Objective: STK4 (serine-threonine protein kinase 4) deficiency is categorized under combined immunodeficiencies, which are a subgroup of primary immunodeficiencies that profoundly affect T cells. Autosomal recessive STK4 deficiency is characterized by recurrent bacterial and viral infections, mucocutaneous candidiasis, and CD4 + T cell lymphopenia. Autoimmune comorbidities including hemolytic anemia and idiopathic thrombocytopenic purpura, and cardiac problems have been reported in STK4-deficient individuals. Current diagnostic tools for STK4 deficiency include next-generation sequencing (NGS) and Sanger sequencing that detect DNA sequence variations, and western blotting, which evaluates altered protein expression. However, all of these assays are timeconsuming; and in particular, NGS is a costly clinical use tool for a diagnostic laboratory. In comparison, flow cytometry is a rapid and reliable system commonly employed in the diagnosis of a wide range of primary immunodeficiency disorders. Materials and Methods: This study aimed to evaluate STK4 protein expression by flow cytometry among four patients with genetically confirmed STK4 gene mutations and seven healthy individuals. We calculated ΔMFI/cell values to investigate differences in protein expression among the subjects. Results: STK4 protein expression was reduced in the peripheral blood mononuclear cells obtained from all STK4-deficient patients compared to those from the healthy controls. Flow cytometry data was validated by western blotting. Conclusion: Flow cytometry is a rapid and reliable method to detect STK4 protein expression, qualified as a diagnostic tool to study STK4 deficiency.

Asthma is one of the most common chronic respiratory diseases in the world and there is great concern about the effect of COVID-19 infection on asthma severity and control. Although the link between asthma and COVID-19 infection remains to be determined, available data indicate that asthma does not seem to be a risk factor for severe COVID-19. This review aims to summarize the updated data about the association between viral infections and asthma exacerbations including COVID infection and management of asthma flare-ups during the COVID pandemic, based on the recommended asthma guidelines.

Montelukast is a leukotriene receptor antagonist that is used to treat allergy and asthma. It acts as a cysteinyl leukotriene receptor antagonist that blocks the action of leukotrienes and decreases inflammation. This agent is generally well tolerated in clinical practice. Although montelukast is generally considered as a safe drug, it can cause a few adverse drug reactions. In this case study, a rare side effect of montelukast that has been reported only twice before is presented. The importance of this case report is that the youngest patient who had ecchymosis due to the use of montelukast treatment is reported

Objective: Periostin, an extracellular matrix protein, is related to the eosinophilic airway inflammation. There is no specific marker in allergen immunotherapy to evaluate clinical response. We aimed to investigate the serum periostin levels in the children who receive allergen immunotherapy. Materials and Methods: Sixteen patients between 8-18 years (12.7±2.8 years) with allergic rhinitis and/or asthma due to grass pollen hypersensitivity and 30 healthy subjects (11.7±2.6 years) were included. Demographic data, eosinophil counts, skin prick tests and the specific IgE levels of the patients are recorded. Symptom scores, visual analog scales, medication scores were determined and the serum periostin levels were measured in the beginning, 4th and 12th months of the allergen immunotherapy. Results: The symptom scores for rhinitis in the 4th month showed significant improvements in all of the patients (p<0.05). Nine patients with allergic rhinitis accompanied by asthma, showed significant improvements in 12th month symptom score for asthma (p=0.018). A significant correlation was detected between the initial serum periostin levels and the symptom scores for the eye (r=0.668, p=0.005). No significant difference was found in serum periostin levels between the patient and the control groups. There were no significant differences in serum periostin levels in 4th and 12th months compared to the ones in the beginning. Conclusion: In this study, there were no significant differences in serum periostin levels of children during the allergen immunotherapy. The association of serum periostin levels with symptom scores for the eye needs to be confirmed in more children with allergic rhinoconjunctivitis.

Objective: Chronic spontaneous urticaria is a disorder characterized by spontaneous development of pruritic erythematous plaques, angioedema or both. Omalizumab is a recombinant monoclonal antibody that selectively binds to IgE and inhibits its binding to FceRI receptors on mast cells and basophils. We sought to retrospectively assess the efficacy of Omalizumab, the adverse effects due to treatment, and the disease-free duration after treatment in treatment-resistant chronic spontaneous urticaria cases. Materials and Methods: The treatment responses of 24 chronic spontaneous urticaria cases treated with Omalizumab at our clinic were retrospectively evaluated. Results: The mean age of the patients was 44 years and the mean duration of disease was 7.2 years. The most common concomitant systemic disease was thyroid disease (29%). The duration of treatment ranged from 4 to 36 months, and total treatment doses from 5 to 28 doses. The treatment of 15 patients was still going on and the mean duration of treatment was 24.4 months. Disease control could not be achieved in three patients but the mean dose of disease control was 3.2 in the other patients. The treatment response was partial in 29% (n=7) and complete in 71% (n=17) of the patients. Side effects (erythema or urticarial plaque at the injection area, headache, dizziness, myalgia, arthralgia) were detected in eight patients. No recurrence was detected in five patients with a mean follow-up duration of 12 months after the treatment. The mean duration until recurrence was 7.7 months after the treatment in five patients who had recurrence. Conclusion: Omalizumab is a good treatment option, thanks to its efficacy and safety, in chronic spontaneous urticaria patients who do not respond to H1-antihistamines.

Objective: It is important to detect allergens that cause sensitization to decrease the morbidity of allergic diseases and to prevent or to delay the development of the disease in already sensitized patients. In this study, we aimed to evaluate which aeroallergens cause sensitization in allergic patients in the Akdeniz Region, Turkey, as well as their frequency of occurrence.Materials and Methods: The demographic properties, diagnoses, total IgE levels, sensitization against aeroallergens detected via EPT (Epidermal prick test), the dates of EPT application and peripheral eosinophil counts at the time of EPT application were analyzed in 510 patients aged 2-18 years who presented to the Akdeniz University Pediatric Allergy – Immunology and Pulmonology Departments and Antalya Education and Research Hospital Pediatric Allergy - Immunology Department with an allergic history or diagnosis between January 2014 and July 2015. All patients underwent EPT during their follow-up and sensitivity against at least one aeroallergen was detected. The seasonal distribution of these aeroallergens was also analyzed.Results: A total of 1180 children to which an allergic skin test had been applied between January 2014 and July 2015 were included in this study. It was seen that 510 patients (43.2%) had a positive response to at least one aeroallergen and 402 patients among them (78.8%) had a positive response to more than one aeroallergen. Males made up 58.4% and females 41.6% of the patients who showed a positive EPT. Sensitivity was most frequently (69%) against house dust mites, followed by tree pollen mix (54.9%) and grass/weed mix (52.5%). Other allergens were animal dander (45.3%), fungi mix (43.4%), herb/pollen mix (34.9%), cockroach (16.9%) and olea (6%). Further, by analyzing the seasonal distributions of allergens, it was seen that sensitivity was most frequently against house dust in all seasons.Conclusion: Avoiding specific allergens is important in eliminating and managing the symptoms in allergic patients. Determining the regional differences regarding allergen sensitivity is therefore critical.

Giriş: Lipopolysaccharide-responsive beige-like anchor (LRBA) inhibitör bir protein olan sitotoksik T lenfosit antijen-4 (CTLA4)'ün hücre yüzeyinde ifade edilmesinde rol oynar. Yakın zamanda tanımlanmış olan LRBA eksikliği immün yetmezlik ve otoimmüniteye yol açar. LRBA eksikliğinin tanısı mutasyon analizi ve protein ifadesinin belirlenmesi ile konur. Bu çalışmada, LRBA eksikliği olan hastalarımızda uyaranlı ve uyaransız ortamda akan hücre ölçer ile hücre içi LRBA protein ifadesi değerlendirilmiştir.Gereç ve Yöntem: Çalışmaya LRBA eksikliği olan beş hasta ve yedi sağlıklı kontrol alındı. Periferik kan mononükleer hücrelerde forbol miristat asetat ve ionomisin ile uyaranlı ve/veya uyaransız olarak LRBA ifadesi ölçüldü. Ortalama florasan yoğunluğu farkı (?MFI) hesaplandı. Bulgular: Uyaransız durumda ortalama florasan yoğunluğu farkı sağlıklı kontrollerde ortalama 24±9 iken LRBA hastalarında 4.8±2.8 olarak ölçüldü. İki hasta ve bir sağlıklı kontrolde eşzamanlı uyaransız ve uyaranlı ölçümlerin karşılaştırılması sonucu elde edilen değişime bakıldığında; uyaransız durumda ?MFI değeri Hasta-3 (H3)'de 4.8, H4'de 4.6 ve sağlıklı kontrolde 20,1 saptanırken, uyaranlı durumda bu değer H3'de 20.8, H4'de 19 ve sağlıklı kontrolde 49.6 bulundu. Sonuç: Akan hücre ölçer ile LRBA ifadesinin değerlendirilmesi hızlı ve kolay bir yöntem olup mutasyon tanılı hastalarımızda etkin ve güvenilir sonuç vermiştir.

Embryonic stem (ES) cells are derived from cells embedded in the inner cell mass of embryonic blastocytes at the preimplantation stage. These cells have self-renewal and pluripotent capacities. Because of these properties, these cells are thought to be useful in the treatment of many degenerative and genetic diseases. Scientists are forced into new research areas as experiments on human embryonic stem cells become harder because of ethics, politics and religious issues and their limitations related to scientific research. Yamanaka et al. were able to produce induced pluripotent stem (IPS) cells by reprogramming human and mice fibroblasts with four transcription factors (Oct ¾, Sox-2, Klf-4, c-Myc) (OSKM factors) in 2006 and they started a new era. A new field in stem cell research is established as the produced IPS cells have the same functions as embryonic stem cells. A new scientific field in cellular research for in vitro drug experiments has emerged as personal and disease-specific IPS cells can now be produced.