Hatice Çelik Tuğlu

Background/Objectives: Relapse after omalizumab withdrawal is common in chronic spontaneous urticaria (CSU), but patients requiring repeated treatment re-initiation across successive withdrawal cycles remain poorly characterized. This study aimed to characterize patients with repeated relapse requiring omalizumab re-initiation and to determine whether routinely available baseline parameters could distinguish them from other patients with CSU. Methods: This retrospective, single-center study included 46 adults with CSU who achieved disease control with standard-dose omalizumab after an initial 6-month course. Patients were evaluated during a fixed 12-month period following the first withdrawal. Repeated omalizumab re-initiation was defined as relapse requiring re-initiation within 12 weeks after withdrawal on at least two occasions. Baseline clinical and laboratory characteristics were compared between groups, and multivariable logistic regression was performed. Results: Twenty-nine patients (63.0%) met the criteria for repeated omalizumab re-initiation. Baseline disease activity, angioedema, atopic status, autoimmune thyroid disease, previous systemic corticosteroid use, total immunoglobulin E (IgE), anti-thyroid peroxidase antibody (anti-TPO), C-reactive protein (CRP), eosinophil and basophil counts, and inflammatory indices did not differ significantly between the repeated-treatment and comparison groups. Vitamin B12 was the only laboratory parameter showing a significant between-group difference in univariable analysis (259 vs. 335 pg/mL; p = 0.034); however, this association was not retained after multivariable adjustment. None of the variables included in the multivariable model were independently associated with repeated omalizumab re-initiation. Conclusions: Repeated relapse requiring omalizumab re-initiation across successive withdrawal cycles was common during the 12-month observation period. Routinely available baseline clinical and laboratory parameters did not reliably distinguish patients who developed this relapse–retreatment pattern. These findings highlight the difficulty of predicting repeated retreatment requirements from conventional baseline assessments and support further prospective investigation of individualized withdrawal and step-down strategies in patients who develop recurrent relapse–retreatment cycles.

Introduction: Identifying the eosinophilic, neutrophilic, or infectious phenotypes of exacerbations, particularly those occurring during biologic agent therapy, may provide valuable guidance for determining maintenance therapy for patients and preventing recurrent exacerbations. Methods: The first asthma exacerbation experienced by the patients after the 16th week of biological agent treatment was evaluated in terms of inflammatory phenotype and clinical features. White blood cell counts and C-reactive protein levels, related season, antibiotic use, and hospitalization during the exacerbation were recorded from patients’ medical file records. Results: Medical records of 135 patients diagnosed with severe asthma treated with biologic agents were reviewed. Of these, 46 patients did not experience any exacerbations after initiating biologic agent therapy. In addition, 14 patients who benefited from biologic therapy but could not completely discontinue low-dose maintenance steroid treatment were excluded from the study. As a result, data of 75 patients diagnosed with severe asthma receiving biological treatment were analyzed. The mean age of the study population was 48.0 ± 11.0 (mean ± standard deviation), and 52 (69.3%) of them were female. Among the patients, 70.7% (n=53) were using omalizumab, and 29.3% (n=22) were using mepolizumab. More than half of the exacerbations were eosinophilic both in patients using omalizumab and in patients using mepolizumab (69.8% and 54.5%, respectively). Conclusion: Phenotyping of asthma exacerbations that persist in spite of biologic therapy will guide treatment adjustments and decisions to switch biologic agents to improve outcomes.

Background and Objectives: Drug provocation tests (DPTs) diagnose drug hypersensitivity reactions (DHRs) and identify safe alternatives. DHRs contribute to patient anxiety. The aim of this study was to evaluate anxiety and hopelessness levels before and after DPT and to examine patients’ avoidance characteristics of the tested drugs. Materials and Methods: Patients undergoing DPT were included. The State–Trait Anxiety Inventory (STAI) assessed anxiety, and the Beck Hopelessness Scale measured hopelessness. Demographic and clinical data, pre- and post-DPT scores, the status of using the medication provided after DPT, and the reason for not using it were analyzed. Results: Seventy-nine patients (60 female, 75.9%) participated. Patients’ Beck Hopelessness Scale, STAI–State, and STAI–Trait scores decreased significantly after the DPT compared to the initial scores. Among the patients who developed a reaction during the drug provocation test, the rate of those whose scale scores increased was significantly higher than the rate of those who did not develop a reaction. A total of 42 patients (53.2%) did not use the alternative safe drug. Of these, six (14.3%) reported that their reluctance stemmed from a fear of experiencing a reaction similar to their initial adverse event. Patients with concomitant allergic diseases were less likely to use alternative safe drugs. Conclusions: DPT reduces long-term anxiety and hopelessness. However, one in seven patients avoids the prescribed safe drug due to fear of recurrence. Effective communication, especially with patients who have allergic conditions or experience a reaction during DPT, and psychological support may improve adherence to the tested medication.

Real-life studies are needed to evaluate the clinical outcomes of add-on tiotropium therapy in patients with asthma. The effects of adding tiotropium bromide to the treatment of asthmatic patients on pulmonary functions and asthma control using real-life data. In a retrospective study, spirometric measures and asthma control states were compared before and one year after of tiotropium treatment in asthmatic adults whose disease was not adequately controlled with a combination of inhaled corticosteroids and long-acting β2-agonists. One year after tiotropium treatment, mean FEV1, FEV1%, and FEV1/FVC ratio increased significantly compared to pretreatment values. Among 32 patients added tiotropium due to symptomatic asthma, 28 (87.5%) patients achieved well-controlled (ACT ≥ 20) end of the year and GINA treatment step-down in 4 (12.5%) patients. Monoclonal antibody therapies (mepolizumab or omalizumab) were initiated in 9 patients (28.1%). FEV1 values and FEV1/FVC ratios showed a statistically significant improvement from baseline measurements obtained prior to the initiation of tiotropium therapy, independent of monoclonal antibody use (p < 0.001 for each). The mean age of these patients was 48.78 ± 11.64 (range: 28 - 81) years, and 25 (78.1%) of them were female. Tiotropium bromide is an effective and reliable add-on therapy for symptomatic asthma when combined with ICS plus LABA, also leads to improvements in respiratory function and asthma control.

Aims: This study aims to define characteristics of hypersensitivity reactions with etoposide, and outcomes of desensitizations in immediate-type hypersensitivity rections Methods: This is a retrospective observational study of patients who had hypersensitivity reactions with etoposide from January 2019 to December 2023. Results: A total of 39 patients with lung cancer were included in the study. Ten (25.6%) patients had known other drug allergies and three (7.7%) patients had previous chemotherapeutic hypersensitivity two with paclitaxel and one with docetaxel. Most of the initial hypersensitivities were in the first or second cycle (n=29, 74.4%). Ten (25.4%) patients had hypersensitivity reactions at the first application of etoposide. Thirty (76.9%) patients had immediate-type hypersensitivity reactions. There was no significant difference in terms of patient and initial hypersensitivity characteristics between patients who had immediate or non-immediate type hypersensitivity reactions. Of the 30 patients with immediate-type hypersensitivity reactions, initial reaction was mild in 16 (53.3%) and moderate in 14 (46.7%) patients. Most common symptoms were erythema in 29 (96.7%), dyspnea in 13 (43.3%), chest tightness in 8 (26.7%), discomfortness in 7 (23.3%), and hypertension in 6 (20%). Skin tests were negative in five patients who underwent skin testing. A total of 98 desensitization courses were performed in 27 patients and 3 (11.1%) patients had breakthrough reactions. Conclusion: Most of the hypersensitivity reactions to etoposide are immediate-type and not severe. Desensitization is an effective and safe procedure to manage these reactions. Further research is needed to elucidate the mechanisms of hypersensitivity reactions.

Propolis is a resinous substance produced from tree buds and bark, digested by bees, and is mainly composed of resins, wax, pollen, and essential oils. Propolis is used in traditional medicine due to its antiinflammatory, antioxidant, antiseptic, and local anesthetic properties. The increase in the use and popularity of propolis-containing products coincides with a linear increase in the incidence of propolis-related allergic contact dermatitis. In this report, we present a case of local allergic contact dermatitis that developed after local propolis application for wound care in a 69-year-old male patient.

Coronavirus disease 2019,treatment,hydroxychloroquine,tocilizumab,convalescent plasma