Environmental exposure plays a major role in the development of allergic diseases.The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects.Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic
BackgroundData are limited regarding the effectiveness of omalizumab in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Our aim was to evaluate the clinical and functional effectiveness of omalizumab in patients with EGPA in long-term follow-up.MethodsThis study was a retrospective chart review of patients with EGPA who were treated with omalizumab injections between May 2012 and April 2018. Once treatment with omalizumab was started, data were collected at various time points: baseline, the 16th week, 1st year, and annually until the last evaluation.ResultsEighteen patients (16F/2M) with a mean age of 48.61 ± 11.94 years were included. Data were available for all patients for the first year, 12 patients for the second year, 10 patients for the third year, 8 patients for the fourth year and 5 patients for the fifth year. All patients were on mean dosage of 15.77 ± 7.6 mg/day oral corticosteroid (OCS) as daily bases for mean 8.61 ± 4 years besides high-dose inhaler corticosteroid/long-acting beta agonist. Antineutrophil cytoplasmic antibodies (ANCA) were positive in 2 patients, and 8 patients were diagnosed as having vasculitis by skin biopsy, one patient had polyneuropathy, and one patient had cardiac involvement.By considering the individual responses of patients and the level of improvement at the last evalulation, 10 (55.6%) patients responded completely, 1 responded partially, and 7 (38.9%) had no improvement. Omalizumab worked as a steroid-sparing agent in all patients and the daily OCS dose was reduced with a mean dosage of 6.28 mg/day at the end of the first year. The mean OCS reduction time for the whole group was 4 months. A reduction in asthma exacerbations/hospitalizations, improvement in forced expiratory volume in 1 second, and no decrease in the eosinophil count during treatment with omalizumab were also observed.ConclusionsOmalizumab improved asthma control in some patients with EGPA with uncontrolled asthma by reducing asthma exacerbations and oral steroid requirement. However, more data are needed before recommending widespread use of omalizumab in patients with EGPA.
In this study, we aimed to evaluate the effect of CPAP treatment on hemograms of patients with severe OSA in the lack of comorbidities which might affect the real values of hematological parameters.This retrospective cohort study patients selected from those whose polysomnography reports were compatible with severe OSAS and who underwent PAP titration in our sleep medicine department. 49 patients were enrolled to the study. The baseline hemograms of the participants were collected from one of the patients' visits before they started to use CPAP devices. The control hemograms were evaluated from one of the control visits in the first six months of treatment. We examined the red cell distribution width (RDW), mean platelet volume (MPV), hemotocrit (Hct) and platelet (Plt) count from the hemograms.The mean age was 58.2 years ± 11.3 years, 38.8% were female and 61.2% were male. 69.4% were non-smokers and 30.6% were ex-smokers. The mean body mass index (BMI) was 31.6 ± 5.8 while the mean apnea hypopnea index (AHI) was 50.2 ± 29. The mean duration of CPAP therapy was 4.8 months ± 3.3 months. The mean RDW, MPV, Hct and Plt count values before CPAP treatment were in normal ranges of laboratory tests. All of the values reduced after CPAP therapy but only the decrease in MPV was statistically significant.The reduced values supported that CPAP treatment helped to control hypercoagulability and prevented from cardiovascular disorders in OSAS. Hemogram may be a cheap and easily found laboratory test for monitoring the response to CPAP therapy.
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