Given the high rate of malnutrition in patients with CVID, nutrition assessment is recommended rather than starting with nutrition screening.
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    Evaluation of the Effectiveness of the 6 Warning Signs of the European Society for Immunodeficiencies for Primary Immunodeficiencies in Older Adults
    (Karger, 2024) Yildiz, Eray; Colkesen, Fatih; Evcen, Recep; Aykan, Filiz Sadi; Kilinc, Mehmet; Arslan, Sevket
    Introduction: Diagnostic delay in cases of primary immunodeficiency (PID) is a significant problem for clinicians, and most do not have sufficient awareness of this uncommon disorder. The European Society for Immunodeficiencies (ESID) has developed 6 warning signs to increase awareness of adult PIDs. The aim of this study was to determine the prevalence of PID in older adults regardless of the reason for presentation and to evaluate the effectiveness of the 6 warning signs of ESID in the diagnosis of PIDs. Methods: The study included 1,331 patients aged >= 65 years who presented at our clinic for any reason and were questioned about the ESID 6 warning signs for PIDs. After the exclusion of reasons for secondary immunodeficiency (SID), all the patients underwent immunological evaluation for the diagnosis of potential underlying PIDs. Results: After excluding 6 patients diagnosed with SID, PID was diagnosed in 16 (1.2%) of 1,325 older adults using ESID warning signs. The most common reasons for presentation were infection (69%) in the PID group and urticaria and/or angioedema (41.5%) in the non-PID group. The most common PID subgroup was common variable immunodeficiency (50%). In 12 of the patients diagnosed with PID, there was at least 1 positive ESID warning sign. In 4 patients, PID was determined despite negative ESID warning signs. The patients diagnosed with PID showed a significant, minimal level of agreement with questions 1 and 4 of the ESID warning signs (p < 0.001, kappa = 0.204, p = 0.005, kappa = 0.208, respectively). Conclusion: The ESID warning signs do not encompass all the symptoms and findings of PIDs. There is a need for more infection-centered questions to determine PIDs in older adults. Therefore, the ESID warning signs should be further developed.
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    High digit ratio (2D:4D) is associated with attack frequency and severity in hereditary angioedema patients
    (Elsevier Ireland Ltd, 2023) Evcen, Recep; Colkesen, Fatih; Saygin, Duygu Akin; Aykan, Filiz Sadi; Kilinc, Mehmet; Ergun, Ummugulsum Yilmaz; Akkus, Fatma Arzu
    Background: Hereditary angioedema (HAE) caused by a deficiency or dysfunction of the plasma protease C1inhibitor is a rare autosomal-dominant disorder. We explored a possible correlation between the ratio of the second and fourth finger lengths (2D:4D) and the frequency of HEA attacks, and whether the ratio might predict laryngeal attack. Method: We evaluated 35 HEA patients aged 19 to 66 years; 3 were subsequently excluded. The 2D:4D ratio was calculated by dividing the length of the second finger by that of the fourth finger of both hands. A structured clinical questionnaire exploring HAE course and treatment over the prior year was administered.Results: Of the 32 participants, 56.25 % (n = 18) were female. Of them, those with high 2D:4D ratios suffered significantly more laryngeal attacks than others; 93.3% of patients with high 2D:4D ratios experienced >= 5 attacks annually, significantly more than those with low ratios. Among type 2 HEA patients, 75 % of those experiencing >= 5 attacks annually had high 2D:4D ratios; all patients with low 2D:4D ratios reported <5 attacks annually. These significant effects were found for right-hand 2D:4D ratios and not left-hand 2D:4D ratios.Conclusion: The data suggest that intrauterine sex hormone exposure, which affects the 2D:4D ratio, is significantly associated with HEA attack frequency and severity, and laryngeal edema.
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    Increasing Prevalence of Sensitization to Cat/Dog Allergens in the COVID-19 Pandemic
    (Karger, 2024) Evcen, Recep; Colkesen, Fatih; Yildiz, Eray; Aykan, Filiz Sadi; Kilinc, Mehmet; Akkus, Fatma Arzu; Arslan, Sevket
    Introduction: Cat and dog allergens are common indoor triggers for respiratory allergies such as allergic rhinitis and asthma. This study aims to evaluate the prevalence of cat and dog allergies in adults and analyze changes during the COVID-19 pandemic.Methods: We retrospectively analyzed the medical records of 8,102 patients who visited an allergy clinic and underwent skin prick testing (SPT) from March 2018 to March 2022: 2 years before and 2 years during the pandemic. Demographic information, clinical attributes, and laboratory results were examined based on patient records.Results: Of 8,102 SPTs performed, 400 (4.9%) were sensitized to cat allergen and 289 (3.6%) to dog allergen. Allergic rhinitis was the predominant clinical diagnosis in both groups. Of the 400 subjects exposed to cats, 240 (60%) experienced allergic symptoms, while of the 289 subjects exposed to dogs, 65 (22.5%) experienced allergic symptoms during exposure. Within the cat-sensitized group, anaphylaxis was observed in 5 patients (1.3%), while no cases of anaphylaxis were reported in the dog-sensitized group. Compared to the pre-pandemic period, patients presenting during the pandemic had higher rates of cat and dog sensitization (5.7% vs. 4.1%; p < 0.05, 5.2% vs. 1.7%; p < 0.05).Conclusion: During the COVID-19 pandemic, there was an increase in cat and dog allergies among adults. Increased exposure to pet antigens, both directly and indirectly, has resulted in more people becoming sensitized to cats or dogs.
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    Poor Sleep Quality and Associated Factors in Patients with Common Variable Immunodeficiency
    (Galenos Publ House, 2022) Yildiz, Eray; Arslan, Sevket; Yildiz, Buket Tugan; Berktas, Deniz Tuncel; Colkesen, Fatih; Evcen, Recep; Aykan, Filiz Sadi
    Objective: This study aimed to examine the sleep quality of common variable immunodeficiency (CVID) patients and to investigate the relationship between sleep quality and depression, anxiety, fatigue, excessive daytime sleepiness and naturel killer (NK) cell counts. Materials and Methods: The study included 53 patients followed with CVID diagnosis. To determine sleep quality and conditions associated with sleep quality in CVID patients, Pittsburgh sleep quality index (PSQI), fatigue severity scale (FSS), Hamilton depression scale (HAM-D), Hamilton anxiety scale (HAM-A) and Epworth sleepiness scale (ESS) were used. Results: Fatigue was found in 37 (70%) patients, poor sleep quality in 34 (64%), depression in 20 (38%), anxiety in 16 (30%), and excessive daytime sleepiness in 11 (21%) patients. All patients CVID patients received immunoglobulin replacement therapy: Intravenous immunoglobulin (IVIG) in 37 (72%) and subcutaneous immunoglobulin (SCIG) in 16 (28%) patients. The PSQI, HAM-A, HAM-D and FSS scores of the patients receiving IVIG treatment were higher than those of the patients receiving SCIG treatment (all, p<0.05). According to the multivariate logistic regression analysis, lower NK cell counts [odds ratio (OR) =13.384, 95% confidence interval (CI)= 2.478-72.284, p=0.003] and depression (OR=7.030, 95% CI=1.320-37.435, p=0.022) were risk factors for poor sleep quality. Conclusion: Our results showed that patients with CVID had a higher frequency of poor sleep quality, depression, anxiety, fatigue, and excessive daytime sleepiness than the general population. Therefore, sleep quality and mental status should be questioned in detail during routine control in patients with CVID.