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Öğe Asthma-like symptom or “cystic fibrosis asthma”?(2021) Öztürk, Gökçen; Gülen, Figen; Demir, Esen; Eşki, AykutIntroduction: The diagnosis of asthma is still a difficult problem in cystic fibrosis. There is no consensus on how to define “CF asthma”. The aim of this study was to determine the role of bronchodilator response and laboratory evidence of allergy in “CF asthma”. Materials and Methods: Patients aged ?6 years with evaluated bronchodilator response and characteristics of atopy were included in the study. Patients diagnosed with Allergic Bronchopulmonary Aspergillosis or pulmonary exacerbation were excluded. Results: A total of 204 CF patients were evaluated, and 40 who met the criteria were included. Asthma had been diagnosed in ten patients. A positive bronchodilator response was present in 47.3% of the patients tested. Aeroallergen sensitization was present in 52.5% of the patients. While the frequency of recurrent/history of wheezing, family history of atopy and elevated total immunoglobulin E were similar (p> 0.05), the frequencies of inhaled medication use and coexistence of asthma were statistically higher in the group with positive allergen sensitization (p< 0.05). The frequencies of positive bronchodilator response (77.7% versus 37.9%) and a family history of asthma/atopy (40% versus. 23%) were found to be similar in CF asthma and CF. There were significant increases in total IgE and allergen-specific IgE and an increase in the frequency of aeroallergen sensitization in CF asthma compared to CF (p< 0.05). Conclusion: Although not routinely used in the evaluation of patients, allergen specific-IgE and skin prick test for aeroallergen sensitization may be used as an adjunctive test in patients with suspected clinical findings. The recognition of CF asthma may facilitate the development of targeted therapiesÖğe Asthma-like symptomcystic fibrosis asthma?(Turkish Assoc Tuberculosis & Thorax, 2021) Ozturk, Gokcen Kartal; Eski, Aykut; Demir, Esen; Gulen, FigenIntroduction: The diagnosis of asthma is still a difficult problem in cystic fibrosis. There is no consensus on how to define CF asthma. The aim of this study was to determine the role of bronchodilator response and laboratory evidence of allergy in CF asthma. Materials and Methods: Patients aged 6 years with evaluated bronchodilator response and characteristics of atopy were included in the study. Patients diagnosed with Allergic Bronchopulmonary Aspergillosis or pulmonary exacerbation were excluded. Results: A total of 204 CF patients were evaluated, and 40 who met the criteria were included. Asthma had been diagnosed in ten patients. A positive bronchodilator response was present in 47.3% of the patients tested. Aeroallergen sensitization was present in 52.5% of the patients. While the frequency of recurrent/history of wheezing, family history of atopy and elevated total immunoglobulin E were similar (p> 0.05), the frequencies of inhaled medication use and coexistence of asthma were statistically higher in the group with positive allergen sensitization (p< 0.05). The frequencies of positive bronchodilator response (77.7% versus 37.9%) and a family history of asthma/atopy (40% versus. 23%) were found to be similar in CF asthma and Cf. There were significant increases in total IgE and allergen-specific IgE and an increase in the frequency of aeroallergen sensitization in CF asthma compared to CF (p< 0.05). Conclusion: Although not routinely used in the evaluation of patients, allergen specific-IgE and skin prick test for aeroallergen sensitization may be used as an adjunctive test in patients with suspected clinical findings. The recognition of CF asthma may facilitate the development of targeted therapies.Öğe Astım bronşiale tanılı çocuklarda IL-1? ve IL-1 reseptör antagonisti gen polimorfizmi(Ege Üniversitesi, 2007) Demir, EsenAstım hava yollarının kronik inflamatuar bir hastalığıdır. Astım ve atopik hastalıklar multifaktöryel, poligenik kompleks hastalıklar olarak ele alınmakta ve oluşumlarında birden fazla gen ile çevresel faktörlerin birlikte rol oynadığı düşünülmektedir. Astımın genetik zeminde gelişen bir hastalık olduğu bilinmekle birlikte hastalıkla ilişkili spesifik genetik markırları saptamak zordur. Sitokin genleri astım ve atopik hastalıklarda aday genler olarak düşünülmektedir. Bu çalışmada IL-1 ve IL-1Ra gen polimorfizmi ile çocuklarda astım bronşiale varlığı arasındaki ilişkinin araştırılması amaçlanmıştır. Bu çalışmaya Ege Üniversitesi Tıp Fakültesi Pediatrik Allerji Bilim Dalı polikliniğinde en az bir yıldır izlenen ve atopik astım tanısı konulmuş olan 97 erkek, 67 kız toplam 164 olgu alındı. Kontrol grubu olarakta astım ve atopisi olmayan 63 erkek, 78 kız toplam 141 olgu alındı. Bütün olgulara total ve spIgE bakıldı. Hasta grubundaki çocuklara DPT yapıldı. IL-1? ve IL-1Ra için polimorfizm analizi, EDTA'lı periferik kandan elde edilen genomik DNA'dan alel spesifik PCR yöntemi ile yapıldı. Hasta ve kontrol grubunda IL-1? ve IL-1Ra genotip ve alel dağılımında istatistiksel olarak anlamlı bir fark saptanmadı. Astım grubunda IL-1? için CC, CT ve TT genotipini, IL-1Ra için de 2/2, 1/2 ve 1/1 genotipini taşıyanların astım kliniğinin şiddeti, ailede atopi ve laboratuar özellikleri bakımından karşılaştırılması sonucunda IL-1Ra için 2/2 genotipini taşıyanlarda 1/1 genotipini taşıyanlara göre spIgE düzeyi ve 2 alelini taşıyanlarda yüksek atak sayısı anlamlı derecede yüksek saptandı. Astım grubunda, yaş gruplarına göre IL-1? ve IL-1Ra genotip dağılımına baktığımızda istatistiksel olarak anlamlı bir fark saptanmadı. IL-1? genotip ve alel dağılımına erkek ve kız çocuklarda ayrı olarak baktığımızda dağılımda herhangi bir fark saptanmadı. Fakat IL-1Ra genotip ve alel dağılımına erkek ve kız çocuklarda ayrı olarak baktığımızda erkek çocuklarda astımlılarda 2/2 genotipi, kontrol grubunda ise 1/2 genotipi, kızlarda ise astım grubunda 4 aleli, kontrol grubunda 1/5 genotipi ve 5 aleli istatistiksel olarak anlamlı derecede yüksek saptandı. Sonuç olarak IL-1? -511C/T gen polimorfizmi ile astım ve atopi arasında birliktelik saptamadık. Fakat IL-1Ra gen polimorfizmi ile erkek ve kız çocuklarda astım gelişimini hem artırıcı hemde azaltıcı yönde anlamlı bir birliktelik saptadık. Ayrıca IL-1Ra gen polimorfizmi ile astımın klinik şiddeti ve spIgE düzeyi arasında birliktelik saptadık. Bu bulgular sonucunda IL-1Ra geninde VNTR polimorfizminin saptanmasının her iki cinste de farklı genotipleri dikkate alarak astıma duyarlılığın saptanması ve bugün için deneysel aşamada olmakla birlikte gelecekte hastaların tedavisi için de yararlı bir markır olabileceğini düşünmekteyiz.;Asthma, IL-?, IL-Ra, single nucleotidepolymorphisms, children.;Astım, IL-?, IL-Ra, gen polimorfizmi, çocuk.Öğe Astım bronşiale tanılı çocuklarda IL-1β ve IL-1 reseptör antagonisti gen polimorfizmi(Ege Üniversitesi, 2007) Demir, Esen; Özkınay, Ferda; Zeyrek, C. Dost; Onay, HüseyinAstım hava yollarının kronik inflamatuar bir hastalığıdır. Astım ve atopik hastalıklar multifaktöryel, poligenik kompleks hastalıklar olarak ele alınmakta ve oluşumlarında birden fazla gen ile çevresel faktörlerin birlikte rol oynadığı düşünülmektedir. Astımın genetik zeminde gelişen bir hastalık olduğu bilinmekle birlikte hastalıkla ilişkili spesifik genetik markırları saptamak zordur. Sitokin genleri astım ve atopik hastalıklarda aday genler olarak düşünülmektedir. Bu çalışmada IL-1 ve IL-1Ra gen polimorfizmi ile çocuklarda astım bronşiale varlığı arasındaki ilişkinin araştırılması amaçlanmıştır. Bu çalışmaya Ege Üniversitesi Tıp Fakültesi Pediatrik Allerji Bilim Dalı polikliniğinde en az bir yıldır izlenen ve atopik astım tanısı konulmuş olan 97 erkek, 67 kız toplam 164 olgu alındı. Kontrol grubu olarakta astım ve atopisi olmayan 63 erkek, 78 kız toplam 141 olgu alındı. Bütün olgulara total ve spIgE bakıldı. Hasta grubundaki çocuklara DPT yapıldı. IL-1β ve IL-1Ra için polimorfizm analizi, EDTA’lı periferik kandan elde edilen genomik DNA’dan alel spesifik PCR yöntemi ile yapıldı. Hasta ve kontrol grubunda IL-1β ve IL-1Ra genotip ve alel dağılımında istatistiksel olarak anlamlı bir fark saptanmadı. Astım grubunda IL-1β için CC, CT ve TT genotipini, IL-1Ra için de 2/2, 1/2 ve 1/1 genotipini taşıyanların astım kliniğinin şiddeti, ailede atopi ve laboratuar özellikleri bakımından karşılaştırılması sonucunda IL-1Ra için 2/2 genotipini taşıyanlarda 1/1 genotipini taşıyanlara göre spIgE düzeyi ve 2 alelini taşıyanlarda yüksek atak sayısı anlamlı derecede yüksek saptandı. Astım grubunda, yaş gruplarına göre IL-1β ve IL-1Ra genotip dağılımına baktığımızda istatistiksel olarak anlamlı bir fark saptanmadı. IL-1β genotip ve alel dağılımına erkek ve kız çocuklarda ayrı olarak baktığımızda dağılımda herhangi bir fark saptanmadı. Fakat IL-1Ra genotip ve alel dağılımına erkek ve kız çocuklarda ayrı olarak baktığımızda erkek çocuklarda astımlılarda 2/2 genotipi, kontrol grubunda ise 1/2 genotipi, kızlarda ise astım grubunda 4 aleli, kontrol grubunda 1/5 genotipi ve 5 aleli istatistiksel olarak anlamlı derecede yüksek saptandı. Sonuç olarak IL-1β -511C/T gen polimorfizmi ile astım ve atopi arasında birliktelik saptamadık. Fakat IL-1Ra gen polimorfizmi ile erkek ve kız çocuklarda astım gelişimini hem artırıcı hemde azaltıcı yönde anlamlı bir birliktelik saptadık. Ayrıca IL-1Ra gen polimorfizmi ile astımın klinik şiddeti ve spIgE düzeyi arasında birliktelik saptadık. Bu bulgular sonucunda IL-1Ra geninde VNTR polimorfizminin saptanmasının her iki cinste de farklı genotipleri dikkate alarak astıma duyarlılığın saptanması ve bugün için deneysel aşamada olmakla birlikte gelecekte hastaların tedavisi için de yararlı bir markır olabileceğini düşünmekteyiz.Öğe Atelectasis: An Uncommon Sign of Achalasia inChildhood(2021) Alper, Hüdaver; Öztürk, Gökçen; Gülen, Figen; Demir, Esen; Eşki, Aykut; Şakul, Gözde; Divarcı, EmreAn 11-year-old boy presented to our pediatric pulmonology clinic with a 3-month history of atelectasis evident onhis chest radiography. Breath sounds revealed fine crackles in the right lower zone and rhonchi in the upper zones.His initial pulmonary function test was compatible with restrictive pulmonary disease. Chest tomography revealedthat the trachea, right intermediate, and middle lobe bronchi were narrowed by megaesophagus. Esophagogramdetermined dilatation of the esophagus and “bird-beak” sign in the esophagogastric junction but it was not suffi cient to diagnose. Esophageal manometry which is the gold standard test for achalasia was performed and type 2achalasia was diagnosed. His symptoms improved following Heller myotomy conducted together with Dor fun doplication. Although respiratory problems are more common in infants and younger children, atypical respiratorypresentations may also occur during adolescence. Achalasia should be one of the rare differential diagnoses ofpediatric restrictive pulmonary disease.Öğe Çocuklarda uçucu madde kullanımının solunum sistemi üzerine etkisi(Ege Üniversitesi, 2008) Can Büker, Halime Sema; Demir, EsenAMAÇ: İnhalan kötüye kullanımı adolesanlar arasında oldukça yaygın ve sıklıkla görmezden gelinen bir madde kullanım bozukluğudur. İnhalanların akut etkileri ani ölüm, asfiksi, aspirasyon, ciddi kaza ve yaralanmalardır. Kronik inhalan kullanımı solunum, kardiyak, renal, hepatik ve nörolojik sistemlerde hasar yaratabilir. Boya tineri ve yapıştırıcı, ülkemizdeki adolesanlar tarafından en çok kötüye kullanılan maddelerdir. Bu çalışmanın amacı uçucu madde inhalasyonunun solunum ve kardiyak sistem üzerine olan etkilerini belirlemektir. GEREÇ ve YÖNTEM: Öykü, fizik bakı, solunum ve kardiyak sistem yakınmalarını sorgulayan bir anketle olguların genel sağlık durumları değerlendirildi. Uçucu madde kullanım şiddeti YUKUD ölçeği kullanılarak hesaplandı. Olgulara, akciğer fonksiyonlarını değerlendirmek amacıyla spirometri, akokardiyografi, ventilasyon/perfüzyon sintigrafisi ve yüksek çözünürlüklü bilgisayarlı tomografi uygulandı. SONUÇLAR: Çalışmaya 31 erkek olgu ve 19 sağlıklı kontrol alındı. İlk uçucu madde kullanmaya başlama yaşı ortalama 14.6±2.16 (9-18) yıl ve madde kullanım süresi 3.67±1.70 yıldı. En sık rastlanan yakınma burun tıkanıklığı (% 45.16) idi. Bunu sırasıyla balgam çıkarma (% 38.71), çabuk yorulma (% 32.26) ve öksürük (% 22.58) izlemekteydi. Spirometrik ölümlerde 12 (% 41.4) olguda, restriktif tipte solunum fonksiyon bozukluğunu gösteren, beklenene göre <% 80 FVC değerleri saptandı. Restriktif tipte solunum fonksiyon bozukluğu, istatistiksel olarak anlamlı olmamakla birlikte, çalışma grubunda daha fazla idi. Restriktif tipte solunum fonksiyon bozukluğu ile uçucu madde kullanmaya başlama yaşı, süresi ve miktarı, solunumsal yakınmalar ve sintigrafik bulgular arasında anlamlı ilişki saptanmadı. Restriktif tipte solunum fonksiyon bozukluğu ile HRCT?de anormal bulgu olması arasında istatistiksel olarak ileri derecede anlamlı bir ilişki izlendi (p<0.01). İki boyutlu (2D) ekokardiyografide, çalışma grubunda her iki ventrikül sistolik fonksiyonlarında bozukluk saptandı (p<0.05). Doppler ekokardiyografide LVMPI çalışma grubunda kontrol grubuna göre daha uzundu (p<0.01). Pulmoner akselerasyon zamanı, çalışma grubunda kontrol grubuna göre istatistiksel olarak anlamlı olmasa da daha kısa bulundu. Ventriküler fonksiyonların doku Doppler yöntemiyle incelenmesinde çalışma grubunda, sol ventriküler sistolik ve sağ ventriküler diyastolik fonksiyonlarında bozulma izlendi. SONUÇ: Bu çalışmada, uçucu madde bağımlılığı ile restriktif tipte solunum fonksiyon bozukluğu arasında pozitif korelasyon olduğu saptanmıştır. Her iki ventrikülde etkilenme olması, uçucu maddelerin hem subklinik pulmoner hipertansiyona yol açacak hem de direkt etki ile kardiyak hasar oluşturduğunu göstermektedir.Öğe Çocukluk çağı bronşiyal astmasında inhale nedokromil sodyumun idrar leukotiren-E4 atılım hızı üzerine etkisi(2000) Yüksel, Hasan; Gousseinov, Afig; Demir, Esen; Çoker, Işıl; Tanaç, RemziyeNedokromil sodyum (NKS) bronşiyal astma tedavisinde kullanılan inhale bir ajandır. İnflamatuvar mediyatörlerin (lökotrien vs) salınımını önlediği gösterilmiştir. Lökotrien-E4 (LTE4)'ün idrarda atılım hızı (İ-LTE4) tüm vücuttaki lökotrien üretiminin göstergesi olarak kabul edilmektedir. Çalışmada bronşiyal astmalı çocuklarda NKS'in İ-LTE4 üzerine etkisi olup olmadığı araştırılmıştır. Çalışmaya dermatofagoid duyarlılığı olan 43 astmalı çocuk alınmıştır. 24 olguya 16 hafta süreyle inhale NKS (12 mg/gün) ve 19 astmalı çocuğa ise aynı sürede plasebo verilmiştir. Bu sürede semptom skorları, ekspiratuvar tepe atım hızları (PEFR), beta-2 agonist gereksinimleri kaydedilmiş, İ-LTE4 saptanması için idrar örnekleri toplanmıştır. NKS kullanan astmalılarda semptom, PEFR ve beta-2 agonist gereksinim skorlarında anlamlı olarak azalma gözlenmiş, plasebo grubunda ise bu parametrelerde anlamlı değişiklik izlenmemiştir. NKS alan grupta çalışma öncesi İ-LTE4 95±30 pmol/mmol-kreatinin iken tedavi sonunda istatistiksel olarak anlamlı düşmüş ve 35±12 pmol/mmol-kreatinin olarak saptanmıştır (p<0.05). Plasebo grubunda ise bu değerler sırasıyla 110±35 ve 95±29 pmol/mmol-kreatinin olarak saptanıp farkın istatistiksel olarak anlamlı olmadığı gözlenmiştir (p>0.05). Sonuç olarak, NKS çocukluk çağı astmasında etkindir ve klinik bulgularla birlikte İ-LTE4'nı anlamlı olarak düşürür. Dolayısı ile bu bulgular çocuklarda anti- inflamatuar tedavinin monitörize edilmesinde İ-LTE4'nın bir markır olarak kullanılabileceğini düşündürmektedir.Öğe Çocukluk çağı kronik maksiller sinüzitinde nazal budesonidin etkinliği(1999) Yüksel, Hasan; Demir, Esen; Mürşitoğlu, Nihan; Tanaç, RemziyeAMAÇ: Çocuklarda sinüs cerrahisine ait görülen erken ve geç komplikasyonlar nedeniyle kronik maksiller sinüzitte öncelikle tıbbi tedavi yöntemlerinin kullanılması önerilmektedir. Bu nedenle yeni ve daha etkin tıbbi tedavi yöntemleri araştırılmaktadır. Bu çalışmada kronik maksiller sinüzit tanısı alan çocuk hastalarda nazal topikal steroidin (budesonid) etkinliği araştırılmıştır. YÖNTEM: Çalışmaya yaşları 6-17yıl (ortalama 8.8±2.2 yıl) arasında değişen, allerji yada kronik bir solunum yolu patolojisi olmayan kronik maksiller sinüzit tanısı almış 19 erkek (% 56) ve 15 kız (% 44) olgu alınmıştır. 23 olguya nazal salin lavajı ve kısa süreli topikal dekonjestan yanında üç ay süreyle 200 mgr/gün nazal budesonid; kontrol grubu olarak alınan 11 olguya ise yalnızca nazal salin verilmiştir. BULGULAR: Olguların başlıca geliş yakınmaları üç ayın üzerinde devam eden öksürük (% 83), postnazal akıntı (% 58) ve başağrısı (% 47) olarak gözlenmiştir. Çalışma sonunda steroid grubundaki 15 olguda (% 65) klinik ve radyolojik tam düzelme elde edilmiştir. Kontrol grubunda ise kısmi klinik ve radyolojik düzelme saptanan 3 olgu dışında semptomlarda anlamlı düzelme gözlenmemiştir. SONUÇ: Bu sonuçlar bize çocukluk çağı KMS' de nazal steroidin etkin olduğunu ve cerrahi tedavi öncesi maksimal tıbbi tedavide alternatif olarak kullanılabileceğini düşündürmektedir.Öğe Comparison of the "ProDect BCS RV CHIP" assay with the combination of shell vial cell culture and immunofluorescence antibody test for the detection of respiratory viruses(Elsevier Science Bv, 2007) Cicek, Candan; Gulen, Figen; Karatas, Eylem; Demir, Esen; Tanac, Remziye; Bacakoglu, Feza; Bilgic, AltinayIn the present study, a multiplex reverse transcriptase polymerase chain reaction combined with a chip hybridization assay (ProDect BCS RV CHIP) was evaluated as an alternative to the combination of immunofluorescent antibody test and shell vial cell culture considered as gold standard for the detection of respiratory viruses. Among 100 specimens, 40 were positive using the combination of immunofluorescent antibody test and shell vial cell culture assay in which 9 of them were infected by two different viruses (27 parainfluenza virus type 3, 10 adenovirus, 9 respiratory, syncytial virus. 2 influenza type B, and 1 influenza type A). ProDect BCS RV CHIP detected only 10 positive specimens in which one of them was infected by two different viruses (5 respiratory syncytial virus, 3 parainfluenza virus type 3, 2 adenovirus, and I influenza virus type B). The sensitivity. specificity, PPV. NPV and diagnostic accuracy of ProDect BCS RV CHIP were 25.0%, 100%, 100%, 66.6%, and 70.0%, respectively, compared to the combination of shell vial cell culture and immunofluorescent antibody test. As a result, the specificity of ProDect BCS RV CHIP is high. however. the sensitivity (25%) of the assay is not sufficient for routine laboratory use. (C) 2007 Elsevier B.V. All rights reserved.Öğe Could Age and Oral Challenge Outcomes Identify High-Risk Patients During Cow's Milk Oral Immunotherapy?(Mary Ann Liebert, Inc, 2022) Senol, Handan Duman; Topyildiz, Ezgi; Severcan, Ezgi Ulusoy; Akercan, Sanem Eren; Gunaydin, Nursen Cigerci; Gulen, Figen; Demir, EsenObjective: Severe immunglobuline E (IgE)-mediated reactions during oral immunotherapy (OIT) are major obstacles to treatment. The present study aimed to evaluate and identify clinical and laboratory biomarkers of adverse events during OIT among children with cow's milk (CM) allergy.Study Design: Eighty-six children older than 36 months who had undergone OIT with milk were enrolled. Clinical data, oral food challenge (OFC) test results, and laboratory data were recorded retrospectively.Results: The median duration of the build-up phase of OIT was 19 weeks (min 10-max 40) and the duration of the maintenance phase was 86.5 (min 1-max 132) months. A total of 11,767 CM doses were administered during the build-up phase and adverse reactions were seen in 62 (73.8%) patients with reactions registered for 157 doses among 11,767 (1/75 doses). The number of reactions during the maintenance phase was 41 (47.6%) in 24 (27.9%) patients. There was a significant reduction in the number of reactions (P = 0.000) between the build-up phase and maintenance phase. Adverse reactions and anaphylaxis were higher for patients who had cough during OFC (P = 0.003, P = 0.002, respectively) during the build-up phase and also during the maintenance phase too (P = 0.000). Evaluation for all reactions and anaphylaxis (during build-up and maintenance) with Kaplan-Meier and Cox regression analysis showed class IV-VI of CM-specific immunoglobulin E (sIgE), casein-sIgE and cough during OFC were significantly associated with increased probability of reaction and anaphylaxis. Younger age at onset of OIT was associated with risk reduction (0.017).Conclusion: Laboratory data and reactions during the OFC (especially cough) can help to identify high-risk patients during OIT.Öğe Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies(Frontiers Media Sa, 2019) Sackesen, Cansin; Altintas, Derya Ufuk; Bingol, Aysen; Bingol, Gulbin; Buyuktiryaki, Betul; Demir, Esen; Kansu, Aydan; Kuloglu, Zarife; Tamay, Zeynep; Sekerel, Bulent EnisThis review addresses the current strategies of inducing tolerance development in infant and childhood cow's milk protein allergy (CMPA). The change in prevention strategies for CMPA has been emphasized based on the lack of evidence to support the efficacy of food allergen avoidance in infancy and the concept of the dual-allergen-exposure hypothesis, which suggests that allergen exposure through the skin leads to sensitization, whereas early oral consumption of allergenic food protein induces oral tolerance. The new approach is based on the likelihood of early introduction of allergenic foods to the infant's diet to reduce the development of food allergies through oral tolerance induction. The latest treatment guidelines recommend the continuation of breast feeding and the elimination of cow's milk and products from the maternal diet in exclusively breast-fed infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy, eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as well as cases of multiple system involvement, multiple food allergies, and intolerance to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current knowledge on tolerance development in infants and children with CMPA to increase the awareness of the clinicians concerning the new approaches in CMPA treatment Tolerance development is considered a relatively new concept in CMPA, inducing a shift in interventions in CMPA from a passive (avoidance of responsible allergen) toward a proactive (tolerance induction) strategy.Öğe Cut-Off Values of Specific IgE and Skin Prick Test to Predict Oral Food Challenge Positivity in Children with Cow's Milk Allergy(AVES, 2022) Gunaydin, Nursen Cigerci; Akarcan, Sanem Eren; Gulen, Figen; Bal, Cem Murat; Tanac, Remziye; Atasever, Mesude; Demir, EsenObjective: The cut-off values for the skin prick test diameters and cow's milk-specific IgE measurements are used to predict the result of the oral food challenge test for the diagnosis of cow's milk allergy. This study aimed to determine the diagnostic values of skin prick test and cow's milk-specific IgE according to age groups and compare the diagnostic powers of these 2 methods. Materials and Methods: In total, 153 children who had a preliminary diagnosis of cow's milk allergy were evaluated. Group A (n = 90) consisted of cow's milk allergy patients whose diagnosis was confirmed by a positive oral food challenge or a history of anaphylaxis. Group B (n = 63) was composed of patients with a negative oral food challenge. The demographic, clinical, and laboratory findings of 2 groups were compared. Results: The cut-off points for cow's milk-specific IgE and cow's milk-skin prick test were determined as >2.12 kUA/L and >5 mm, respectively. The area under the curve was 0.844 for cow's milk-skin prick test (sensitivity 73%, specificity 84%) and 0.745 for cow's milk-specific IgE (sensitivity 67%, specificity 86%). The diagnostic power of skin prick test was determined to be higher when compared to cow's milk-specific IgE (P=.02). According to the predicted probability curves, decision points for cow's milk-specific IgE and cow's milk-skin prick test with 95% probability were determined as follows, respectively: for <= 24 months: 22 kUA/L, 11.3 mm; for >24 months: 44.1 kUA/, 15.1 mm. The lowest cut-off value with a positive predictive value of 95% and a specificity of 96% was found in patients <1-year-old (>3.3 kUA/L) Conclusion: The use of high probability diagnostic values of communities for specific IgE and skin prick test along with a significant clinical history may provide accurate and rapid diagnosis of cow's milk allergy and facilitate patient follow-up.Öğe Development of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy(Allergy Immunol Soc Thailand,, 2007) Gulen, Figen; Zeyrek, Dost; Can, Demet; Altinoz, Serdar; Koksoy, Huseyin; Demir, Esen; Tanac, RernziyeIt has been hypothesized that specific immunotherapy (SIT) significantly decreases the development of new allergen sensitizations in mono-sensitized patients. In this study, we evaluated the effect of SIT on the development of new allergen sensitizations in 129 asthmatic children mono-sensitized to house dust mite. SIT was accepted by only 70 of them (SIT group). The remaining 59 children were treated only with medication (control group). At the end of the study we found that 33% of all patients developed new sensitizations. Surprisingly, the prevalence of new sensitizations was significantly higher in the SIT group (45.5%) than in the control group (18.1 %). Ash tree (Fraxinus excelsior), Olive and Meadow fescue (Festuca elatior) were the most common allergens responsible for the new sensitizations. We conclude that SIT did not prevent the onset of new sensitizations in asthmatic children mono-sensitized to house dust mite.Öğe Early diagnosis effects the prognosis in children with atypical wheeze(Turkish Pediatrics Assoc, 2020) Severcan, Ezgi Ulusoy; Demir, Esen; Gulen, Figen; Bilgin, Raziye Burcu Guven; Tanac, RemziyeAim: Recurrent wheezing is a common problem in preschool children. It is classified into two groups because there can be many reasons for wheeze: typical and atypical. the aim of this study was to identify the general features of atypical wheezy children. Material and Methods: Three hundred two children who presented to our clinic between 2000 and 2015 for three or more wheezing attacks and were diagnosed as having an underlying disease such as bronchiectasis, foreign body aspiration, recurrent aspiration pneumonia, cystic fibrosis, bronchopulmonary dysplasia, congenital anomalies, and tuberculosis, were included in the study. Results: in this study, 127 (42.1%) girls and 175 (57.9%) boys were evaluated. the diagnostic distribution of the patients was as follows: bronchopulmonary dysplasia (21.9%), bronchiolitis obliterans (16.6%), bronchiectasis (14.5%), bronchiolitis obliterans + primary immunodeficiency (12.3%), cystic fibrosis (10.3%), bronchiectasis + primary immunodeficiency (7.9%), recurrent aspiration pneumonia (3.6%) and foreign body aspiration (3.3%), and other diseases (9.6%). Mosaic oligemia, bronchiectasis, atelectasis, bronchiolectasis, and small airway disease were the most distinct findings on high-resolution lung tomography. When the patients were evaluated clinically, radiologically, and according to pulmonary functions after an average period of 40 months, it was seen that 9.2% deteriorated, 33.9% regressed, and 56.7% remained stable. Presentation to hospital after the first attack occurred earlier in patients with bronchopulmonary dysplasia, bronchiolitis obliterans and bronchiolitis obliterans + primary immunodeficiency compared with patients with bronchiectasis, bronchiectasis + primary immunodeficiency, and cystic fibrosis. When presentation time and outcomes were evaluated, it was found that 63.4% of patients who presented to hospital early (0-6 months) and 7.5% of patients who presented late (after 5 years) had regression. Conclusion: Recurrent wheezy children must be promptly evaluated for an underlying disease. Early diagnosis and treatment influence the prognosis.Öğe Early diagnosis effects the prognosis in children with atypical wheeze(2020) Severcan, Ezgi Ulusoy; Demir, Esen; Gülen, Figen; Bilgin, Raziye Burcu Güven; Tanaç, RemziyeAim: Recurrent wheezing is a common problem in preschool children. It is classified into two groups because there can be many reasons for wheeze: typical and atypical. The aim of this study was to identify the general features of atypical wheezy children. Material and Methods: Three hundred two children who presented to our clinic between 2000 and 2015 for three or more wheezing attacks and were diagnosed as having an underlying disease such as bronchiectasis, foreign body aspiration, recurrent aspiration pneumonia, cystic fibrosis, bronchopulmonary dysplasia, congenital anomalies, and tuberculosis, were included in the study. Results: In this study, 127 (42.1%) girls and 175 (57.9%) boys were evaluated. The diagnostic distribution of the patients was as follows: bronchopulmonary dysplasia (21.9%), bronchiolitis obliterans (16.6%), bronchiectasis (14.5%), bronchiolitis obliterans + primary immunodeficiency (12.3%), cystic fibrosis (10.3%), bronchiectasis + primary immunodeficiency (7.9%), recurrent aspiration pneumonia (3.6%) and foreign body aspiration (3.3%), and other diseases (9.6%). Mosaic oligemia, bronchiectasis, atelectasis, bronchiolectasis, and small airway disease were the most distinct findings on high-resolution lung tomography. When the patients were evaluated clinically, radiologically, and according to pulmonary functions after an average period of 40 months, it was seen that 9.2% deteriorated, 33.9% regressed, and 56.7% remained stable. Presentation to hospital after the first attack occurred earlier in patients with bronchopulmonary dysplasia, bronchiolitis obliterans and bronchiolitis obliterans + primary immunodeficiency compared with patients with bronchiectasis, bronchiectasis + primary immunodeficiency, and cystic fibrosis. When presentation time and outcomes were evaluated, it was found that 63.4% of patients who presented to hospital early (0–6 months) and 7.5% of patients who presented late (after 5 years) had regression. Conclusion: Recurrent wheezy children must be promptly evaluated for an underlying disease. Early diagnosis and treatment influence the prognosis.Öğe Effectiveness and adverse reactions to subcutaneous immunotherapy in children with allergic rhinitis/asthma(Elsevier Ireland Ltd, 2022) Senol, Handan Duman; Topyildiz, Ezgi; Ekici, Betul; Gulen, Figen; Demir, EsenObjective: Adverse reactions, which are mostly local and rarely systemic, can be seen during subcutaneous immunotherapy (SCIT). It was not possible to continue SCIT at times due to systemic reactions. The purpose of the present study was to identify the incidence and risk factors associated with adverse reactions during subcutaneous allergen-specific immunotherapy (AIT).Methods: A total number of 344 patients under 18 years old with allergic rhinitis and/or asthma who underwent SCIT between 2005 and 2021 were included in the study. Demographic characteristics of the patients, laboratory findings [Total Immunglobulin E(IgE), aeroallergen prick test, inhaler, and allergen specific IgE(sIgE) and eosinophil counts], and adverse events observed during AIT were recorded retrospectively. Descriptive and univariate/multivariate logistic regression analyses were used to identify risk factors for adverse events.Results: Among 344 patients, 33.4% (n = 115) were female, mean age was 133.1 +/- 41.0 months, and 42.2% (n = 145) were >12 years old. One hundred-thirty eight (40.1%) of the patients were mono-sensitized, 47 (13.7%) had asthma, 207 (60.2%) allergic rhinitis, and 90 (26.2%) asthma and allergic rhinitis. Single allergen content was administered to 187 (54.4%) patients (62 mite, 114 grass mix, 11 olea), and multiple allergens to 157 (45.6%) patients (121 pollen mix, 36 other (mite/alternaria)]. A total number of 33.008 injections were administered. 840 adverse reactions (262 (31.1%) at up-dosing phase, 578 (68.8%) at maintenance phase) in 195 (56.7%) patients were observed. Among the adverse reactions, 632 (75.2%) were local, 160 (19%) large local, and 48 (5.7%) (39 at maintenance, 9 at up-dosing) (in 31 patients) were systemic (28 Grade 1, 12 Grade 2, 8 Grade 3). Adrenalin was administered to 8 patients with Grade 3 systemic reaction (8/33008; %0.024). Adverse reactions, especially local ones, were seen more frequently in children under 12 years old (p < 0.001). Patients sensitized with grass pollen (p:0.01) and mite (p:0.004), and those who had received SCIT with pollen mixture had more adverse reactions than the others. More adverse reactions were observed in SCIT containing calcium-phosphate as adjuvant (p: 0.01). Local reactions were risk factors for large local (OR = 3.591, %95 CI:2.064-6.247, p < 0.001) and systemic (OR = 2.190, %95 CI:1.005-4.722 p = 0.046) reactions at univariate analyses. Total nasal symptom scores, Visual Analog Scale and asthma symptom control test decreased after one year of treatment (p < 0.01).Conclusion: SCIT is a safe and effective treatment method in childhood that leads to improvements in all nasal symptoms and asthma after one year of treatment.Öğe Effects of Cow's Milk Components, Goat's Milk and Sheep's Milk Sensitivities on Clinical Findings, and Tolerance Development in Cow's Milk Allergy(Kare Publ, 2021) Gunaydin, Nursen Cigerci; Severcan, Ezgi Ulusoy; Akarcan, Sanem Eren; Bal, Cem Murat; Gulen, Figen; Tanac, Remziye; Demir, EsenObjective: Cow's milk (CM) contains some proteins capable of causing an allergic reaction in a sensitized individual and one of the most common causes of food allergy in childhood. Most of the patients will develop tolerance by the age of 3. In this study, we aimed to evaluate sensitivity to CM allergen components as well as goat's milk (GM) and sheep's milk (SM) cross reactions in cow's milk allergic (CMA) patients and to figure out the risk factors for tolerance non-development. Methods: This is a retrospective cross-sectional study including 66 patients for IgE-mediated CMA with mean age of 38 months. We evaluated the patients in two groups: Group 1 (n=50): Patients who have no tolerance in oral food challenge test; Group 2 (n= 16): Patients who were found tolerant to CM after elimination diet. CM-sIgE, alpha-lactalbumin (ALA)-sIgE, beta-Lactoglobulin (BLG)-sIgE, casein (CAS)-sIgE, GM-sIgE, and SM-sIgE, skin prick tests with CM and GM, and eosinophils in peripheral blood were all compared between two groups. Results: In the whole group, GM-sIgE and SM-sIgE were positive in 84.8% and ALA-sIgE, BLG-sIgE, and CAS-sIgE were positive in, respectively, 69.7%, 62.7%, and 77.3% of the patients. Two groups were similar in terms of age at onset and diagnosis, gender, median elimination period, total IgE levels, CM-sIgE, and eosinophilia (p>0.05). Mean wheal diameters of CM and GM in SPT (p<0.001), GM-sIgE (p=0.03), and SM-sIgE (p=0.01) were significantly higher in Group 1. There was a positive correlation between CM-sIgE and total IgE (p=0.001), eosinophilia percentage (p=0.04), CM wheal diameter in SPT (p=0.001), CAS-sIgE (p<0.001), GM-sIgE (p<0.001), and SM-sIgE (p<0.001) in Group 1. Patients with respiratory symptoms and history of anaphylaxis had higher CM-SPT, CM-sIgE, CAS-sIgE, GM-sIgE, and SM-sIgE (p<0.05) levels. Gastrointestinal and skin symptoms showed no relation with laboratory findings. Tolerance was not developed in any patient with a history of anaphylaxis. Conclusions: As with CM-sIgE levels and high induration diameters in SPT, high CAS-sIgE, SM-sIgE, and GM-sIgE levels are also risk factors for persistence of CMA; anaphylaxis, as a first reaction, may also be a risk factor. High CM-sIgE, CAS-sIgE, SM-sIgE, and GM-sIgE levels are associated with respiratory symptoms.Öğe Effects of volatile substance abuse on the respiratory system in adolescents(Novamedia, 2011) Buker, Halime S. C.; Demir, Esen; Yuncu, Zeki; Gulen, Figen; Midyat, Levent; Tanac, RemziyeAim: Inhalant abuse is a prevalent and often overlooked form of substance abuse in adolescents. Chronic inhalant abuse can damage respiratory, cardiac, renal, hepatic, and neurologic systems. This study aims to determine the physiologic effects of inhaling solvents on the respiratory functions. Methods: The general health status of the subjects was assessed by history taking, physical examination and a questionnaire which was designed to show the severity of respiratory symptoms. Spirometry, ventilation/perfusion scintigraphy, and high resolution computed tomography (HRCT) were performed to assess pulmonary functions and anatomy. Results: Thirty-one male volatile substance abusers and 19 control subjects were included in the study. The mean age of onset of inhalant use was 14.6 +/- 2.2 (9-18) years and duration of drug use was 3.7 +/- 1.7 years. The most common respiratory symptoms in volatile substance abusers were nasal congestion (45.2%), sputum (38.7%), exercise intolerance (32.3%) and cough (22.6%). Results of spirometric studies showed 12 (41.4%) subjects with low FVC values < 80% of predicted, indicative of restrictive ventilatory pattern in the study group. Although the difference was not statistically significant, restrictive ventilatory pattern was higher in the study group. There was no statistically significant correlation between restrictive ventilatory pattern and the age of onset/duration/frequency of inhalant abuse, respiratory symptoms and scintigraphic abnormalities. Subjects who had restrictive pattern in their pulmonary function tests were more likely to have abnormal findings at HRCT (p < 0.01). Conclusion: This study has shown a positive correlation between volatile substance abuse and the development of restrictive ventilatory pattern, but more comprehensive studies are needed for more precise conclusions.Öğe Efficacy of pollen immunotherapy in seasonal allergic rhinitis(Wiley, 2007) Can, Demet; Tanac, Remziye; Demir, Esen; Gulen, Figen; Veral, AliBackground:The efficacy of subcutaneous pollen immunotherapy has been documented in published double-blind, placebo-controlled studies related to treatment of seasonal allergic rhinitis. In the present study, subjective (symptom scores) and objective (nasal peak inspiratory flow, nasal smear, nasal biopsy) parameters were used to study the efficacy of pollen immunotherapy. Methods: Forty-eight patients (32 male), mean +/- SE age 13.6 +/- 2.8 years allergic to grass-pollen participated in the present study. Patients were divided into three groups: group I, 24 patients who did not receive pollen immunotherapy; group II, 12 patients who received the build-up phase of pollen immunotherapy; and group III, 12 patients who had just finished pollen immunotherapy. With regard to objective and subjective parameters these three groups were compared. Results:When group I was compared to groups II and III, the patients who had not received any immunotherapy were found to have a high daytime nasal symptoms score (P < 0.01), high daytime eye symptoms score(P < 0.01) and high night-time symptoms score (P < 0.01). In objective parameters, it was found that group I had low nasal peak inspiratory flow (P < 0.05), and a high eosinophil count in nasal smears (P < 0.05) and peripheral blood (P < 0.05). It was also demonstrated that there was an increased eosinophil infiltration (P < 0.01) and mast cell infiltration (P < 0.05) in nasal biopsy in group I. There was no significant difference between group II and group III according to these results (P > 0.05). Conclusions: Immunotherapy leads to a better clinical and histopathological prognosis in children with seasonal allergic rhinitis.Öğe Ege bölgesi sağlıklı Türk çocuklarında solunum fonksiyon testleri(Ege Üniversitesi, 1995) Demir, EsenÖZET Çocuklarda SFT parametrelerinin normallerini bulmaya yönelik çalışmalar çeşitleri ırklar ve etnik gruplarda yapılmıştır. Biz spirometrik testleri 10-15 yaş arasında, 1188 (613 kız, 575 erkek) çocukta İzmir'de yaptık. VC, FVC, FEVP PEF ve FEF25.75 erkek çocuklarda yüksek bulunmuştur. Aynı yaştaki 11-12 yaş grubunda VC, FVC ve FEVj kızlarda erkeklerden yüksekdir. Boylara göre ise aynı boydaki erkek çocuklarda kızlara göre VC, FVC, FEVj ve PEF daha yüksekdir. BMI'leri 3 persantilin altında olan çocukların VC, FVC, FEV, PEF değerleri, BMI'leri normal ve 85 persantilin üzerinde olan çocuklardan düşüktür. Boy SFT parametreleri prediksiyonunda en etkili antropometrik ölçümdür. Referans spirometrik değerler özellikle 160180cm gibi uzun boylularda Sırotkovic ve Polgar'ın değerlerinden düşük bulunmuştur. 70