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Cell-mediated cytotoxicity measurements can be divided in two methods, depending on whether radioactive material is used or not. Natural Killer cell-mediated cytotoxicity is routinely measured with a short-term assay by labeling the target cells with radioactive chromium (51Cr). The advantages of this method are (1) highly sensitivity, (2) easy execution, (3) low spontaneous release, and (4) nontoxic markers. The disadvantages include short half-life of the label and handling and disposal of radioactive supplies. Many attempts have been made to adapt this cytotoxicity assay to abolish radioactivity while maintaining its high sensitivity. Consequently, various nonradioactive methods have been developed. One of these methods utilizing the release of enzymes (LDH) as a result of cytolysis or membrane dyes (PKH-26) is usually less sensitive than radioactive assays. MTT-based colorimetric/enzymatic assays are highly sensitive and easy to use but unfortunately works only with adherent tumor cell targets. Fluorescent dyes such as carboxy-fluorescein diacetate can easily accumulate in the cytoplasm of effector or target cells. After cytotoxicity, the release of the dyes into the supernatant or their retention in target cells is calculated. However, spontaneous release of these dyes can be quite high, causing false positive results leading to a decreased sensitivity and restricting their use in short-term assays. More recently, flow cytometric methods using fluorescent monoclonal antibodies such as anti-CD56 for effector and anti-CD33 for target cells have been defined. [ABSTRACT FROM AUTHOR]

Objective: Intravenous immunoglobulin preparations have been used in the treatment of primary immunodeficiency for many years. Recently, immunoglobulin administration via the subcutaneous route has become popular. Subcutaneously administered immunoglobulin provides more stable serum immunoglobulin levels and has a lower incidence of systemic adverse effects than the intravenous route. This method increases the quality of the patient's life by self administration or parental administration at home. Immunoglobulin preparations designed for subcutaneous administration have been available in Europe and the US since 2006. Although subcutaneous immunoglobulin preparations are not available in Turkey, the subcutaneous administration route has recently been included in the instructions of the three intravenous products with 10% concentration. Our aim was to use one of these intravenous immunoglobulin preparations via the subcutaneous route and describe its advantages and disadvantages. Materials and Methods: Six primary immunodeficiency patients were selected from our clinic. The procedure was described and informed consent obtained. They had been treated with intravenous immunoglobulin for the last few years. Their monthly immunoglobulin dosage was calculated and roughly divided into weekly doses. The first few administrations took place under medical supervision at the hospital until the patients and/or their family learned the procedure. Results: They were encouraging with fewer side effects, better life quality and lower infection rates in our small sample of patients. Conclusion: In this article, we describe our experience with 6 primary immunodeficiency patients of our clinic in whom we successfully used intravenous immunoglobulin preparation via the subcutaneous route. [ABSTRACT FROM AUTHOR]

The genera of molds that most often cause allergic symptoms are Alternaria, Aspergillus, Cladosporium and Penicillium. The most frequently implicated genera in children are Cladosporium in Nordic countries, and Alternaria in the Mediterranean region and North America. Although the prevalence of sensitization to commercial fungal extracts is approximately 3% in epidemiologic studies, the sensitization rate may increase up to 80% in selected patients, particularly in those with asthma. Alternaria has been increasingly recognized as a risk factor for the development and persistence of asthma, asthma severity, and potentially fatal asthma exacerbations. Additionally, mold allergy could result in a more severe course of asthma or rhinoconjunctivitis. Presently, the diagnosis and allergen immunotherapy of mold allergy is hindered by the poor quality of most of the commercially available extracts. There are only a few randomized double-blind placebo-controlled studies that have evaluated the efficacy of immunotherapy with Alternaria extracts against mold allergy in patients with respiratory allergic diseases (rhinitis and asthma). Current reviews demonstrate that the clinical efficacy of immunotherapy with fungal extracts has been shown in actively treated patients in at least 4 controlled trials, with two fungal species including Alternaria alternata and Cladosporium herbarum. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is one of the most common chronic diseases in all age groups. It is an IgE-mediated allergic inflammation of the nasal airways and is characterized by sneezing, swelling and inflammation of the nasal mucosa as well as itchy and watery eyes. It is a global health problem and a burdensome disorder affecting many people from childhood to adulthood. The prevalence of childhood AR shows wide variation throughout the world, ranging from 0.8 to 45%. The prevalence rates for different regions of Turkey ranges from 2.9 to 44%. The aim of the present review is to provide an update on AR treatment and diagnosis. Because of its burden on patient’s lives and its impact on asthma, AR should be taken care of properly with effective and safe treatments. Second-generation antihistamines and intranasal steroids represent the milestone of AR therapy. New formulations of available drugs (rupatadine oral solution, ebastine fast-dissolving tablets, combination of intranasal fluticasone propionate and azelastine hydrochloride), recently discovered molecules (ciclesonide, bilastine, roflumilast, etc.), immunologic targets (omalizumab) and unconventional treatments (homeopathic treatments) are representing new frontiers in AR management. An accurate diagnosis of AR is also crucial to increase treatment success. Further promising improvements in diagnostics are expected from recombinant allergen diagnostics identifying particular molecules of risk. Purified native or recombinant allergens, identifying the individual molecules to which patients are sensitized, can be determined by molecular or component resolved diagnostics. These may decrease the need for provocation testing and improve the specificity of allergen immunotherapy. Different methods to measure nasal nitric oxide (nNO) levels are currently being revealed. Decreased nNO concentration is also typical of cystic fibrosis, even though nNO is not as low as in primary ciliary dyskinesia. The clinical utility of nNO remains to be established in upper airway disorders such as AR. [ABSTRACT FROM AUTHOR]

Flow cytometry is a device that analyzes the physical and/or chemical characteristics of cells or particles as they pass through a fluid system one by one. Laser beam diffracted and florescent light emitted by each cell or particle while passing through the fluid system are gathered by optic filters and mirrors, separated into varying wavelengths, and transformed into analogue signals. The signals are digitalized and transferred to a screen as histograms. The histograms are based on the principle of demonstrating the frequency distributions of the parameters measured visually. While the data obtained can be demonstrated in different graphics, the cells are separated according to cell size and granular structure. Analysis of cell groups through fluorescently labeled antibodies enabling analysis of more than one surface antigen at the same time can also be performed by flow cytometry. Today, immunologic diseases are one of the most common fields where flow cytometry is used. Monoclonal antibodies used to detect lymphocyte subgroups in flow cytometry are crucial in the diagnosis of disease groups and types. Examples of some types of immunodeficiency diagnosed by flow cytometry are given in this study. Immunologic diseases such as severe combined immunodeficiency, Bruton’s disease, chronic granulomatous disease, common variable immunodeficiency and bare lymphocyte syndrome can be assessed with flow cytometry. Its use in allergic diseases is based on measuring basophil activation in flow cytometry. When the basophil contacts with antigen, the cell activates and expresses CD63 on the surface. Besides, there are clinical studies showing that the basophil activation test can be used to monitor the effectiveness of allergen immunotherapy. In near future, flow cytometry will be continued to be used more intensely in the diagnosis and follow-up of allergic and immunologic diseases with new markers and more developed technology. [ABSTRACT FROM AUTHOR]

Although glucocorticoids are also known as anti-allergic drugs, rare allergic side effects of glucocorticoids have been reported in the literature. These reactions vary from simple rash to anaphylaxis. Here, a patient who developed anaphylaxis several minutes after intravenous methylprednisolone administration is described. With this report, we want clinicians to be aware of rare side effects including anaphylaxis due to methylprednisolone, known as an anti-allergic drug. An 11-year-old female presented to an outside emergency clinic with ataxia, headache, blurred eyesight and being unable to sit without help for the last week. There was an upper respiratory tract infection within two weeks in her medical history. She seemed well and systemic examination revealed normal findings. Neurological exam showed ataxic gait with positive Romberg and Babinski signs. Eye examination revealed bilateral papillary edema. Laboratory investigations revealed normal CBC, ESR, CRP and routine biochemistry values. Cranial MR suggested pseudotumor cerebri and intravenous methylprednisolone pulse therapy was initiated at the pediatric ward. Several minutes later, a maculopapular rash appeared on her neck and trunk followed by nausea, tachypnea, dsypnea and tachycardia. Consequently, a type 1 hypersensitivity reaction was suspected so the infusion was stopped temporarily and an antihistaminic administered by the pediatrician. The symptoms were resolved but they reappeared when the infusion was restarted mistakenly. An anaphylactic reaction to methylprednisolone was considered and dexamethasone pulse was advised by the allergy unit instead of methylprednisolone. Previous tolerance to the oral form of methylprednisolone by the patient verified the presumption that the reaction was against an excipient. This case indicates that there may even be an allergic reaction to anti-allergic medications. [ABSTRACT FROM AUTHOR]

Cockroach allergy has been considered as an important cause of respiratory allergic diseases for over three decades. The most common domiciliary cockroach species are Blattella germanica (German cockroach) and Periplaneta americana (American cockroach). Blattella germanica is a small cockroach, approximately 16 mm in length, which commonly infests houses worldwide. Periplaneta americana is a large cockroach, approximately 35–53 mm in length, that infests houses, schools, hospitals, and other large buildings. There are more than 20 different cockroach species in Turkey, and Blattella germanica is known as the most common. In the United States, the prevalence of cockroach allergy ranges from 17 to 41%’in various studies involving both children and adults. European studies on children and adults attending an allergy clinic show a high variability in cockroach sensitisation varying from %4–26. In Turkey, cockroach allergy prevalence rate varies from %2.2-51.4 in different studies consisting of both children and adults. Tropomyosin, designated as Bla g7 and Per a7, has been identified as a major allergen in cockroaches. Tropomyosin is also an important allergen involved in cross-reactivity among insects and invertebrates including mites, crustaceans, mollusks and parasites. Cosensitization to other invertebrate allergens in cockroachsensitized individuals is a common feature. Consequently, parasite infestations could regulate allergic reactivity through cross-reactive antibody responses. A sustained decrease in cockroach allergen levels is difficult to accomplish even after successful extermination of cockroach populations and commercial cockroach extracts used for diagnosis and treatment remain non-standardized. Although some of the studies suggest that cockroach immunotherapy may be effective, further randomized, controlled clinical trials, using wellcharacterized cockroach extracts, and with larger number of patients and longer follow-up are required to establish the efficacy and safety of specific allergen immunotherapy in the treatment of cockroach allergic patients. [ABSTRACT FROM AUTHOR]

Hopkins' syndrome is a motor neuron disease which leads to a flaccid paralysis due to anterior horn cell damage and normal sensation affecting one or more limbs resembling poliomyelitis. It occurs less than one week after an asthma attack and its prognosis is poor. Although there has been no satisfactory explanation for the etiology; drug neurotoxicity, steroids and viruses (enteroviruses, Mycoplasma and Herpes simplex) have been implicated. Here, a rarely seen male patient having Hopkins' syndrome was described. A five year old male with persistent asthma, allergic rhinitis and atopic dermatitis presented to us with left lower extremity (LLE) flaccid paralysis and hyporeflexia. Three weeks earlier, he was treated for an exacerbation of asthma with-7-day course of oral prednisone, fluticason and albuterol nebules with improvement. However, he had another attack one dav prior to flaccid paralysis. His weakness began with pain and paraesthesia in that morning. He then started to limp and was unable to stand or walk on that left leg a couple of hours later. Physical examination revealed flaccid and areflexic LLE on admission. Plantar reflexes, sensation, hip movements on both lower extremities and sphincter tone were normal. Several months later, he walked with a limp and had persistent LLE weakness and muscle atrophy. CBC, routine biochemistry, CRP, ESR, CPK, toxicology screen and urine analysis were within normal. lgM to EBV, CMV and PCR for enteroviruses were negative. Specific IgE was positive for dust mite. CSF showed normal findings. MRI of spine/peivis/cranium and both extremities was normal. EMG revealed anterior horn cell damage. Hopkins' syndrome should be kept in mind in the differential diagnosis of any flaccid paralvsis associated with an asthma attack. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome (SJS) is an acute, self-limiting but life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be an immune-complex- mediated hypersensitivity that affects the skin and mucous membranes. SJS is most often an adverse effect of medication, and frequently occur two weeks after use. There is an oral medication called as Scholl solution, which has different formulations, correcting base deficit in renal tubular acidosis (RTA). It is made of pure citric acid and salt of sodium citrate or salt of sodium and potassium citrate in distilled water. SJS is not reported to be related to Scholl solution till now. Since a patient, with cystinosis using Scholl solution for years, who developed SJS after receiving Scholl solution with different formula is presented, we want to increase awareness on this issue. Three-year-old-female presented to us with complaints of maculo-papular rash on her face and over the trunk. She has been taking cysteamine, carnitine, calcitriol, neutral phosphate and Scholl solution. After consanguineous marriage, she has two siblings having cytinosis and one sibling required renal transplantation. Physical examination showed erythematous maculo-papular rash on her face and over the trunk and extremities, later skin lesions were resulted in exfoliation. C-reactive protein, CBC, with differential, biochemistry and blood gas were normal. Following dermatology consultation, she was diagnosed with SJS after biopsy, but the patient was thought to be inclined to develop toxic epidermal necrolysis (TEN). Methylprednisolone, pheniramine, desloratadin, and intravenous immunoglobulin were given to prevent developing TEN. Skin lesions regressed after discontinuing medications. Since the etiology was uncertain, when medications restarted, the skin lesions recurred after Scholl solution containing pure citric acid. This patient shows that physicians keep Scholl solution in mind as a cause for SJS in RTA patient. [ABSTRACT FROM AUTHOR]

Food allergy is an important public health problem that affects adults and children and has been increasing in incidence. Despite the risk of severe allergic reactions and even death, there is still no certain treatment for food allergy at the moment. Moreover, the diagnosis of food allergy may be problematic as well, given that non-allergic food reactions, such as food intolerances and intoxications, are frequently confused with food allergy. Gastrointestinal system symptoms e.g. vomiting and diarrhea in consequence of food allergy include a spectrum of disorders such as proctocolitis and enterocolitis that result from adverse immunologic responses to dietary antigens. Cutaneous reactions to foods are some of the most common presentations of food allergy and include IgE-mediated (urticaria), cell-mediated (contact dermatitis), and mixed IgE/cell-mediated reactions (atopic dermatitis). Food-induced respiratory system manifestations such as asthma and Heiner's syndrome are also discussed in this review. Although any food might cause systemic symptoms such as anaphylaxis, the most commonly implicated foods in fatal cases are peanut, tree nuts, shellfish, and fish. [ABSTRACT FROM AUTHOR]

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