Publications by authors named "Alİ Fuat Kalyoncu"

14 Publications

  • Page 1 of 1

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients.

Respir Med 2021 07 28;183:106433. Epub 2021 Apr 28.

Department of Pulmonary Medicine, Kestel State Hospital, Bursa, Turkey. Electronic address:

The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5-5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6-23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.
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July 2021

Clinical implications of fungal isolation from sputum in adult patients with cystic fibrosis.

Turk J Med Sci 2021 Jan 12. Epub 2021 Jan 12.

Background/aim: Cystic fibrosis is an autosomal recessive disease with a defect in mucociliary activity that is characterized by recurrent pulmonary infections. Bacterial agents most frequently implicated in airway colonization and infection are Haemophilus influenzae, Staphylococcus spp. and Pseudomonas spp. Fungal isolation from sputum species is more common in adults. However, growth of fungal agent only in sputum culture in patients with cystic fibrosis is insufficient for the diagnosis of fungal diseases. There is limited and contraversial data about the clinical significance of fungal isolation in sputum cultures. The aim of the present study was to investigate the clinical outcomes including characteristics, lung function, therapy modalities and frequency of exacerbations and clinical significance of fungal isolation from sputum samples in adult patients with CF.

Materials And Methods: This retrospective cohort study included patients who have been admitted between October 2017 and January 2019 in an Adult Cystic Fibrosis Unit. Patients were grouped according to fungal pathogenicity as; fungal disease group, colonization group, and non-isolated group. The data of the last one year, including patients demographics, clinical data, laboratory results, treatment modalities, results of cultured bacteria and fungus from sputum samples, respiratory function parameters, frequency of exacerbation and hospitalization were compared between groups.

Results: A total of 330 sputum samples from 88 adult patients with CF were collected during the preceeding one year. Patients were divided into three groups, fungal disease group (n = 10, 11.4%), colonization group (n = 49, 55.7%), and non-isolated group (n = 29, 32.9%). Presence of pulmonary exacerbation and number of admission to emergency department and the number of positive cultures for bacteria from sputum were significantly higher in the fungal disease group (p = 0.03, p = 0.01 and p ?0.001). Patients in the fungal disease group had higher rate of administered antibiotics by parenteral route than other groups (p = 0.001) whereas lung function parameters were similar. Use of nutritional supplementation and parenteral antibiotherapy in the preceeding one year were the factors associated with elevated risk of fungal isolation.

Conclusion: Frequent use of parenteral antibiotics and use of nutritional supplementation were found to be independent risk factors for fungal isolation from sputum in adult CF patients.
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January 2021

The Effect of Asthma Severity on Perinatal Outcomes: A Tertiary Hospital Experience.

Z Geburtshilfe Neonatol 2020 Oct 14. Epub 2020 Oct 14.

Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey.

Objective: To evaluate the effect of asthma severity and disease exacerbation on pregnancy outcomes.

Materials And Methods: Pregnancies were classified into 3 groups as mild (n=195), moderate (n=63), and severe (n=26) according to preconceptional asthma severity. Demographic features, clinical characteristics, and perinatal outcomes were compared between the groups. Delivery characteristics and pregnancy outcomes were also compared between the pregnancies with or without asthma exacerbation (43 and 241 pregnancies, respectively).

Results: Worsening of symptoms during pregnancy was higher in moderate and severe asthma groups (p<0.001). Rates of spontaneous abortion, fetal structural anomaly, preterm delivery, preeclampsia, fetal growth restriction (FGR), oligohydramnios, gestational diabetes, and intrauterine fetal demise were higher in moderate and severe asthma groups (p-values were < 0.001, 0.01, 0.008, 0.02, 0.01, < 0.001, < 0.001, and 0.007, respectively). Admissions to neonatal intensive care units and neonatal complication rates were higher among moderate and severe asthma groups (p=0.035 and < 0.001). Spontaneous abortion, preterm delivery, preeclampsia, FGR, oligohydramnios, and neonatal complication rates were higher (p<0.001) in the group with exacerbated symptoms.

Conclusion: Moderate to severe asthma before pregnancy and the exacerbation of asthma symptoms during pregnancy may lead to increased rates of perinatal complications.
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October 2020

A practical method of drug provocation testing to prove tolerance to alternative drugs in drug hypersensitivity

Turk J Med Sci 2021 04 30;51(2):604-609. Epub 2021 Apr 30.

Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey

Background/aim: Drug provocation tests (DPTs) are the gold standard method performed at the end of a stepwise approach in a drug allergy workup. Drug provocation tests are administered as a single drug on a test day. Testing more than one drug in a day is a feasible option and could be a safe and time- and manpower-saving procedure in well-selected patients. The aim of the present study was to investigate the efficacy and safety of performing a DPT with two or three alternative drugs in one test day (Hacettepe method).

Materials And Methods: Adult patients who were admitted with drug hypersensitivity between August 2010 and December 2016 and underwent DPTs with the described method were included. The method was based on performing DPTs with two or three different, alternative drugs on the same test day. Data was obtained from standard drug provocation test forms and from patient files.

Results: A total of 1448 DPTs were performed by the Hacettepe method in 1131 patients. The reaction rate was 5.45% (n = 79), and none of the reactions were severe. The Hacettepe method saved 19.95 DPTs per month which was a considerable time savings.

Conclusion: In cases of proven drug hypersensitivity reactions, performing a drug provocation test with a combination of two or three different, alternative drugs instead of one saved time and manpower and was a safe procedure. We recommend implementing this method in drug allergy workups.
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April 2021

ARIA 2019, Allerjik Rinite Tedavi Yaklaşımı-Türkiye.

Turk Thorac J 2020 03 1;21(2):122-133. Epub 2020 Mar 1.

MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France.

Gerçek yaşamda, çevresel maruziyetlerin de etkilediği rinit ve astım mültimorbidite durumlarında, dijitalleşmiş ve kişiye odaklanan tedaviler için bütünleştirilmiş tedavi yollarının değerlendirilmesi önerilmektedir. Gerçek yaşamdaki bu durum mültisipliner bir yaklaşımla basamaklandırılıp, rehberilerinde ülkelerdeki gereksinimlere göre değiştilmesini gerektirebilir. Allerjik rinitte hem farmakoterapi hem immünoterapi açısından acil yeni yaklaşımlara ihtiyaç olduğu görülmüştür. 3. Aralık 2018'de Paris'te bir toplantı yapılmış ve iki ayrı belge hazırlanmıştır. Bu yayında bunlara ait bir özet sunulup, ülkeye ve sağlık sistemine uygun kullanımın çerçevesi oluşturulmak istenmiştir.
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March 2020

Screening instrument to identify skin prick test-negative patients with asthma and/or rhinitis.

Clin Respir J 2019 May 24;13(5):314-320. Epub 2019 Mar 24.

Division of Allergy and Clinical Immunology, Department of Chest Diseases, School of Medicine, Hacettepe University, Ankara, Turkey.

Introduction: To the best of our knowledge, there is no prediction tool for determining respiratory allergy in patients with asthma and/or rhinitis.

Objectives: As such, this study aimed to develop an instrument for identifying skin prick test (SPT)-negative patients with asthma and/or rhinitis.

Methods: This cross-sectional study screened 510 consecutive patients diagnosed with asthma and/or rhinitis between November 2009 and May 2011 in Ankara, Turkey. A structured questionnaire was the screening tool that was administered during the initial visit by the treating specialist and compared with a SPT result. All 15 variables were analysed using the logistic regression model to obtain β values (a score) for each variable. Each variable had a score, and scores were summed up to obtain final score for each patient.

Results: The study included 363 patients, of which 165 (45.5%) were SPT positive. The final model included 13 variables. The lowest and highest scores were -21 and 26. A total score of 5.5 had sensitivity of 63% and specificity of 80%. The area under the receiver operating characteristic curve was 0.78. The histogram of the total scores for the study population was bimodal.

Conclusions: We designed a highly specific 13-item instrument for identifying SPT-negative patients. It may be used in middle income countries where allergy testing is expensive, not reimbursed or few allergy clinics are available. We think that our idea is interesting, that needs further research.
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May 2019

[MASK (Mobile Airways Sentinel networK) in Turkey-the ARIA integrated mobile solution for allergic rhinitis and asthma multimorbidity].

Tuberk Toraks 2018 Jun;66(2):176-181

MACVIA-France, Fondation partenariale FMC VIA-LR, Macvıa-france, Fondation Partenariale Fmc Via-lr,. INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles Sttin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France and Euforea, Brussels, Belgium, Montpellier, FRANSA.

mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. Allergic Rhinitis and its impact on asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity MASK-rhinitis (Mobile Airways Sentinel networK), the Phase 3 ARIA initiative, is based on the freely available app. The Allergy Diary is used by people who were informed by physicians, searched the internet, Apple App Store, Google Play. Turkish Validation has been available and currently in use.
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June 2018

Long-Term Omalizumab Treatment: A Multicenter, Real-Life, 5-Year Trial.

Int Arch Allergy Immunol 2018 17;176(3-4):225-233. Epub 2018 May 17.

Medical Department, Novartis Pharmaceuticals, Istanbul, Turkey.

Background: Omalizumab has demonstrated therapeutic benefits both in controlled clinical trials and real-life studies. However, research concerning the long-term effects and tolerability of omalizumab is needed. The main objective of this study was to evaluate the effectiveness and tolerability of treatment with omalizumab for up to 5 years.

Methods: A multicenter, retrospective, chart-based study was carried out to compare documented exacerbations, hospitalizations, systemic steroid requirement, FEV1, and asthma control test (ACT) results during 1 year prior to omalizumab treatment versus at 1, 3, and 5 years of treatment. Adverse events and reasons for discontinuation were also recorded at each time point.

Results: Four hundred and sixty-five patients were enrolled in the study. Outcome variables had improved after the 1st year and were sustained after the 3rd and 5th years of treatment with omalizumab. Omalizumab treatment reduced the asthma exacerbation rate by 71.3% (p < 0.001) at 1 year, 64.3% (p < 0.001) at 3 years, and 54.8% (p = 0.002) at 5 years. The hospitalization rate also decreased; by the 5th year of the treatment no patients were hospitalized. ACT results had also improved significantly: 12 (p < 0.001) at 1 year, 12 (p < 0.001) at 3 years, and 12 (p = 0.002) at 5 years. Overall, 12.7% of patients reported adverse events (most of these were mild-to-moderate) and the overall dropout rate was 9.0%.

Conclusion: Omalizumab had a significant effect on asthma outcomes and this effect was maintained over 5 years. The drug was found to be generally safe and treatment compliance was good.
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July 2018

[ARIA 2016 executive summary: integrated care pathways for predictive medicine across the life cycle].

Tuberk Toraks 2017 Mar;65(1):32-40

Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were (i) to propose a new allergic rhinitis classification, (ii) to promote the concept of multi-morbidity in asthma and rhinitis and (iii) to develop guidelines with all stakeholders for global use in all countries and populations. ARIA- disseminated and implemented in over 70 countries globally- is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK (MACVIA (Contre les MAladies Chroniques pour un VIeillissement Actif)-ARIA Sentinel NetworK) uses mobile technology to develop care pathways in order to enable the management of rhinitis and asthma by a multi-disciplinary group or by patients themselves. An App (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.
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March 2017

Wraparound eyeglasses improve symptoms and quality of life in patients with seasonal allergic rhinoconjunctivitis.

Int Forum Allergy Rhinol 2016 07 25;6(7):722-30. Epub 2016 Feb 25.

Department of Chest Diseases, Division of Allergy and Clinical Immunology, School of Medicine, Hacettepe University, Ankara, Turkey.

Background: Allergen avoidance is important for allergic rhinitis management. However, studies evaluating the efficiency of avoidance measures from pollens are lacking. We aimed to investigate the efficiency of wraparound eyeglasses in seasonal allergic rhinoconjunctivitis (SAR).

Methods: Eligible patients with a diagnosis of SAR (n = 70) rated their symptom scores, filled the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and were randomized either to receive wraparound eyeglasses in addition to medical treatment (group 1, n = 39) or medical treatment only (group 2, n = 31) throughout the 3 pollen seasons in the years 2011, 2012, and 2013. Patients rated their symptom scores and checked the need for use of rescue medications in their diaries over a period of 4 weeks. RQLQ was reapplied 1 week and 4 weeks after randomization.

Results: The median (interquartile range [IQR]) change from baseline over 4 weeks in the eye itching (-2.51 [-3.65 to -1.36] vs -0.88 [-1.95 to 0.43], p < 0.001), eye watering (-2.31 [-3.09 to -1.24] vs -1.60 [-2.59 to -0.21], p = 0.02), sneezing (-2.26 [-3.19 to -1.51] vs -1.68 [-2.27 to -0.56], p = 0.03), and rhinorrhea (-2.48 [-3.74 to -1.49] vs -1.59 [-2.88 to -0.87], p = 0.04) scores were significantly higher in group 1 compared to group 2. There were significantly higher improvements in ocular symptoms domain score (-1.75 [-3.12 to -1.00] vs -0.50 [-2.31 to -0.31], p = 0.002), nasal symptoms domain score (-2.25 [-4.06 to -1.50] vs -1.25 [-2.37 to -0.68], p = 0.004), and total RQLQ score (-1.98 [-2.67 to -0.88] vs -1.10 [-2.06 to -0.25], p = 0.02) and reduced need for rescue medication use in group 1 compared to group 2 at the end of 4 weeks.

Conclusion: Standard wraparound eyeglasses can provide a safe, convenient, and effective measure for protection from pollens in patients with SAR.
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July 2016

Evaluation of anxiety levels and factors associated with positive test results in patients with drug hypersensitivity.

Allergy Asthma Proc 2015 Nov-Dec;36(6):439-46

Division of Allergy and Immunology, Department of Chest Diseases, School of Medicine, Hacettepe University, Ankara, Turkey.

Background: High anxiety has been reported in patients with drug hypersensitivity reaction (DHR); however, its relationship with the test results was not studied previously.

Objective: We aimed to investigate the association of patient anxiety with the results of drug tests together with the other contributing factors.

Methods: Sixty-seven patients were included in the study between November 2012 and April 2013, in whom drug tests were performed after clinical evaluation and application of the Penn State Worry Questionnaire (PSWQ).

Results: The mean ± standard deviation (SD) age was 43.5 ± 12.9 years, and 73.1% of the patients were females. The patient group had significantly higher mean ± SD PSWQ score than 35 control subjects without histories of DHRs and major psychiatric disorders (47.95 ± 14.64 versus 40.22 ± 11.86, p = 0.008). However, the mean ± SD. PSWQ score of the patients with positive drug test results was not significantly different from the patients with negative drug test results (46.06 ± 13.41 versus 50.47 ± 18.02, p = 0.32). Panic attack symptoms were more common in the reactions with positive test results than in the reactions with negative test results (74.0% versus 48.9%, p = 0.01). However, presence of panic attack symptoms [odds ratio (OR): 1.25, 95% confidence interval (CI): 0.44-3.54; p = 0.67] was not found independently associated with positive test results in the multiple logistic regression model.

Conclusion: Patients with DHR have high levels of anxiety; however, this is not related to the results of drug tests. Because panic reaction symptoms may accompany the objective symptoms of DHR, a complete clinical work-up is required before deciding whether the reaction is related to panic or a "true DHR."
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August 2016

Turkish version of the Drug Hypersensitivity Quality of Life Questionnaire: assessment of reliability and validity.

Qual Life Res 2016 Jan 20;25(1):101-9. Epub 2015 Jun 20.

Allergy Unit, Complesso Integrato Columbus, Rome, Italy.

Purpose: The first disease-specific quality-of-life questionnaire in patients with drug hypersensitivity, Drug Hypersensitivity Quality of Life Questionnaire (DrHy-Q), was developed and validated recently. The aim of this study was to assess validity, reliability and responsiveness to interventions of the Turkish version of the DrHy-Q.

Methods: The Turkish version of the DrHy-Q was administered to prospectively enrolled 736 patients with drug hypersensitivity from ten allergy units. To assess validity, all patients completed the validated Turkish version of Psychological General Well-Being Index (PGWBI). For test-retest reliability, 182 patients completed the DrHy-Q 1 week after the first questionnaire administration without any intervention. Responsiveness was assessed on 97 patients who had a DrHy-Q recorded at a follow-up visit after the intervention.

Results: The internal consistency and test-retest reliability of the scale were adequate (Cronbach's alpha = 0.934, intra-class correlation coefficient = 0.783). The DrHy-Q scores showed weak negative correlations with the PGWBI total and domain scores (r = - 0.378 to -0.254, p < 0.001). DrHy-Q was able to discriminate the patients with one drug hypersensitivity reaction from the patients with two and above two reactions (p = 0.012 and p < 0.001, respectively), and the patients who experienced a respiratory reaction from the patients who did not (p = 0.018). However, it did not discriminate the patients with comorbid disease including psychiatric comorbidity (p > 0.05). The baseline DrHy-Q scores were significantly higher than the post-intervention scores (p = 0.008).

Conclusion: The Turkish version of DrHy-Q is reliable and valid for evaluating quality of life in patients with drug hypersensitivity, and it appeared responsive to interventions.
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January 2016

Development of rhinitis may be an indicator for the persistence of childhood asthma.

Int J Pediatr Otorhinolaryngol 2014 May 1;78(5):843-9. Epub 2014 Mar 1.

Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, 06100 Ankara, Turkey. Electronic address:

Objectives: Results of previous studies have established several factors related with the natural course of childhood asthma. The aim of this study is to investigate the prognosis of childhood asthma and to determine possible risk factors for disease persistence.

Methods: An outpatient cohort with a median (interquartile range) follow-up duration of 19.4 (17.7-21.8) years was re-evaluated. Current clinical remission (CR) was defined as no asthma symptoms and no use of controller medication within the past year.

Results: Out of 115 patients, 78 could be surveyed with questionnaire and 46 patients with a median age of 25.3 (23.9-27.0) years were further investigated with clinical work-up. Nineteen (24.4%) patients were in CR in both visits (adolescence and young adulthood). A further 7 patients (9.0%) who were not in CR at adolescence were in CR at the young adulthood visit. However, 21 patients (26.9%) who were in CR at adolescence were not in CR at the young adulthood visit. Thirty-one patients (39.7%) with persistent symptoms at adolescence were not in CR at young adulthood, either. In multivariate logistic models, the presence of obstructive pattern (forced expiratory volume in 1s (FEV1)/forced vital capacity (FVC) <80% vs. ≥80%) in pulmonary function tests during the adolescence period (odds ratio; [95% confidence interval] (6.71 [1.65-27.29]; p=0.008) and later-onset rhinitis (10.27 [1.18-89.13]; p=0.035) predicted the absence of CR at young adulthood.

Conclusion: A substantial number of patients who were in CR during adolescence have re-emerging disease. The presence of obstructive pattern in adolescence and later-onset rhinitis were associated with the absence of CR in young adults with asthma. Awareness of risk factors along with early interventions may provide better results in childhood asthma.
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May 2014

Risk factors for asthma and other allergic diseases in seasonal rhinitis.

J Asthma 2008 Oct;45(8):710-4

Department of Chest Diseases, Adult Allergy Unit, Hacettepe University School of Medicine, Ankara, Turkey.

Background: Rhinitis and asthma are common comorbidities. The aim of this study was to determine the risk factors for asthma and other allergic diseases in seasonal rhinitis (SR) patients.

Methods: Records of 922 patients diagnosed as SR between 1991 and 2005 were evaluated retrospectively. Patients were grouped according to the results of our standard skin prick tests as follows: I-No sensitization: no sensitization to any allergen; II-Mono-pollen sensitization: sensitization to only one pollen allergen; III-Poly-pollen sensitization: sensitization to more than one pollen allergen; IV-Mite sensitization: sensitization to mite with or without any other allergen sensitization.

Results: The mean age of the patients was 29.5 +/- 9.6 and 587 patients (63.2%) were females. Age at onset of SR was median 21 years (16-29 years). Of the 922 patients, 99 had no sensitization, 335 had poly-pollen sensitization, 346 had mono-pollen sensitization, and 142 had mite sensitization. The most prevalent allergens were P. pratense (85.3%) and O. europae (31.5%). No sensitization group as compared to poly-pollen sensitization group had significantly higher prevalence of asthma as a single accompanying disease (14.1%, p < 0.05). Mono-pollen sensitization was significantly associated with lower risk of any accompanying allergic disease (OR: 0.7, 95% CI 0,5-0,9) while no sensitization group (OR: 2.8, 95% CI 1.3-5.9) and mite sensitization were associated with asthma (OR: 2.3, 95% CI 1.2-4.4).

Conclusion: SR is a condition that presents with different phenotypes. The group with no sensitization and mite sensitization has the highest prevalence of asthma while SR patients with mono-pollen sensitization are unlikely to have an accompanying allergic disease, including asthma.
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October 2008