Background/Objectives: Immediate-type hypersensitivity reactions (HSRs) to proton pump inhibitors (PPIs) represent a clinically relevant adverse drug reaction and pose diagnostic and management challenges, including variable cross-reactivity (CR). Drug provocation testing (DPT) is the diagnostic gold standard, but real-life use after testing remains uncertain. This study aimed to describe clinical features, diagnostic outcomes, CR profiles, and real-life PPI use in patients with immediate-type PPI hypersensitivity. Methods: Single-center ambispective study of 40 patients evaluated for immediate-type PPI HSRs (2014–2023). Index reactions, culprit PPI, and skin test/DPT results were recorded retrospectively. Patients tolerating an alternative PPI on DPT were followed prospectively; real-life tolerance and use were assessed by structured telephone interview. Results: Among 40 patients (87.5% female; mean age 48 years), lansoprazole was the most frequent culprit (50%); anaphylaxis occurred in 65%. Skin tests were positive in 25% (n = 9), and a shorter interval from reaction to testing was associated with positivity (p = 0.025). CR was detected in 25% (n = 10), most often between lansoprazole and pantoprazole. All 29 patients undergoing DPT tolerated at least one alternative PPI. In real-life follow-up (n = 27), 11 (40.7%) restarted PPIs without recurrence; 1 (3.7%) developed a mild cutaneous reaction despite negative testing. Fifteen (55.6%) did not restart therapy; 4 (14.8%) cited drug-related anxiety or physician-advised avoidance. Conclusions: In immediate-type PPI hypersensitivity, skin test sensitivity appears time-dependent, supporting early evaluation. DPT identifies safe alternatives, yet behavioral and clinician-related barriers limit real-life implementation; addressing these barriers is essential to optimize PPI allergy management.

Background: Biologic agents are widely used in clinical practice, but hypersensitivity reactions (HSRs) may limit their use. Rapid drug desensitization (RDD) allows patients to safely continue essential therapy by inducing temporary tolerance, but evidence on newer biologics such as daratumumab, brentuximab vedotin, and pertuzumab remains scarce. Methods: We retrospectively reviewed 11 patients who underwent RDD for biologic-induced HSRs between 2020 and 2024 at a tertiary allergy center. Each protocol was jointly designed by an experienced allergist and clinical pharmacist and carried out in the intensive care unit under close nurse and physician supervision. Demographic, clinical, and laboratory data, reaction grades, skin test results, premedication regimens, and breakthrough reactions (BTRs) were analyzed. Results: A total of 43 RDD cycles were performed for rituximab (n = 18), brentuximab vedotin (n = 13), daratumumab (n = 9), and pertuzumab (n = 3). Six patients underwent skin testing, two with positive results. Four patients (36%) experienced only mild cutaneous BTRs during their first RDD cycle, and no severe events occurred. The overall BTR rate per cycle was 9.3%. Extending premedication to more than 24 hours before desensitization reduced BTR frequency from 17% to 4%. Conclusion: RDD proved to be a safe and effective approach for managing HSRs to both common and less frequently used biologic agents. All patients completed treatment without discontinuation. Extended premedication period, multidisciplinary planning, and intensive care unit-based monitoring appear to enhance procedural safety and support the broader implementation of RDD in clinical allergy practice. Plain Language Summary: Biologic drugs are important treatments for many immune, blood, and cancer-related diseases. However, some patients develop allergic or hypersensitivity reactions that prevent them from continuing these medicines. RDD is a medical procedure that allows patients to safely receive a medication that previously caused a reaction. It works by gradually introducing small doses of the drug until the body temporarily tolerates it. In this study, we reviewed the experiences of 11 adult patients who had allergic reactions to biologic agents such as rituximab, brentuximab vedotin, daratumumab, and pertuzumab. A total of 43 desensitization cycles were performed under close medical and nursing supervision in an intensive care unit. The desensitization plans were designed together by allergists and clinical pharmacists. The results showed that the procedure was safe and effective. Mild reactions occurred in a few cases, but no serious problems were seen. When premedication (such as steroids and antihistamines) was started more than 24 hours before the procedure, allergic symptoms were less frequent. This highlights the importance of careful planning and teamwork in making desensitization safer for patients.

Background/Objectives: Quinolones are among the most frequently implicated antibiotics in immediate hypersensitivity reactions, yet diagnostic evaluation remains challenging and the real-world behaviour of patients after de-labeling has received little attention. We examined the diagnostic work-up, outcomes, and post-de-labeling drug-use behaviour of patients with suspected quinolone hypersensitivity. Methods: This single-centre ambispective study included 29 patients evaluated between January 2020 and April 2024. Clinical, demographic, skin test, and drug provocation test (DPT) data were extracted retrospectively. Patients in whom allergy had been excluded or a safe alternative identified were contacted by structured telephone interview between May and June 2025. Results: Anaphylaxis was the most common index reaction (42.9%), and ciprofloxacin was the most frequently implicated agent (57.1% of drug instances). Skin tests were positive in 84.2% of cases, but the positive predictive value in the DPT-tested subset was only 20.0%. Of the 12 reached patients, 11 had quinolone allergy excluded; among these, only 4 (36.4%) had reused the de-labeled quinolone, while 7 (63.6%) had avoided it, including 4 who declined it when clinically indicated. Conclusions: Quinolone skin tests show limited specificity, and successful de-labeling does not guarantee real-world drug use. Patient anxiety and counselling are central to effective management.

Background/Objectives: Stigmatization is an under-recognized burden in hereditary angioedema (HAE) that may exacerbate psychosocial distress and functional impairment. Although links to adverse outcomes exist, the domain-specific pathways remain insufficiently characterized. This study investigated the impact of stigma types (workplace, healthcare, social) on anxiety, quality of life, and functional impairment, specifically testing the mediating role of disease-specific quality of life. Methods: This single-center, cross-sectional study included 60 adults with confirmed HAE. Participants completed the Chronic Illness Anticipated Stigma Scale (CIASS), Hospital Anxiety and Depression Scale (HADS), Angioedema Quality of Life Questionnaire (AE-QoL), and Work Productivity and Activity Impairment Questionnaire (WPAI). Hierarchical regression and mediation analyses were used to assess relationships between stigma domains, psychosocial outcomes, and activity impairment. Results: Female patients reported significantly higher anxiety (d = 0.85) and poorer quality of life (d = 0.77) compared to males. In hierarchical regression models, workplace stigma was a significant predictor of activity impairment (p = 0.002). Mediation analysis suggested an indirect association between workplace stigma and activity impairment through disease-specific quality of life (Indirect effect = 1.22; 95% CI: 0.29–3.01). Conclusions: Anticipated stigma in HAE appears to follow domain-specific patterns, with workplace stigma showing the strongest association with functional impairment and poorer disease-specific quality of life. Female gender emerged as an independent correlate of anxiety. These findings underscore the need for HAE management strategies that integrate psychosocial evaluation alongside biomedical control.

Amaç: Nazal polipli kronik rinosinüzit (CRSwNP) klinik pratikte sıklıkla Th2-aracılı ve eozinofilik bir hastalık olarak değerlendirilir; astım sık görülen bir komorbidite olup, bildirilen atopi oranları kohortlar arasında değişkenlik göstermektedir. Ancak primer immün yetmezlik (PİY) hastalarındaki nazal polip fenotipi literatürde yeterince karakterize edilmemiştir. Bu çalışmanın amacı, merkezimizde takipli PİY tanılı ve nazal polipi olan hastaların demografik, immünolojik, atopik ve klinik özelliklerini tanımlamak ve bu polip fenotipini klasik CRSwNP ile karşılaştırmalı olarak yorumlamaktır.Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Allerji ve Klinik İmmünoloji polikliniğinde takipli, PİY tanılı ve kliniko-radyolojik olarak nazal polip saptanan 16 erişkin hasta retrospektif olarak değerlendirildi. PİY tanıları ilgili tanısal kriterlere göre konulmuştu. Demografik özellikler, PİY alt tipleri, immünoglobulin düzeyleri, atopik hastalıklar, spesifik IgE, kan eozinofil sayısı, FESS öyküsü, oral kortikosteroid kullanımı, koku kaybı ve bronşiektazi varlığı kaydedildi. Veriler tanımlayıcı istatistiklerle sunuldu.Sonuç: Hastaların ortalama yaşı 40.4 ± 12.4 yıl olup çoğunluğu erkekti (%62.5); en sık alt tip CVID idi (%62.5). Kohortta sistemik atopik/Tip 2 belirteçler genel olarak düşüktü: allerjik rinit %31.3, astım %12.5; spesifik IgE hastaların %93.8’inde negatifti, total IgE ve periferik eozinofil düzeyleri büyük çoğunlukta düşük/normaldi. Buna karşın hastalık şiddeti yüksekti (FESS %68.8, bronşiektazi %43.8). PİY hastalarındaki nazal polip; düşük atopi, düşük IgE ve düşük eozinofili ile karakterize non-atopik bir fenotip sergilemekte, ancak yüksek FESS ve bronşiektazi oranıyla dirençli ve sistemik bir sinonazal hastalığa işaret etmektedir. Bu bulgular “her nazal polip alerjik değildir” yaklaşımını desteklemekte ve dirençli/atipik poliplerde altta yatan immün yetmezliğin araştırılmasını, alerji-immünoloji-KBB multidisipliner yönetimini vurgulamaktadır.Anahtar Kelimeler: Atopi; Kronik Rinosinüzit; Nazal Polipler; Primer İmmün Yetmezlik Hastalıkları; Yaygın Değişken İmmün Yetmezlik

Background/Objectives: We examined how allergy findings related to candidate-agent identification, subsequent real-world imaging and clinical outcomes. Methods: This single-centre retrospective cohort included 29 adults evaluated between January 2019 and May 2025 for contrast media hypersensitivity. Imaging and outcomes between allergy evaluation and a structured telephone interview in July 2026 were assessed retrospectively and verified in national electronic health records, without prospective follow-up. Primary outcomes were skin test positivity and new hypersensitivity reactions during subsequent contrast administration. Results: The culprit contrast agent was not documented by name in 18 patients (62.1%); median evaluation delay was 60 months. Skin tests were positive in 1/20 patients (5.0%); skin-test-negative candidate agents were identified in 19/20 (95.0%). New reactions occurred in 3/14 contrast recipients (21.4%), all with immediate Brown Grade III index reactions to iohexol. Subsequent reactions included one cardiac arrest after iohexol and two Grade II reactions after iodixanol. Of seven patients imaged without contrast, four had candidate agents but reported continuing patient and physician concerns. No Holm-adjusted comparison was significant. Conclusions: Skin testing identified a candidate agent in most tested patients, but candidate identification did not establish clinical tolerance or independent protection. A shared, individualised imaging plan should communicate agent selection, premedication decisions, test limitations and precautions to patients and radiologists while preserving access to necessary imaging.