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Öğe A potential immunological silver bullet for COVID-19: The trivalent chimpanzee adenoviral serotype-68 vector (Tri:ChAd)(Wiley, 2022) Ardicli, Ozge; Azkur, Ahmet Kursat; Azkur, Dilek[Abstract No tAvailable]Öğe Allergic Contact Dermatitis to Temporary Black Henna Tattoo Due to Sensitization to Para-Phenylenediamine(Bilimsel Tip Yayinevi, 2021) Dibek Misirlioglu, Emine; Tanidir, Merve; Buyuktiryaki, Betul; Kanik Yuksek, Saliha; Sahiner, Neriman; Guvenir, Hakan; Azkur, DilekThe fashion for temporary black henna tattoo is becoming increasingly more common among young adults and teens. An adolescent case with itching, erythema, edema, and inflammatory discharge on the right forearm two days after a temporary tattoo application is presented in this report. To determine the contact sensitizer, a patch test was performed one month after the end of the treatment. A bullous strong positive reaction (3+) was observed against para-phenylenediamine at the 48th and 72nd hours of evaluation after the application. Despite the common belief that henna tattoo application is harmless, the ingredients used in henna tattoo especially paraphenylenediamine can lead to allergenic reactions that can even be severe.Öğe Clinical and etiologic evaluation of the children with chronic urticaria(Ocean Side Publications Inc, 2016) Azkur, Dilek; Civelek, Ersoy; Toyran, Muge; Misirlioglu, Emine Dibek; Erkocoglu, Mustafa; Kaya, Aysenur; Kocabas, Can NaciBackground: Chronic urticaria (CU) is a skin disorder defined as daily or almost daily exhibition of pruritic and transient wheals that last for >6 weeks. CU is divided into two subtypes: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Objectives: To evaluate the clinical features, possible causes, associated findings, and laboratory results of different subtypes of CU in children according to a new classification. Methods: In this study, we evaluated the clinical features, laboratory investigations, and provocation tests of children with different subtypes of CU according to a new classification. Results: Two hundred and twenty-two children (59.9% girls) were enrolled in the study. Of the study patients, 59.9% and 40.1% were diagnosed as having CSU and CIndU, respectively. Antithyroid antibody levels were positive in 7.1% of the patients with CSU, 32.8% of the children had positive 14C-urea breath test results, and 6.5% of the patients had positive stool examination results for parasites. Autologous serum skin test results were positive in 53.5% of the patients with CSU. Of the patients with CIndU, 77.5% had symptomatic dermographism, 16.8% had cold urticaria, 2.2% had cholinergic urticaria, 2.2% had solar urticaria, and 1.1% had aquagenic urticaria. Conclusion: Children with CSU represent the majority of patients with CU, and more than a half of these patients might have autoimmune urticaria. Symptomatic dermographism was the most common type of CIndU.Öğe Clinical and Treatment Evaluation of Anaphylaxis in Children Aged 0-2 Years: Multicenter Study(Springernature, 2024) Selmanoglu, Ahmet; Haci, Idil Akay; Koc, Fatih Sultan Mehmet; Yildiz, Yuksel Kavas; Yilmaz, Ebru Arik; Azkur, Dilek; Erdem, Semiha BahceciBackgroundDiagnosing anaphylaxis in children within the first 2 years of life can be difficult due to the often confusing and nonspecific signs and symptoms.ObjectiveThis study focuses on the phenotype of anaphylaxis in children within the first 2 years of life and aims to increase awareness of anaphylaxis in this age group.MethodsThe study included children between 0 and 2 years who were diagnosed as having anaphylaxis by pediatric allergists in 11 tertiary hospitals.ResultsA total of 402 anaphylaxis episodes experienced by 360 patients (68.7% males) were included in the study. Food was the most common causative agent (n = 374, 93%), with the most common foods being cow's milk (n = 179, 44.6%). Drugs were the second most common trigger (n = 15, 3.7%). The most common clinical findings were cutaneous (95%) and respiratory (72%); nonspecific symptoms such as weakness (n = 63, 15.6%) and hoarseness (n = 14, 3.4%) were also reported. There was a biphasic course in 3 infants (0.8%). Only 3 of the 41 parents who had an adrenaline autoinjector used it during anaphylaxis.ConclusionInfants experience anaphylaxis most often when they are at home with their mothers, and the most common triggers are foods, particularly cow's milk and egg. Greater awareness of anaphylaxis symptoms and autoinjector use among mothers can facilitate management.ImpactInfant anaphylaxis cases may present with different symptoms compared to classic presentations, potentially leading to diagnostic oversight.The study elucidates the clinical course of anaphylaxis in children under 2 years of age.It details the treatment strategies employed in managing these cases.Anaphylaxis triggers were identified over several years.Cases from 11 regions of Turkey were included, representing a population reflective of national data.The study highlights the distinctiveness of anaphylaxis cases in children within the first 2 years of life.Öğe Cold-induced urticaria in children: A multicenter, retrospective cohort study(Ocean Side Publications Inc, 2023) Citlak, Hilal Karabag; Azkur, Dilek; Yildiz, Yuksel Kavas; Demirel, Ali Can; Kot, Hakan; Vezir, Emine; Kilic, MehmetBackground: Studies of cold-induced urticaria (ColdU) in pediatric patients are limited and not well characterized. Objective: The objective of the study was to investigate the characteristics of ColdU in children. Methods: A multicenter, retrospective chart review was performed in children ages <= 18 years diagnosed with ColdU at 11 pediatric allergy and immunology centers in Turkey between September 1, 2010, and August 31, 2022. Results: A total of 83 children with ColdU were included, 54.2% were girls, and the mean age of symptom onset was 8.8 years. The median duration of ColdU at the time of diagnosis was significantly higher in the girls than in the boys (1.0 years [0.0-13.8 years] versus 0.3 years [0.0-15.0 years]; p = 0.007). All the patients underwent an ice cube test, and 71.1% were found positive (typical ColdU). The mean +/- standard deviation age of onset was significantly higher in the patients with typical ColdU versus atypical patients (9.4 +/- 4.5 years versus 7.3 +/- 4.5 years; p = 0.041). Swimming alone and in combination with the wind were significantly the most reported triggers in patients with cold-induced anaphylaxis (ColdA) when compared with patients with ColdU and with nonanaphylactic symptoms (70.0% versus 28.9% [p = 0.022], and 50.0% versus 4.1% [p < 0.001], respectively). Only patients with other chronic urticaria were found to be associated with the development of typical ColdU (p = 0.036). The median total serum immunoglobulin E (IgE) was significantly higher in typical ColdU than in atypical patients (72.5 IU/mL [3.86 - 2500 IU/mL] versus 30.0 IU/mL [0.83 - 1215 IU/mL]; p = 0.007); however, total serum IgE differences were not found to affect ColdU resolution between the two groups (p = 0.204). The resolution was documented in 30.4%. Conclusion: Those who were boys and had a positive ice cube test result could have an association with earlier onset of ColdU. Those swimming alone on a windy day were at highest risk for ColdA. It is still unclear what characteristics are associated with the resolution of ColdU, and this warrants further investigation.Öğe COVID-19 hastalığının immünopatolojisi ve immünolojisindeki güncel veriler(2020) Azkur, Dilek; Azkur, Ahmet Kürşat31 Aralık 2019 tarihinde Çin Halk Cumhuriyeti’nden dünyaya yayılan Ağır Akut Solunum Sendromu (severe acute respiratory syndrome- SARS) koronavirüs (CoV)2’nin neden olduğu hastalık tablosu koronavirüs hastalığı-2019 (CoronavirusDisease 2019-COVID-19) olarak adlandırılmıştır. Bu derlemede, SARS-CoV-2’nin doğal ve adaptif bağışıklık ile etkileşiminin güncel makaleler ile detaylı bir şekilde ele alınmasıamaçlanmıştır. COVID-19 geçiren ağır vakalarda, immünolojik homeastazisin bozulduğu ve neticesinde sitokin fırtınasının geliştiği rapor edilmiştir. COVID-19 geçiren hastalardaartan viral yük, lenfopeni, eozinopeni, azalan trombosit sayısı hastalığın patolojisi ve şiddetinin derecesi ile ilişkilendirilen önemli belirteçler olmuştur. Koruyucu antikorlarınbeklenenden hızlı bir şekilde azalması ise, tekrarlayan enfeksiyonlara karşı daha dikkatli olunmasının zorunlu olduğunugöstermektedir. Bu neden ile etkin, güvenli aşı ve antiviral tedaviler bulunana kadar COVID-19 hastalığı ile sürdürülebilirve disiplinli mücadele şarttırÖğe General characteristics of patients presenting skin and mucosal symptoms admitted a pediatric allergy clinic(Wiley-Blackwell, 2016) Azkur, Dilek; Tandırcıoğlu, Ayşe; Karabulut, Ayşe Anıl…Öğe Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19(WILEY, 2020) Azkur, Ahmet Kursat; Akdis, Mubeccel; Azkur, Dilek; Sokolowska, Milena; van de Veen, Willem; Bruggen, Marie-Charlotte; O'Mahony, LiamAs a zoonotic disease that has already spread globally to several million human beings and possibly to domestic and wild animals, eradication of coronavirus disease 2019 (COVID-19) appears practically impossible. There is a pressing need to improve our understanding of the immunology of this disease to contain the pandemic by developing vaccines and medicines for the prevention and treatment of patients. In this review, we aim to improve our understanding on the immune response and immunopathological changes in patients linked to deteriorating clinical conditions such as cytokine storm, acute respiratory distress syndrome, autopsy findings and changes in acute-phase reactants, and serum biochemistry in COVID-19. Similar to many other viral infections, asymptomatic disease is present in a significant but currently unknown fraction of the affected individuals. In the majority of the patients, a 1-week, self-limiting viral respiratory disease typically occurs, which ends with the development of neutralizing antiviral T cell and antibody immunity. The IgM-, IgA-, and IgG-type virus-specific antibodies levels are important measurements to predict population immunity against this disease and whether cross-reactivity with other coronaviruses is taking place. High viral load during the first infection and repeated exposure to virus especially in healthcare workers can be an important factor for severity of disease. It should be noted that many aspects of severe patients are unique to COVID-19 and are rarely observed in other respiratory viral infections, such as severe lymphopenia and eosinopenia, extensive pneumonia and lung tissue damage, a cytokine storm leading to acute respiratory distress syndrome, and multiorgan failure. Lymphopenia causes a defect in antiviral and immune regulatory immunity. At the same time, a cytokine storm starts with extensive activation of cytokine-secreting cells with innate and adaptive immune mechanisms both of which contribute to a poor prognosis. Elevated levels of acute-phase reactants and lymphopenia are early predictors of high disease severity. Prevention of development to severe disease, cytokine storm, acute respiratory distress syndrome, and novel approaches to prevent their development will be main routes for future research areas. As we learn to live amidst the virus, understanding the immunology of the disease can assist in containing the pandemic and in developing vaccines and medicines to prevent and treat individual patients.Öğe Kronik Ürtiker ve Etiyolojisi(2018) Azkur, DilekÜrtiker sık görülen bir deri lezyonudur ve hayat boyu prevalansı %15-23 olarak bildirilmiştir (1). Hastaların yarısında ürtikere anjioödem eşlik eder (2). Ürtikerin altı haftadan uzun sürmesi ve haftanın hemen her günü ortaya çıkması durumunda kronik ürtiker olarak sınıflandırılır (3). Kronik ürtiker, sıcak, soğuk, güneş ışınları gibi çeşitli fiziksel etkenlerle tetikleniyorsa kronik uyarılabilir ürtiker olarak değerlendirilir (3). Bazı hastalarda kronik uyarılabilir ürtikerin farklı tipleri bir arada görülebilir. Kronik ürtiker, toplumun %0.5-5’ini etkilemektedir (4).Hastaları değerlendirirken alınacak ayrıntılı öykü ve fizik muayene hem tanı hem de yapılacak laboratuvar tetkiklerini planlamak için yol gösterici olacaktır. Başta erişkinlerde olmak üzere kronik ürtiker etiyolojisinde çok farklı etkenler araştırılmış olmakla birlikte hastaların %50’sinde altta yatan neden bulunamamaktadır. Tanısal testler ayırıcı tanı, hastalık aktivitesinin değerlendirilmesi ve uyaranların/altta yatan nedenlerin aydınlatılması amacıyla yapılmaktadır. Farklı çalışmalarda fonksiyonel oto-antikorlar, ilaçlara ve besinlere karşı gelişen psödo-alerji (alerjik olmayan hipersensitivite reaksiyonları), akut ve kronik enfeksiyonlar (Helicobacter pylori veya paraziter enfeksiyonlar) ve ağır sistemik hastalıklar gibi çeşitli faktörler kronik ürtiker nedeni olarak bildirilmiştir (3). Derginin bu sayısında yayımlanan Arıkoğlu ve ark.nın (5) çalışmasında kronik ürtiker tanısı ile izlenen 18 yaşın altındaki 80 hastanın dosyaları retrospektif olarak değerlendirilmiş. Hastaların %53.7’sinde kronik uyarılabilir ürtiker, %46.3’ünde kronik spontan ürtiker tespit edilmiş, etiyolojiye yönelik yapılan tetkiklerinde hastaların %23.7’sinde atopi, %16.4’ünde Helicobacter pylori pozitifliği, %20.3’ünde tiroid otoantikor varlığı, %33’ünde antinükleer antikor pozitifliği, %25’inde gıda katkı maddesi ile ilişkili ürtiker ve %6.7’sinde gaitada parazit saptanmış. Literatürde konuyla ilgili ülkemizden yapılan az sayıda çalışma olması nedeniyle bu makalenin ülkemizdeki duruma ışık tutması açısından okuyuculara yol gösterici olması beklenmektedir.Öğe Recent developments in the immunopathology of COVID-19(Wiley, 2023) Zhang, Huan-ping; Sun, Yuan-li; Wang, Yan-fen; Yazici, Duygu; Azkur, Dilek; Ogulur, Ismail; Azkur, Ahmet KursatThere has been an important change in the clinical characteristics and immune profile of Coronavirus disease 2019 (COVID-19) patients during the pandemic thanks to the extensive vaccination programs. Here, we highlight recent studies on COVID-19, from the clinical and immunological characteristics to the protective and risk factors for severity and mortality of COVID-19. The efficacy of the COVID-19 vaccines and potential allergic reactions after administration are also discussed. The occurrence of new variants of concerns such as Omicron BA.2, BA.4, and BA.5 and the global administration of COVID-19 vaccines have changed the clinical scenario of COVID-19. Multisystem inflammatory syndrome in children (MIS-C) may cause severe and heterogeneous disease but with a lower mortality rate. Perturbations in immunity of T cells, B cells, and mast cells, as well as autoantibodies and metabolic reprogramming may contribute to the long-term symptoms of COVID-19. There is conflicting evidence about whether atopic diseases, such as allergic asthma and rhinitis, are associated with a lower susceptibility and better outcomes of COVID-19. At the beginning of pandemic, the European Academy of Allergy and Clinical Immunology (EAACI) developed guidelines that provided timely information for the management of allergic diseases and preventive measures to reduce transmission in the allergic clinics. The global distribution of COVID-19 vaccines and emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with reduced pathogenic potential dramatically decreased the morbidity, severity, and mortality of COVID-19. Nevertheless, breakthrough infection remains a challenge for disease control. Hypersensitivity reactions (HSR) to COVID-19 vaccines are low compared to other vaccines, and these were addressed in EAACI statements that provided indications for the management of allergic reactions, including anaphylaxis to COVID-19 vaccines. We have gained a depth knowledge and experience in the over 2 years since the start of the pandemic, and yet a full eradication of SARS-CoV-2 is not on the horizon. Novel strategies are warranted to prevent severe disease in high-risk groups, the development of MIS-C and long COVID-19.Öğe Risk factors for severe and critically ill COVID-19 patients: A review(WILEY, 2020) Gao, Ya-dong; Ding, Mei; Dong, Xiang; Zhang, Jin-jin; Azkur, Ahmet Kursat; Azkur, Dilek; Gan, HuiThe pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type I interferon secretion capacity, and pregnancy. Possible complications include acute kidney injury, coagulation disorders, thoromboembolism. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1 beta, Krebs von den Lungen-6 (KL-6), and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of severity of COVID-19.
