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Local allergic rhinitis is a new rhinitis phenotype characterized by symptoms similar to allergic rhinitis, in non-atopic patients with a positive nasal allergen provocation test (NAPT). The disease is diagnosed in over 25% of non-atopic patients with rhinitis, marked as non-atopic rhinitis. It most often has perennial and severe symptoms and a progressive course. It is often associated with conjunctivitis and/or asthma. It is necessary to consider local allergic rhinitis in patients with non-atopic rhinitis. The gold standard for diagnosis is a positive NAPT. Pharmacological therapy fails to stop the natural progression and development of comorbidities. Allergen immunotherapy reduces the symptoms, consumption of medicines and increases the tolerance to allergens responsible for local allergic rhinitis. New studies are needed to confirm the curative effects and evaluate the preventive effects of allergen immunotherapy.

Many epidemiological studies have shown a positive association between black carbon (BC) concentrations and exacerbation of allergic rhinitis and asthma. The aim of this study was to examine, for the first time in Serbia, the connection between visits to emergency services due to worsening of allergic rhinitis and allergic asthma and the concentration of BC in the air. Materials and methods: A time-stratified case crossover design was applied for emergency room visits due to allergic rhinitis and worsening asthma that occurred in the Užice region between 2012-2014. Data on visits were routinely collected at the Uzice Health Center. Results: A statistically significant association was observed between the worsening of allergic rhinitis and BC concentration two days before the visit to the emergency department (UO = 359, UO = 3.20 and UO = 3.24, depending on whether the analysis is not adjusted or adjusted for appropriate weather conditions). There was also a statistically significant association between worsening of allergic asthma and BC concentration two days before the emergency service visit (UO = 3.15, GP = 0.98-10.14) and three days before the emergency service visit (UO = 2.98; UO = 3.23 ; UO = 2.98). Conclusion: Exposure to soot, especially during the heating season, increases the risk of emergency services due to worsening of allergic rhinitis and asthma.

Introduction/Objective. The purpose of this study was to compare clinical efficacy of casein phosphopeptide – amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) with 0.05% NaF, and to assess their influence on the quality of life among individuals with Sjogren’s syndrome. Methods. Thirty patients were randomized into three groups treated with different remineralizing agents: CPP-ACP, CPP-ACFP, and 0.05% NaF. Oral health was evaluated at the beginning of the study, after 28 days (short-term effects), and after six months. The diagnosis of dental caries was performed using the decayed, missing, and filled teeth (DMFT) / decayed and filled surfaces (DFS) criteria. Enamel demineralization was visually examined using the white spot lesion index (Gorelick). The gingival health was evaluated with the gingival index (Loe–Silness). Assessment of oral hygiene was done using the simplified oral hygiene index (Greene–Vermilion). The Xerostomia Inventory was used to quantify dry-mouth symptoms. The oral health-related quality of life was analyzed using the short form of the Oral Health Impact Profile (OHIP-14). Results. During the evaluation period, caries increment was not significant. Considerable regression of white spot lesions was noted in all three experimental groups (p < 0.001). No significant improvement in gingival health and oral hygiene was observed. Physical pain was decreased in all three experimental groups, and subjective feeling of dry mouth was reduced in CPP-ACP and CPP-ACFP groups. Conclusion. CPP-ACP and CPP-ACFP may reduce the caries activity and relieve the dry-mouth symptoms in patients with Sjogren’s syndrome.

Introduction: Beta(β)-lactam antibiotics are one of the most prescribed medical drugs worldwide. The incidence of self-reported penicillin allergy ranges from 1 to 10 percent. Patients with registered allergy on β-lactam antibiotics are treated with drugs of second choice which are usually more toxic and more expensive. Aim: The aim of this study was to exam the prevalence of penicillin allergy and correlation of clinical, laboratory and socio-demographic characteristic of patients with and without hypersensitivity to penicillin which were available in medical records. Material and methods: This retrospective, descriptive study included consecutive patients, which were treated in Clinic of Allergology and Immunology, Clinical Center of Serbia (CCS), in the period between the years 2010-2015. Anamnestic data of patients with self-reported allergic reaction to penicilin and the rest of β-lactam antibiotics were used, as well as results of in vivo and in vitro tests. Results: 81 patients were evaluated in the study, of which 59 (72.8%) were females. The average age of patients was 41.7±16.47 years. Adverse effects to penicillin were reported by 70/81 (86.4%) tested patients. In accordance with other studies, the most common initial symptoms were rash (exanthema) and angioedema. None of the 70 patients with self-reported allergic reaction to penicillin had positive in vitro tests. Total number of patients with positive in vivo tests is 2/81 (2.5%) Conclusion: Despite a small percentage of positive penicillin hypersensitivity tests of patients with anamnestic data of self-reported allergic reaction, it is necessary to perform in vivo drug provocation test as a gold standard for confirmation of penicillin hypesensitivity in order to reduce the utilization of alternative antimicrobial drugs, the risk of microbial resistance and treatment costs.

Introduction. Wegeners’s granulomatosis is a disease characterized by granulomatous inflammation of the upper and/or lower respiratory tract, glomerulonephritis with varying degrees of small vessel vasculitis and classic anti-neutrophil cytoplasmic antibodies (c-ANCA) findings. The treatment uses different modalities of immunosuppressive therapy which does not always lead to remission. We presented the efficacy of biological therapy in a patient with refractory form of the Wegeners’s granulomatosis. Case report. A 23-years-old patient, was treated in August, 2011 at the Clinic of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Center of Serbia because of suppurative otitis media, resulting twice in mastoidectomy. On the day 7 after the surgery, hemoptysis and fever occurred. Considering lung x-ray that showed presence of the round soft-tissue changes on both sides, nonspecific inflammatory syndrome in laboratory analysis and positive c-ANCA (1 : 160) with high titers the antibodies to the proteinase 3 (anti-PR 3), Wegener's granulomatosis was diagnosed. Due to the fact that administration of glucocorticoids, cyclophosphamide and immunomodulatory dose of immunoglobulin did not lead to clinical remission, it was decided to apply rituximab. After its application clinical remission occurred and it lasted fifteen months. Conclusion. Application of biologic therapy might be successful in the treatment of patients with severe form of refractory granulomatosis with polyangiitis.

Introduction. Angioedema is characterized by subcutaneous and/or submucosal swelling usually localized to the lips, eyelids, tongue, oral cavity, larynx and pharynx. Various types of angioedema, caused by different pathophysiologic mechanisms, can have the same or very similar clinical picture and require different diagnostic and therapeutic procedures. The immediate threat to life as a result of rapidly developed edema of the pharynx and larynx with airway obstruction requires endotracheal intubation or emergency tracheotomy. Standard therapy, which includes epinephrine, second-generation antihistamines and steroids, is not effective in the treatment of all types of angioedema. Objective. On the basis of the clinical presentation and course of angioedema, this retrospective study was aimed at contributing to a better understanding of the etiopathogenesis of the disease and at helping determine the most effective available treatment modalities. Methods. This retrospective study included patients treated under the diagnosis of angioedema of the upper aerodigestive tract between 2000 and 2012 in the Department of Otorhinolaryngology, Clinical Center of Banja Luka. Results. A total of 76 subjects were included in the study. The average age was 62.8 years. There were 40 (52.6%) male and 36 (47.4%) female patients. The largest number of patients (44.7%) had type II angioedema. Almost half of the patients or 36 patients (47.4%) were on treatment with an angiotensinconverting enzyme inhibitor (ACEi), but there was no statistically significant difference under the total number of patients (p=0.678). Conclusion. Better understanding of pathophysiologic mechanisms and the adoption of diagnostic protocols contributes to more effective treatment of angioedema.

Introduction. Primary mucosal melanoma of the sinonasal tract is a rare neoplasm, accounting for less than 1% of all melanomas. It has an aggressive and unpredictable biologic behavior characterized by frequent incidence of local recurrence, local and distant metastasis of the disease. Case report. This report summarizes the results of the previous research concerning sinonasal mucosal melanoma, and by the example of the two patients suffering from mucosal melanoma, we described clinical and histopathological features of this rare neoplasm and our experience in its diagnosis and treatment. Conclusion. Only histopathological analysis complemented by immunohistochemical analysis contributes to early and accurate diagnosis of the disease.

Introduction. Infections in patients with systemic lupus erythematosus (SLE) are a significant factor of morbidity and mortality. Although central nervous system infections, including septic meningitis, are rare in patients with SLE, they can be significant causes of mortality inspite of the prompt and accurate diagnosis and proper management. Case report. We presented a woman with the diagnosis of SLE and diffuse proliferative lupus nephritis. Because of disease activity we introduced cytostatic immunosuppressive therapy, cyclophosphamide and then azathioprine. Meningoencephalitis, staphylococcal sepsis and abscess of the brain, with resulting seizures developed. Conclusion. This case alerts to the need of careful examination of patients with SLE, collection of adequate cultures and evaluation of predisposition towards ifnections, before the introduction of immunosuppressants due to potentially fatal infection.

Sublingual allergen immunotherapy (SLIT) is considered to be safer and more convenient than subcutaneus immunotherapy. SLIT trials with house dust mites involving patients with allergic rhinitis (AR) and asthma reported discordant results. The aim of the study was to investigate the clinical efficacy and safety of SLIT with Dermatophagoides pteronyssinus (D.pt) extract produced in Serbia and patient’s satisfaction through open-label trial. Adult patients with allergic rhinitis were randomized into two groups: one received drugs and SLIT, while other received only drugs. Symptom score (SS), medication score (MS) and cumulative score (CS), skin prick tests (SPT) and serum level of D. pt specific IgE were assessed. One year after, the patients were re-evaluated. In total, 61 patients were enrolled in the study, but 52 of them were analyzed at the end of the year. CS (29.3%, p

Allergic rhinitis is a chronic inflammatory disease of the airways, which can interfere with many aspects of an individual's life and severely diminish the quality of life of the person affected. The objective of this study was to assess the quality of life of patients suffering from allergic rhinitis during and out of pollen season. The study involved 100 patients diagnosed with allergic rhinitis, 48 of who had seasonal, 25 perennial, and 27 who manifested both forms of allergic rhinitis. All study participants were treated at the Institute of Allergology and Immunology, Clinical Centre of Serbia, Belgrade, in the period March-November 2002. A specific quality of life questionnaire for patients with rhinoconjunctivitis was used in the study. During pollen season, itchy eyes (x2=6.34; p=0.042), red eyes (x2=7.44; p=0.024), and swollen eyes (x2=6.65; p=0.036) caused significantly more difficulties for subjects with seasonal and those with both seasonal and perennial rhinitis than for subjects with perennial allergic rhinitis. A highly significant difference in the mean scores of the indoors activity variable during and out of pollen season (F=347.28; p=0.000) was noted, that is to say, significant irritation was noted during pollen season among subjects with seasonal and those with both seasonal and perennial allergic rhinitis, however the dynamics of irritation remained the same in both study groups (F=0.145; p=0.704).The patients with seasonal and those with both seasonal and perennial allergic rhinitis experienced a significantly poorer quality of life during pollen season than out of it, as well as an inferior quality of life in comparison to patients with perennial allergic rhinitis during pollen season.

Introduction: Tryptase is an important biomarker widely used in the laboratory confirmation of severe hypersensitivity reactions, especially anaphylaxis. It also plays a crucial role in the diagnosis, risk stratification, management and prognostic evaluation of many other mast cell-related conditions. Aim: This paper aims to highlight the role of serum tryptase, both in allergic disorders and other mast cell-related conditions. Two clinical cases regarding timely serum tryptase acquisition (in drug hypersensitivity reactions during the imaging procedure and perioperative anaphylaxis) are meant to emphasize the clinical potential of this protease. Method: We performed a comprehensive literature search of the PubMed/Medline and Scopus databases. From a total of 640 subject related publications, dating from 1940 to 2024, 45 articles written in English were selected. Literature search results: Total serum tryptase is a simple, cost-effective analysis with a normal baseline tryptase (sBT) level below 8.4 µg/L. Elevated sBT can indicate hereditary alpha-tryptasemia (HαT), mastocytosis and other non-allergic disorders. Patients with higher sBT levels, especially with insect venom allergy, have an increased risk of severe reactions and thereby require a prolonged treatment. All immediate systemic hypersensitivity reactions require a correlation between serum acute tryptase (sAT) and sBT. According to the guidelines, measuring sAT 30 min to 2 h after the symptom onset and sBT 24 h after the resolution, using the 20 + 2 rule and an sAT/sBT ratio of 1.685, improves the diagnostic accuracy in anaphylaxis. Conclusions: Tryptase levels should be acquired in all cases with clinical suspicion of MC degranulation. Given the increasing clinical relevance, elevated baseline serum tryptase levels require a multidisciplinary approach and further investigation.

Background: Strong epidemiological evidence suggests that air pollution plays a significant role in the exacerbation of allergic respiratory diseases. This study aimed to assess the potential relationship between daily levels of sulfur dioxide (SO 2 ) and emergency department (ED) visits for allergic diseases., Materials and Methods: Data regarding ED visits for allergic respiratory diseases were routinely collected from the EDs in the Zlatibor district, and the General Hospital, Užice. The daily average concentrations of SO 2 were obtained from the regional automatic air quality monitoring stations. All data were collected from June 2012 to July 2014. A time-stratified case-crossover design was used. Crude odds ratios (ORs) and ORs adjusted for weather conditions were calculated using conditional logistic regression., Results: Statistically significant associations were seen between 0-day lagged exposure to SO 2 and ED visits for all allergic diseases (OR = 1.62; 95% confidence interval [CI]: 1.05-2.48; P = 0.028) and between 2-day lagged exposure to SO 2 and ED visits for asthma with allergic rhinitis (OR = 2.00; 95% CI: 1.03-3.88; P = 0.042). These results were adjusted for temperature, temperature 2 , and humidity., Conclusion: Our results suggest that short-term exposure to SO 2 conferred an increased risk of ED visits for allergic respiratory diseases, particularly for asthma with concomitant allergic rhinitis., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Research in Medical Sciences.)

Background: As in many fields of medical care, the coronavirus disease 2019 (COVID-19) resulted in an increased uncertainty regarding the safety of allergen immunotherapy (AIT). Therefore, the European Academy of Allergy and Clinical Immunology (EAACI) aimed to analyze the situation in different countries and to systematically collect all information available regarding tolerability and possible amendments in daily practice of sublingual AIT (SLIT), subcutaneous AIT (SCIT) for inhalant allergies and venom AIT., Methods: Under the framework of the EAACI, a panel of experts in the field of AIT coordinated by the Immunotherapy Interest Group set-up a web-based retrospective survey (SurveyMonkey ® ) including 27 standardized questions on practical and safety aspects on AIT in worldwide clinical routine., Results: 417 respondents providing AIT to their patients in daily routine answered the survey. For patients (without any current symptoms to suspect COVID-19), 60% of the respondents informed of not having initiated SCIT (40% venom AIT, 35% SLIT) whereas for the maintenance phase of AIT, SCIT was performed by 75% of the respondents (74% venom AIT, 89% SLIT). No tolerability concern arises from this preliminary analysis. 16 physicians reported having performed AIT despite (early) symptoms of COVID-19 and/or a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Conclusions: This first international retrospective survey in atopic diseases investigated practical aspects and tolerability of AIT during the COVID-19 pandemic and gave no concerns regarding reduced tolerability under real-life circumstances. However, the data indicate an undertreatment of AIT, which may be temporary, but could have a long-lasting negative impact on the clinical care of allergic patients., (© 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on the quality of life (QoL). This study aims to evaluate the impact of AD on the QoL of children and their parents and to identify predictors affecting their QoL., Methods: The cross-sectional study was conducted in Montenegro. It included 200 children with AD aged 5-16 years and their parents. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaire., Results: The mean CDLQI score of the children affected by AD was 17.11 and the mean DFI score of their parents 19.86. There was a significant correlation between AD severity score assessed by a doctor (TIS) and both CDLQI and DFI scores (r=0.53 and r=0.27, respectively). A moderate positive correlation was observed between the QoL of children with AD and QoL of their parents (r=0.53). According to multiple linear regression, more impaired QoL of affected children was associated with more severe AD, younger parent's age and their lower educational level. Poorer QoL of parents was associated with female sex, younger age of children, more severe AD, lower educational level of parents and absence of a family history of atopic disease., Conclusions: The present study confirmed that AD has a large negative impact on QoL of both patients with AD and their families. More impaired QoL was associated with more severe AD.

Introduction: Many time-series studies have shown a positive association between air pollution and asthma exacerbation. However, till now only one study in Serbia has examined this relationship., Aim: To examine the associations between air pollution and asthma emergency department (ED) visits in the Užice region, Serbia., Material and Methods: A time-stratified case-crossover design was applied to 424 ED visits for asthma exacerbation that occurred in the Užice region, Serbia, in 2012-2014. Data about ED visits were routinely collected in the Užice Health Centre. The daily average concentrations of particulate matter (PM 2.5 and PM 10 ), sulphur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and black carbon (BC) were measured by automatic ambient air quality monitoring stations. Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression adjusted for the potential confounding influence of weather variables (temperature, humidity and air pressure)., Results: Statistically significant associations were observed between ED visits for asthma and 3-day lagged exposure to BC (OR = 3.23; 95% CI: 1.05-9.95), and between ED visits for asthma with coexisting allergic rhinitis and 0-day lag exposure to NO 2 (OR = 1.57; 95% CI: 0.94-2.65), 2-day lag exposure to SO 2 (OR = 1.97; 95% CI: 1.02-3.80), and 3-day lag exposure to PM 10 (OR = 2.38; 95% CI: 1.17-4.84)., Conclusions: Exposure to ambient air pollution in the Užice region increases the risk of ED visits for asthma, particularly during the heating season., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Termedia Sp. z o. o.)

Background and objectives: The relationship between air pollen quantity and the sensitization of allergic patients is crucial for both the diagnosis and treatment of allergic diseases. Weather conditions influence the distribution of allergenic pollen and increases in pollen concentration may negatively affect the health of allergic patients. The aim of this study was to analyze the implementation of allergen immunotherapy with regard to air pollen concentration. Material and Methods : Here we examined the relationship between Betula air pollen concentration and the usage of Betula verrucosa allergen immunotherapy in Serbia. Examination covered the period from 2015 to 2018. Measurement of airborne pollen concentration was performed with Lanzoni volumetric pollen traps. The evidence of the usage of sublingual allergen immunotherapy (SLIT) was gathered from patients with documented sensitization to specific pollen. Results: During this period tree pollens were represented with 58% ± 21% of all measured air pollen species, while Betula pollen represented 15% ± 8% of all tree pollens. Betula pollination peaked in April. Allergen immunotherapy to Betula verrucosa in Serbia is entirely conducted as sublingual immunotherapy and represents 47.1% ± 1.4% of issued tree pollen SLIT. The use of pollen SLIT increased by 68% from 2015 to 2018, with an even greater increase in usage recorded for Betula SLIT-80%. Conclusions: This analysis shows a clear causative relationship between pollination and the type/prevalence of applied allergen immunotherapy. Information about the flowering seasons of allergenic plants is very important for people who suffer from allergy, for clinical allergologists, as well as for governing authorities. The presented data is of practical importance to the proper timing of immunotherapy initiation and of importance for urban landscaping. The obtained data can be the starting point for the instatement of a thorough epidemiological study and the inclusion of Serbia on the pollen map of Europe., Competing Interests: The authors declare no conflict of interest.

Background: Atopic dermatitis (AD) is one of the most common childhood skin diseases that can affect the quality of life (QoL) of children. The QoL of Montenegrin children with AD has not been sufficiently explored. The aim of this study was to assess their QoL with special emphasize on age differences., Methods: This cross-sectional study included children with AD seen at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro (CCM) in Podgorica between August 2017 and July 2018. The QoL was assessed with the Infants' Dermatitis Quality of Life Index (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI). Disease severity was measured by the Three Item Severity (TIS) score., Results: A total of 386 children with AD aged from newborn to 16 years took part in this study. The mean total score of the QoL was 14.7 in infants (0-4 years old), 19.4 in younger children (5-9 years old), and 16.6 in older children (10-16 years old). Age was in negative correlation with the CDLQI score, leisure domain of the CDLQI and CDLQI sleep, and in positive correlation with the IDQOL child mood. TIS score was in positive correlation with both the IDQOL and CDLQI score., Conclusions: The QoL measured by CDLQI was more impaired in younger children, whilst IDQOL child mood was more impaired in older infants. The most impaired QoL was seen in children in the age group 5-9 years. Regardless of disease severity, treatment and counseling of children suffering from AD should be tailored specifically to their age., Competing Interests: The authors have declared that no competing interests exist.

Background and Objectives: Many epidemiological studies have shown a positive association between black carbon (BC) and the exacerbation of allergic rhinitis and allergic asthma. However, none of the studies in Serbia examined this relationship yet. The aim of this study was to examine the associations between BC and emergency department (ED) visits for allergic rhinitis and allergic asthma in the Užice region of Serbia. Materials and Methods: A time-stratified case-crossover design was applied to 523 ED visits for allergic rhinitis and asthma exacerbation that occurred in the Užice region of Serbia between 2012-2014. Data regarding ED visits were routinely collected in the Health Center of Užice. The daily average concentrations of BC were measured by automatic ambient air quality monitoring stations. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression adjusted for the potential confounding influence of weather variables (temperature, humidity, and air pressure). Results : Statistically significant associations were observed between ED visits for allergic rhinitis and 2-day lagged exposure to BC (OR = 3.20; CI = 1.00-10.18; p = 0.049) and allergic asthma and 3-day lagged exposure to BC (OR = 3.23; CI = 1.05-9.95; p = 0.041). Conclusion: Exposure to BC in the Užice region increases the risk of ED visits for allergic rhinitis and asthma, particularly during the heating season.

Atopic dermatitis (AD) is a common, chronic skin disease in children that may affect their quality of life (QoL). The aim of this study was to assess QoL in children in Montenegro with moderate to severe AD. A cross-sectional study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Podgorica, between January and December 2014. The study group included 200 children (97 boys and 103 girls) with the diagnosis of AD. The Infants' Dermatitis Quality of Life Index (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI) were used to determine QoL for 90 infants (<4 years old) and 110 children (4-16 years old), respectively. Severity of disease was measured by the three-item severity (TIS) score. The mean scores were 14.38±5.57 for IDQOL and 18.43±4.88 for CDLQI. A positive correlation was observed between AD clinical severity (TIS) and all the items of IDQOL with Spearman's correlation coefficient (ρ) ranging from 0.31 to 0.74, and between AD clinical severity and all domains of CDLQI (ρ=0.31-0.69). The impact of AD on health-related quality of life (HRQoL) was more severe for younger girls, but only in some domains (IDQOL), and for older boys (CDLQI). The linguistically validated Serbian versions of both IDQOL and CDLQI questionnaires showed good internal consistency with Cronbach's alpha values of 0.88 and 0.73, respectively. In conclusion, our results demonstrate that AD has a great impact on QoL. A positive correlation between clinical severity and quality of life was seen.

Introduction: Lupus nephritis is an example of glomerulonephritis mediated by immune complexes. The information obtained by kidney biopsy corroborates diagnosis and evaluation of disease activity, specify of prognosis and mode of treatment. The object of our study was to determine the prevalence of particular pathohistological types of lupus nephritis in our group of patients, to establish if there was a correlation of laboratory and morphological parameters, and to present the use of specific therapeutical protocols., Method: The study included 58 patients with diagnosed systemic lupus erythematosus (SLE) and lupus nephritis, who had biopsy of kidneys. The indications for biopsy were the following: proteinuria level over 0.5 g/24 hrs, erythrocyturia and cylindruria. The patients were examined and treated at the Institute of Allergology and Immunology, Clinical Centre in Belgrade, over the period 1994-2001. Within the testing, besides standard laboratory tests, the immunological evaluation was also performed as follows: the level of standard serum immunoglobulins, C3 and C4 components of complement, antinuclear antibodies (ANA) and antibodies to double-stranded DNA (dsDNA), were determined., Results: There was 84.48% of female patients in the studied group. The mean-age was 36.5 years, while the average duration of disease (SLE) to kidney biopsy was 28.3 months. Considering cytopenia, leukopenia was found in 26.79% of patients, lymphopenia was recorded in 62.26% of cases while anaemia was noted in 52.63% of patients. The values of serum creatinine were elevated in 25.86% of patients, while creatinine clearance rate was lower (below 80 ml/min) in 75% of cases. The values of proteinuria are illustrated in Graph I. Cylindruria was found in 20.69% of subjects, massive erythrocyturia in 44.83%, and 46.55% of patients had more than 5 red blood cells in urinary sediment. Regarding the pathohistological findings, according to WHO classification, the biopsy of kidneys revealed the following distribution: class I--3.45% of patients, class IIA--24.14%, class IIB--31.03%, class III--12.07%, class IV--24.14%, class V--3.35%, and class VI 1.72% of cases., Discussion: Within the immunological evaluation, the increased serum immunoglobulin G (IgG) level was found in 26.79% of subjects, suggesting that the consumption of complements in formation of immune complexes was the basic pathogenetic mechanism of lupus nephritis. Positive finding of ANA was recorded in about 95% of subjects, what was typical for SLE, while antibodies to dsDNA were positive in no less than 72.72% of cases, arguing for the fact that they were one of major nephritogenic antibodies. Considering the correlation analysis, no correlation between pathohistological findings and serum creatinine level was found, but there was the correlation between pathohistological findings and decreased creatinine clearance rate. The correlation between pathohistological findings and proteinuria up to 0.5 g/24 hrs was verified. There was no correlation between the increased IgG level and kidney biopsy findings, but it was found that decreased level of C4 complement component correlated with the degree of kidney lesion. The value of diastolic pressure also correlated with pathohistological findings. Concerning the applied mode of treatment, 46.55% of patients were administered pulse doses of cyclophosphamide combined with pulse doses of methylprednisolone, 5.17% had pulse doses of cyclophosphamide and 32.76% pulse doses of methylprednisolone, while 12.07% received glucocorticoid drugs combined with azathioprine, and glucocorticoids only were given to 3.45% of them. The conclusion will be that the biopsy of kidneys is the imperative in the evaluation of lupus nephritis, because the complete insight into the degree and type of kidney lesion as well as search for an optimal mode of treatment may be achieved only by assessment of combined clinical, laboratory and morphological parameters.

Angioedema is a rare, but important effect of arterial hypertension treatment with drugs which inhibit angiotensin-converting enzyme. Usually, it develops in the first week of therapy, but some atypical cases of the development of angioedema after several months to few years after the onset of the therapy have been reported. Undesired reactions caused by these drugs are probably not allergic, but they are caused by pharmacological effect of these drugs in persons with risk of allergic reaction. In this paper we present some patients with angioedema.

Production of leukotrienes, lipooxygenase products of arachidonic acid metabolism, plays an important role in inflammatory reactions, particularly well studied in bronchial asthma. Lipooxigenase-5 and lipooxygenase-activating protein-5 are crucial in the production of leukotrienes with potent biological activities. Leukotriene B4 is a leukocytic chemoattractant and it induces aggregation and adherence of leukocytes to endothelial vasculature. Sulfidopeptid leukotrienes (C4, D4 and E4) are potent bronchoconstrictors, producing mucous secretion in the airways and increasing vascular permeability. Leukotrienes participate in the process of inflammation, as well as in early and late asthmatic responses. They are found in the blood, liquid obtained upon bronchoalveolar lavage as well as in the urine, irrespectively whether bronchospasm developed spontaneously or it was induced by an allergen. Administration of the specific leukotriene receptor antagonists or leukotriene synthesis inhibitors ameliorates the symptoms and signs of bronchial asthma.

Prostaglandins likewise leukotriens are proinflammatory mediators resulting from metabolic degradation of the arachidonic acid originating from membrane phospholipids. The most important products of enzyme cyclooxygenation of arachidonic acid are prostaglandins D2, E2, F2a, tromboxane A2 and prostacyclin. Prostaglandins express their tissue effects via the five basic receptor types. Within the allergic inflammation activated mast cell synthesizes prostaglandin D2 (first lipid mediator) which has bronchoconstrictive and vasodilating effects and attracts neutrophilic leukocytes. Moreover, it also participates in the late phase reactions, six hours subsequent to the exposure to the allergen. This mediator is also important in pathogenesis of urticaria, allergic rhinitis and allergic bronchial asthma. In addition to prostaglandin D2, prostaglandin F2a and tromboxane A2 also have bronchoconstrictive actions, while prostacyclin and prostaglandin E have bronchodilating effects. Inhalation of prostaglandin E prevents asthmatic attacks caused by allergens, strain, metabisulfite and ameliorates attacks of aspirin asthma, which confirms the hypothesis that aspirin asthma is based on cyclooxigenase inhibition and increased leukotriene production. In patients with atopic dermatitis, prostaglandin E has suppressive effects on Interferon gamma production by Th1 helper cells and increases production of Interleukin 4 by the Th2 cells. Tromboxane A2 plays a certain role in the development of bronchial hyperreactivity and late asthmatic response. Prostaglandins are also important mediators in the pathogenesis of allergic conjunctivitis. Most of nonsteroidal antiinflammatory drugs inhibit the enzyme cyclooxygenase and thus also prostaglandin biosynthesis and release.

T lymphocytes are the crucial cells in immunopathogenesis of allergic diseases since they regulate the occurrence of allergic sensitisation, synthesis of immunoglobulin E and allergic inflammation. The importance of lymphocyte T is reflected on the fact that after activation by a specific antigen they are able to produce different cytokines responsible for activation and aggregation of specific inflammatory cells in target tissues, promoting the occurrence and maintenance of allergic inflammation. Discovery of functional dichotomy of activated lymphocytes T CD4+ capable of suppressing synthesis of immunoglobulin E (Th1) or stimulate immunoglobulin E and allergic inflammation (Th2) is an important element in elucidation of pathogenesis of allergic inflammation and inadequate synthesis of immunoglobulin E. The immunoglobulin synthesis is regulated by a complex combination of factors and signals where lymphocytes CD4+ play the central regulatory role.

Sjogren's syndrome is a chronic inflammatory disease of unknown aethiology. It is characterized by decreased secretion of salivary and lacrimal glands, which induces keratoconjunctivitis sicca and xerostomia. Sjogren's syndrome is a central autoimmune disease, and it has characteristics of both organ-specific and generalized autoimmune diseases. It can exist as a primary disease or is associated with other autoimmune diseases (most freyuently with systemic lupus erythematosus or rheumatoid arthritis) and is classified as a secondary Sjogren's syndrome. The aethiology is multifactorial, and it has not yet been completely explained. In the pathogenesis of the disease the important role have genetic predisposition, chronic oestrogen stimulation, end viral infections, especially of the herpes virus group (EBV, CMV, HHV6) and retroviruses. In the clinical picture xerostomia, xerophtalmia and non-erosive arthritis are the most common features, with the whole spectrum of extraglandular manifestations of respiratory, gastrointestinal, skin, and haematologic, neurologic and endocrinologic disturbances. Pathohistological findings of minor labial salivary gland lymphocyte infiltration is the most specific and the most sensitive diagnostic criterion of Sjogren's syndrome. The diagnosis of keratoconjunctivitis sicca is made by Schrimer's test, Rose bengal dye staining and by the "tear break up time". Differential diagnosis of Sjogren's syndrome includes an extremely large number of various pathologic states. The treatment of Sjogren's syndrome consists of symptomatic treatment of dry mucosas (artificial tears, etc.) and also of antiinflammatory drugs, glucocorticoids, immunosuppressive drugs. Plasmapheresis and intravenous administration of immunoglobulins are used for immunosuppression in these patients.

The paper deals with the current data on aetiological factors of allergic bronchial asthma. The cause of allergic bronchial asthma is unknown. In general, endogenous and environmental factors are though to play a certain role in its development. Early contact with allergic agents, air pollution, tobacco smoking and infective agents (viruses), are considered to be environmental factors. Endogenous factors are heredity of allergic diseases and special susceptibility for bronchial asthma.