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Öğe Childhood asthma and atmospheric conditions(Blackwell Science, 1996) Yuksel, H; Tanac, R; Tez, E; Demir, E; Coker, MBronchial asthma is the most common chronic respiratory illness in childhood. It is characterized by paroxysmal bronchospastic periods. There are many studies giving reasons to explain the bronchospasm periods. One of the reasons, atmospheric conditions, is effective in creating a clinical picture of asthmatic patients. In the present study, the correlation between atmospheric conditions and asthmatic symptoms in children was investigated using peak expiratory flow rate (PEFR) as the respiratory function test. Twenty-one children with bronchial asthma were monitored in the study. They were followed as outpatients of the Ege University Medical Faculty, Department of Pediatric Allergy and Pneumotology, between November 1993 and June 1994. Atmospheric conditions were recorded from the local meteorology center. Complaints and the PEFR of children were compared with the meteorological data. Asthmatic symptoms were increased by low temperatures in all asthmatic children. An increase was detected in the extrinsic group by relative humidity and ratio of cloud, but in the intrinsic group only by relative humidity.Öğe The effect of childhood obesity on respiratory function tests and airway hyperresponsiveness(Turkish J Pediatrics, 2006) Ulger, Z; Demir, E; Tanac, R; Goksen, D; Gulen, F; Darcan, S; Can, D; Coker, MThe aims of this study were to investigate the effect of exogenous obesity on respiratory function tests, to define the relationship between the severity of obesity and respiratory function test parameters, and to detect the incidence of airway hyperresponsiveness and exercise-induced bronchospasm in an obese study group. This cross-sectional controlled study was done with 38 exogenous obese patients, aged 9 to 15 years, and 30 healthy children. Basal respiratory function test parameters were measured with spirometry. To display airway hyperresponsiveness, 4.5% hypertonic saline provocation test was used; exercise-induced bronchospasm incidence was defined with bicycle ergometry. Basal respiratory function test parameters were lower in the study group as compared with the control group. Exercise test was positive in 31.6% of the obese group and in 3.3% of the control group (P=0.003). The provocation test with hypertonic saline test was positive in 18.4% of the obese group. There were strong negative correlations between body mass index (BMI), relative weight, skin fold thickness, waist/hip circumference ratio and basal forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF) values. The diagnosis and management of exercise-induced bronchospasm may improve exercise performance and physical activity, assist with weight loss, and break the vicious circle.Öğe Effect of immunotherapy on autoimmune parameters in children with atopic asthma(Turkish J Pediatrics, 2002) Tanac, R; Demir, E; Aksu, G; Sari, G; Kutukculer, NThere is an increased rate of reported autoantibody production in patients with atopic and nonatopic asthma. The possibility of generating autoantibodies after the induction of immunotherapy can be explained by several mechanisms. One of these is immune deviation from TH2 to TH1 response by the effect of immunotherapy in favor of unregulated response to self-antigens. The other theory is a possible antigenic mimicry enabling autoantibody formation in these patients, Sixty-three atopic asthmatic children were included in the study. The patients were divided into three groups: Group 1: patients with atopic bronchial asthma without immunotherapy: Group 11: patients receiving immunotherapy for a maximum of 3 years; Group III: patients receiving immunotherapy for 4-5 years. The autoantibodies examined in the study population were antinuclear antibody, anti-double stranded DNA, rheumatoid factor, liver-kidney microsomal antibody, anti-mitochondrial antibody, anti-thyroglobulin and anti-microsomal antibody, anti-Smith antibody and lupus anticoagulant. An overall incidence of 17.5% autoantibody positivity was observed in patients, with no statistical significance between the treatment groups. IgG levels were significantly elevated in Group III when compared with Group 1. Based on these findings it is suggested, in accordance with other studies, that long-term immunotherapy in the pediatric age group does not cause a significant autoantibody formation other than the overall increased incidence that occurs in asthmatic patients.Öğe Effect of inhaled steroid therapy on distribution of Tc-99m DTPA radioaerosol in asthmatic children(Ocean Side Publications Inc, 2000) Yuksel, H; Yuksel, D; Demir, E; Tanac, R; Kayaliodlu, MThe aim of this study was to evaluate the effect of inhaled steroid therapy on the distribution of inhaled Tc-99m DTPA in asthmatic children. Twenty-one asthmatic children and 15 healthy controls were entered in this study. The distribution of radioaerosols was scored by using a modified standardized score system over both lungs and expressed as homogeneity score/patient The baseline homogeneity score war calculated before the inhalation therapy of budesonide (400 mug/day) for six months. The homogeneity score was repeated at the end of the the second and sixth months of therapy therapy. Asthmatic symptom scores and peak-flow rate variability, which were observed to improve throughout the study, were also recorded Although homogeneity scores of the controls demonstrated no abnormality, mean baseline homogeneity scores of asthmatics was significantly high, 1.7 +/- 0.4/patient, ai rd decreased to 0.6 +/- 0.2 and 0.3 +/- 0.1/patient at the end of second and sixth months, respectively (p < 005). These results revealed significant improvement in the radioaerosol distribution after inhaled steroid therapy. It was concluded that the lack of homogeneity in the distribution of Tc99m-DTPA in the lung, as an indicator for ventilation defects, may be accepted as a useful, noninvasive tool to monitor the efficacy of the therapy with inhaled agents in childhood asthma.Öğe Effect of nedocromil sodium on leukotrienes and platelet-activating factor release in asthmatic children(Mary Ann Liebert Inc, 1998) Yuksel, H; Huseyinov, A; Tanac, R; Coker, I; Demir, EAirway inflammation is the most important component of asthma. Leukotrienes (LTB4, LTB-C-4, LTB-D-4, LTB-E-4) and platelet-activating factor (PAF) play an important role in this inflammation. The pulmonary and peripheral leukocytes of asthmatics have a high potency of mediator-releasing activity after specific stimuli, and plasma levels of these are higher than in healthy controls. Nedocromil sodium (NES) is an inhaled anti-inflammatory drug and its inhibitory effect on inflammatory or epithelial cells has been demonstrated. The aim of this study was to determine whether inhaled NES affects plasma levels and release of PAF and leukotrienes from peripheral leukocytes of asthmatic children that were stimulated by house dust mites (as a specific allergen). Twenty-eight children (9 to 15 years of age) with atopic bronchial asthma were included in the study. They consisted of two age- and sex-matched groups (14 patients in the treatment group [group I]; 14 patients in the control group [group II]). Group I patients received inhaled NES (12 mg/d) for 12 weeks. Blood samples were drawn in the pre- and post-treatment periods. The measurements of plasma levels and secreted mediators levels after stimulation by house dust mites were performed with high-pressure liquid chromatography (HPLC) and radioimmunoassay (RIA) methods. There were no significant differences between pretreatment plasma levels and secreted leukotrienes and PAF values of both groups. At the end of the study, significant decreases in plasma and in vitro stimulated LTB4, LT-C-4, LT-D-4, LT-E-4, and PAF levels in group I were observed. There were no changes in the group II values. These in vivo and in vitro results suggest that NES is an effective anti-inflammatory drug for controlling childhood asthma by decreasing the high levels of inflammatory mediator release and immune cell activation.Öğe Enhanced Production of Platelet Activating Factor By Leucocytes From Asthmatic Children(Monduzzi Editore, 1995) Huseyinov, A; Demir, E; Kurugol, Z; Tanac, R; Yuksel, H; Tez, E; Coker, I; Svjatkina, O; Pogomy, N; Basomba, A; Hernandez, MDÖğe Immediate adverse reactions to immunotherapy(Hogrefe & Huber Publishers, 2003) Can, D; Demir, E; Tanac, R; Gulen, F; Yenigun, ABackground: Immunotherapy, which has been used since the beginning of this century, has potential adverse reactions. The purpose of this study was to evaluate immediate local and systemic reactions to allergen immunotherapy and to compare rates of adverse reactions to aluminium-adsorbed versus calcium-adsorbed allergen vaccines. Methods: 108 cases (38 girls and 70 boys) were given allergen immunotherapy between 1997 and 2001. The following data were recorded for each patient primary disease being treated (allergic rhinitis, asthma, or allergic rhinitis and asthma), allergic sensitivities (dust mite or grass pollen), number of injections, the stage of immunotherapy (buildup or maintenance), dilution of allergen vaccine, and type of allergen vaccine (calcium- or aluminium-adsorbed). Adverse reactions were classified as systemic or local. Local reactions were classified as hyperemia and in duration less than 5 cm, more than 5 cm, itching, and pain. Results: 4783 injections were evaluated in 108 subjects with allergic rhinitis (44%), asthma (40%), allergic asthma, and rhinitis (16%). Frequency of immediate systemic reaction was 0.13%. Frequency of immediate local reactions were hyperemia and induration less than 5 cm 3% greater than 5 cm 0.16%, local itching 0.15% and local pain 0.2%. There was no significant difference in systemic and local reactions between calcium- and aluminium-adsorbed vaccines. Immediate local during maintenance therapy if they had allergic rhinitis (p < 0.05) or were receiving grass pollen vaccine (p < 0.01). Conclusion: Immediate adverse reactions were uncommon when given to children with asthma and allergic rhinitis. Aluminium- and calcium-adsorbed allergen vaccines showed similar rats of systemic and local reactions.Öğe Impact of bronchial asthma and passive smoking on lipid profiles in children(Blackwell Munksgaard, 2002) Can, D; Demir, E; Tanac, R; Gulen, F; Yenigun, AÖğe Is there an increase in the prevalence of allergic diseases among schoolchildren from the Aegean region of Turkey?(Ocean Side Publications Inc, 2005) Demir, E; Tanac, R; Can, D; Gulen, F; Yenigun, AE; Aksakal, KThe prevalence of asthma, allergic rhinitis, allergic conjunctivitis, and allergic skin disorders (urticaria and atopic dermatitis) was investigated between the years 1993 and 1994 in the Aegean region of Turkey and was found to be 3.8, 4.6, 12.6, and 19.4%, respectively (Tanac R, Kurugol Z, Demir E, et at., (Cocuk Sagligi ve Hast Derg 39:77-85, 1996). The aim of the present study was to determine whether there is a change in the prevalence of allergic diseases in the Aegean region in the last 8 years, based on the comparison of the results using the same method applied in the study mentioned above. Three thousand three hundred seventy children (48.6% male participants and 51.4% female participants) between the ages of 5 and 18 years (mean age, 11.55 +/- 3.34 years) were enrolled in the study. The participants were randomly chosen among children attending primary schools in the cities of the Aegean region. The children completed a questionnaire; and physical examinations, serum-specific immunoglobulin E antibody levels, and peak expiratory flow measurements were done for each of them. Of the children, 21.2% were,found to have at least one attack of wheezing whereas the prevalence of asthma was 6.4%. The prevalence (of allergic rhinitis, allergic conjunctivitis, and allergic skin disorders (urticaria and atopic dermatitis) were found to be 13.6, 13.2, and 23.7%, respectively. The increase of prevalence for asthma was 2.6%, for allergic rhinitis was 9%, and for allergic conjunctivitis was 0.6%. These data show that the prevalence of allergic diseases, especially respiratory allergy, has increased among schoolchildren from the Aegean region of Turkey.Öğe Latex allergy and associated risk factors in a group of Turkish patients with spina bifida(Turkish J Pediatrics, 2004) Gulbahar, O; Demir, E; Mete, N; Ulman, I; Can, D; Sin, A; Gulen, F; Kokuludag, A; Tanac, R; Sebik, FAllergic reactions to latex are common in patients with spina. bifida. Its incidence varies between 28% and 67%. The aim of this study was to investigate the incidence of latex allergy and its risk factors in patients with spina bifida in Izmir, Turkey. Forty-six patients (24 male, mean age 10 years) were included in the study. A questionnaire was completed and skin prick tests with latex solution and cross-reacting foods were performed. Total IgE levels, specific IgE to common aeroallergens (Phadiotop), and latex specific IgE levels were measured. Patients with positive skin test reaction and/or who had specific IgE to latex without clinical symptoms were considered as sensitive to latex. The patients who also had clinical symptoms with latex exposure were diagnosed as allergic to latex. Latex sensitivity was found in 5/46 patients (10.8%). Only two patients had latex allergy (4.3%). Total IgE levels were higher (median 157 vs. 40 kU/L, p=0.012) and the duration of clean intermittent catheterization was longer insensitized patients when compared to non-sensitized patients (median 8 vs. 3 years, p=0.015). Specific IgE to common aeroallergens and positive skin prick test to cross-reacting foods were more prevalent in sensitized than in nonsensitized patients (p=0.02 and 0.015, respectively). The incidence of latex allergy in our group was lower than reported in the literature. This result may be due to the low number of surgical interventions. High levels of total IgE, positive Phadiotop, positive skin prick test to crossreacting foods and the duration of clean intermittent catheterization are the risk factors for latex sensitivity in patients with spina bifida.Öğe Latex allergy in Turkish patients with Spina bifida(Blackwell Munksgaard, 2002) Gulbahar, O; Demir, E; Sin, AZ; Ulman, I; Can, D; Mete, N; Gulen, F; Kokuludag, A; Tanac, R; Sebik, FÖğe Leukotrienes and Atopic Bronchial Asthma(Monduzzi Editore, 1995) Huseyinov, A; Demir, E; Kurugol, Z; Tanac, R; Yuksel, H; Tez, E; Coker, I; Svjatkina, O; Pogomy, N; Basomba, A; Hernandez, MDÖğe Plasma Interleukin-3 and Interleukin-4 Concentrations In Turkish Asthmatic-Children(British Med Journal Publ Group, 1995) Kutukculer, N; Ozdogru, E; Demir, E; Tanac, RÖğe Preoperative diagnosis of bronchial atresia presenting with recurrent respiratory symptoms in an infant(Turkish J Pediatrics, 2000) Yuksel, H; Demir, E; Tanac, R; Savas, R; Alper, HBronchial atresia (BA) is a rare respiratory malformation that may be diagnosed from infancy to adulthood. A typical feature of the disease is involvement of the left upper lobe and a mass-like lesion surrounded by a hyperlucent and nondeflating zone. We present a six-month-old male infant who was diagnosed by contrast-enhanced spiral computed tomography (CT) with three-dimensional (3D) technology, and by Tc-99m-macroalbumin aggregate (Tc99m-MAA) radionuclide scintigraphy. We stress that early diagnosis of BA can be made noninvasively using contrast-enhanced spiral CT and radionuclide scintigraphy. 3D computed tomographic reformation allows a more accurate diagnosis as well as a more specific approach to management and follow-up.Öğe Relationship between gastric emptying and gastroesophageal reflux in infants and children(Lippincott Williams & Wilkins, 2006) Argon, M; Duygun, U; Daglioz, G; Omur, O; Demir, E; Aydogdu, SPurpose: The aim of our study was to evaluate the relationship between gastric emptying and gastroesophageal reflux (GER) in infants and children. Methods and Materials: One hundred eight patients (pts) between 3 months and 5 years of age (77 boys, 31 girls) with clinical suspicion of GER disease were included in the study. Patients were divided into 2 groups according to the age range: group A, 0-2 years (57 pts), and group B, 2-5 (51 pts) years. Each group was divided into 2 subgroups according to the scintigraphic study as GER-positive and -negative. Cow's milk with Tc-99m sulfur colloid as radiotracer was used. Gastric emptying was expressed as the half emptying time (T1/2). The detection of activity in the esophagus at any time during scintigraphy was considered an indicator of GER episodes. Reflux episodes were graded as grade I if activity was detected on one or 2 frames and grade 2 if activity was detected on more than 2 frames. Results: Forty of the 108 patients (37%) had GER findings on scintigraphy. The comparison of gastric emptying time between positive GER scintigraphy and negative GER scintigraphy groups was not statistically significant in any age group. No association was found between age and rate of gastric emptying time. Although the comparison of T1/2 between grade 1 patients and the GER-negative group was not statistically significant, grade 2 patients showed significant differences and had prolonged gastric emptying times. Mild statistical correlation between the number of reflux episodes and gastric emptying half time was found. Conclusions: As a conclusion, the relation between gastroesophageal reflux and delayed gastric emptying cannot be ignored. Our results support delayed gastric emptying to be a pathogenetic factor in gastroesophageal reflux in infants and children.Öğe Sublingual immunotherapy and influence on urinary leukotrienes in seasonal pediatric allergy(Prous Science, Sa, 1999) Yuksel, H; Tanac, R; Gousseinov, A; Demir, ESublingual immunotherapy has been suggested for the treatment of respiratory allergies, Many controversial studies have been reported on the efficacy of sublingual immunotherapy The aim of this prospective study was to evaluate whether sublingual immunotherapy was effective according to clinical and laboratory results in pediatric allergies. Thirty-nine allergic, grass pollen sensitive children were admitted into the study. Sublingual immunotherapy was given over a 12-month period to 21 children (mean age 10.5 +/- 3.3 years), 10 of whom had seasonal allergic rhinitis and II seasonal allergic asthma. During the same period, 18 children (mean age II. I +/- 2.5 years), 10 with seasonal allergic rhinitis and eight with seasonal allergic asthma, received placebo. Symptom scores and drug requirements were recorded and urine samples were collected to detect urinary levels of leukotrienes (Uc-LTB4 and Uc-LTE4). In patients who received sublingual immunotherapy, the symptom scores of seasonal allergic rhinitis significantly decreased but no statistically significant changes were observed in terms of symptoms of seasonal allergic asthma. Uc-LTE4 and Uc-LTB4 levels of seasonal allergic rhinitis, with a geometric mean and 95% confidence interval(CI), were significantly decreased from 216 (103-464) and 61 (22-198) pmol/mmol creatinine to 78 (29-159) and 35 (12-118) pmol/mmol creatinine, respectively (p < 0.05 and p < 0.05). On the other hand Uc-LTE4 and Uc-LTB4 levels for seasonal allergic asthma were 180 (92-355) and 78 (44-258) pmol/mmol creatinine and decreased to 156 (72-402) and 69 (32-254) pmol/mmol creatinine, respectively: These changes were not statistically significant (p > 0.05). According to our clinical results and urinary levels of leukotrienes, which are mediators showing the severity of allergic inflammation, it can be suggested that sublingual immunotherapy may be useful in the treatment of seasonal allergic rhinitis but not of seasonal allergic asthma.
