Allergic Rhinitis

Allergic rhinitis is the most common allergic respiratory disease among children and adults. Its prominence in our country is 2-37% among children and 8-30% among adults. Although it may occur at any age, initial symptoms usually appear during childhood and early adulthood. During the past 10 years, however, prominence of allergic rhinitis has been increasing gradually. Patients suffering from allergic rhinitis may exhibit the following symptoms: 

  • Sneezing, nasal discharge, stuffy nose and nasal itching;  
  • Postnasal dripping, coughs, malaise, difficulty smelling; 
  • Itching in the ear and on the palate; and
  • Itching, redness and watering in the eyes. 

Untreated patients may suffer from the following: 

  • Disrupted sleep due to breathing difficulty; 
  • Deficiency of attention and concentration, leading to reduced school performance among children; and
  • Reduced academic and professional performance leading to lower quality of life among adults, depending on the severity of disease. 

Antihistaminic drugs and nasal sprays containing cortisone are the most common medication used to treat allergic rhinitis. As cortisone in sprays is only applied on the nasal area, it triggers almost no side effects. This makes using nasal sprays safely for prolonged periods of time possible. In addition to medication, vaccination therapy (immunotherapy with allergen) is another proven mode of treatment. Allergen immunotherapy should be practiced on eligible patients only by allergy specialists. Patients may consult physicians who follow their cases to gain further information on protection against allergens and determine the mode of treatment suitable for severity of their conditions.

Bee Allergy


Why should you consider allergy after bee stings? 

Mild pain, swelling and redness are common and normal reactions observed in everyone stung by a bee. Individuals with bee allergy, however, will suffer from other and more severe symptoms like rashes around the entire body, swelling in remote areas far from the spot stung by the bee, inability to breathe due to swollen trachea or tongue (edema), vomiting, stomachache, reduced blood pressure and drowsiness. These symptoms are not restricted to specific site of stinging; they afflict vital systems like respiratory and circulatory systems. This reaction is called anaphylaxis. 

The usual symptoms of bee sting, i.e. mild pain, swelling and redness at the stung spot, do not require consulting an emergency service. The aforesaid complaints can be easily subsided by applying ice on the spot. Local reaction of the stung tissue often causes increased severity of pain and swelling as well as local rise in temperature. In such cases, consulting a physician is recommended. Antihistaminic drugs and steroid therapy, if deemed necessary, are capable of treating the symptoms. 
Allergic reactions should be suspected and the nearest medical center should be consulted, if the following symptoms are observed:

  • Extensive rashes, itching or swelling on the skin, reaching out to remote areas other than the site of bee sting; 

  • Swelling in the tongue and face; 

  • Coughing, wheezing; 

  • Vomiting, stomachache, diarrhea; and

  • Low blood pressure and drowsiness, which require immediate epinephrine injection. Otherwise, vital risk may occur.   


How to ensure protection against bee stings?

A complete protective solution for those who are allergic to bee stings does not exist, yet precautions can be taken. Outdoor environments where food and drinks are present will attract bees, and increase your risk of encountering them. This is why you should avoid the following to reduce risk of bee stings especially in warm weather: 

  • Eating and drinking outside; 

  • Walking barefoot; 

  • Gardening (particularly pruning vegetation and picking fruits);

  • Being in vicinity of trash cans; 

  • Engaging in outdoor sports activities;

  • Being close to bee hives; and

  • Trying to manually dispose of wasp hives in areas like windows or roofs. 

It is also worth noting that bees sting humans when they feel threatened and decide to attack. 

How is bee allergy treated? 

The only proven protective treatment method, which is known to provide protection by up to 83-100% as of completion of therapy, is vaccination therapy (venom immunotherapy). This therapy involves building up immunity by injection bee venom to the patient’s arm in regular intervals over the course of at least 4-5 years. Dosage is initially low and injected subcutaneously from the outer surface of upper arm under supervision of a physician. After attaining therapeutic dose, vaccination is resumed in intervals of 4-6 weeks. Patients who previously experienced severe allergic reaction due to bee allergy (anaphylaxis) are required to keep an adrenaline (epinephrine) auto-injector with them until completion of immunotherapy.

Immunotherapy to treat bee allergy should be configured and launched by a specialist experienced in this field. Allergic reactions may still occur following injections. Therefore supervision of a physician is essential during therapy and for at least 30 minutes after therapy.


Asthma is a globally common and significant health issue that affects everyone, young and aged. Its prominence is still on the rise in numerous countries. Increasing air pollution, global warming, urbanization, industrialization, changes in dietary habits, technological advancements, lifestyle changes, and decreased physical activity all factor into the increased prominence. Even though it is becoming more and more common in today’s ever-changing world, it has always been one of the most significant airway diseases known and fought since ancient ages. Currently notable advancements have been achieved in treatment options offered to treat asthma, which is actually a group diseases. Categorized in accordance with their etiologies, outcomes and associated methods of treatment, subtypes of asthma include:

• Allergic asthma;
• Non-allergic asthma;
• Late-onset asthma; and
• Obesity-associated asthma. 

The disease manifests itself with symptoms like wheezing, rale, coughs and dyspnea, which are all triggered by a long-term non-microbial inflammatory condition in the airways. Severity of symptoms may fluctuate over time. An asthma patient might wake up in quite a fine condition in the morning, but still experience sudden bursts of coughing and episodes of wheezing once exposed to smells, known allergens, air pollution, stress, exercise, cold air or viruses. These undesirable events may even cause a sleeping patient to wake up at night in the middle of sleep. 

These uncertainties and the fact that asthma is an entirely controllable disease make it possible to concentrate medical services on three main areas in order to make sure asthma patients continue their lives as if the disease did not even exist:

1. First and foremost, asthma subtype and triggering factors specific to that subtype and the patient should be determined: 

• Hearing an account of the patient’s detailed history from childhood to the present is the first step to be taken. Respiratory and allergy tests may need to be performed as well.

2. A treatment plan aimed at the patient’s complaints and any inflammatory condition the disease may have caused should be planned: 

• To tailor a suitable treatment plan specific to the individual, it is essential to be informed in detail even about the patient’s daily routine, needs, occupation, home life and household circumstances. Anti-inflammatory therapies and medication that takes complaints under control are the basic treatment options. It should nevertheless be noted that asthma patient may still have swollen and edematous airways even when they do not suffer from dyspnea. Therefore, after configuring therapy to levels sufficient to render the disease unnoticeable, physicians should be very cautious in terms of gradually reducing dosage. Reductions too steep may lead to attacks. In this regard, dosage reduction should definitely be undertaken by specialized physicians who initially prescribed the relevant medication.  

• Education is the most important building stone of treatment. Most asthma drugs are inhaled rather than “swallowed” like traditional pills. It is normally a bit difficult to use them on some occasions. Physicians who tend to asthma patients should prescribe the most convenient type of drug and remind the patient how the drug should be taken on every possible occasion. Dosages and content of drugs need to be modified periodically. A patient well-educated about asthma and factors that trigger its symptoms will be able to easily decrease severity of disease.
3. Control of additional diseases and factors is the final important consideration a physician should heed:
• Protective and preventive treatment approaches targeting other diseases and factors such as allergic rhinitis, stomach disorders, sleep apnea syndrome, viral respiratory diseases and smoking addiction are also an integral part of asthma treatment. A persisting and uncontrollable case of asthma may be suddenly diminished through a simple intervention aimed at another condition. 

Asthma and Obesity

Asthma is currently recognized as a disease with different subtypes (allergic asthma, late-onset asthma, aspirin-sensitive asthma etc.) as well as different underlying reasons and outcomes, just like rheumatism. Obesity-asthma is one of the aforementioned subtypes.  

Increasing air pollution, industrialization, technological advancements, lifestyle changes, and decreased physical activity all factor into the increased prominence of this disease. It should also be noted that whereas obesity is known to lay the groundwork for diseases such as gastric reflux, diabetes, cardiovascular diseases, sleep apnea and some types of cancer, its correlation to asthma has only recently started being inquired.   

There are two primary mechanisms causing obesity-asthma. First of all, the immune system perceives obesity as a mild inflammatory event that should be fended off, which confuses white blood cells, warriors of the immune system. This is basically triggered by the increased number of inflammatory cells, which produce more secretion, fill airways with a thick layer of phlegm and constrict them. The second mechanism involves increased strain on airways that develops secondary to weight gain, which renders muscles in this area inadequate for normal respiration. 

Currently, there is no specific medication that can be prescribed for obesity-asthma other than the conventional inhalers (or puffers) used in regular asthma cases for control and relief purposes. Personalized weight loss and exercise programs coupled with airway relief and anti-inflammatory medication are particularly more convenient for such cases. Eligible patients may also benefit from sleeve gastrectomy surgery as well as from an effective weight loss regimen in order to fight immunity problems and overweight strain, which are factors leading to this specific type of asthma. Research has proven that treatment programs ensuring significant weight loss contribute vastly to control of obesity-asthma. Regardless, it is essential to remember that asthma patients may still be suffering from swollen and edematous airways even at times they don’t feel dyspnea. It is therefore essential to reduce drug dosages cautiously once an effective weight loss program has been practiced with results indicating symptomatic improvements. Dosage reduction should only and definitely be configured by the physician who originally prescribed such medication. Despite specific differences between the various types of asthma, the patient should still be advised to quit smoking, regularly use inhalers in the correct manner, get vaccinated for flu and practice methods of stress management, just like any other asthma patient. Individual factors triggering symptoms should also be identified and avoided. 



Detection of allergen:

Allergy can be briefly defined as overreaction of the immune system to environmental factors which are normally considered to be harmless to most people. Allergy tests can assist in detection of the circumstance or factor that triggers reaction, thus rendering a diagnosis possible and enabling configuration of treatment. Under this section, you will find general information on advanced tests performed for this purpose at our clinic.

Skin tests:

Which suspected factor(s) an allergy test will focus on is determined after consulting your physician. 

Tests utilize standardized solutions prepared from allergens which are produced by internationally recognized and acknowledged laboratories under supervision of health organizations. Domestic dust mites, pollens, roaches, mold, pet hair, dander, nutritional allergens, latex, bee venom and drug allergens are some of the solutions commonly employed in these tests in our country. Usually the inner aspect of forearm or skin of the upper back -though less seldom preferred at times when the number of tests is high- are preferred for testing. In order to find out how skin reacts to allergens, a prick test may also be performed using a histaminic solution known as positive control and also a negative control, which is a non-allergenic solution. Tests do not require fasting, yet some anti-allergenic drugs and specific medication need to be skipped prior to an allergy test to avoid misleading results. You may contact our physicians through the phone numbers provided on our website to learn more about this caveat.

Skin tests are highly preferable due to their short term of application, reliability and rapid results. They are evaluated by your physician after approximately 20 minutes, and depending on results obtained, advanced diagnostic studies and treatment options can be adopted. Allergy tests may cause temporary rashes and itching on the area of application, but one can easily return to their daily routine afterwards. 

  • Skin prick tests
    • After a drop of standardized allergen is dripped on the skin, a small scratch is made on the site of the drop using a sterile lancet (a sharp metal medical instrument). 
  • Intradermal tests
    • A minimal amount of liquid allergen is injection under the skin using an injector with a very thin needle. 
Blood tests:
  • Blood tryptase measurement
  • Just like histamine and some other chemicals, tryptase is a protein enzyme secreted by allergen-reactive cells called mast cells. It is quite important in diagnosis of life-threatening allergic reactions such as anaphylaxis and rare diseases like mast cell activation dysfunction. Whether this measurement is essential or not is to be determined by your physician under the light of evaluation findings. Our laboratory is one of the few in its league which are capable of rapidly performing this test. 
  • Specific IgE test
    • Another means of identifying an allergen is measuring antibodies, which the body produces in blood as a defense mechanism against allergens. There is strong correlation between prick test results and serum-specific IgE readings. Measuring serum-specific IgE is recommended in cases with dermographism and extensive dermal lesions where discontinuing anti-allergens is not an option and exposure to allergens triggers severe symptoms. 
  • Evaluation of allergenic components
  • With their three-dimensional structure, allergens trigger allergenic response by fitting into spaces of cells of the immune system just like a custom key designed for a specific door. Allergic responses may differ in accordance with the various components of these doors and keys. Latest technological advancements make it possible to measure such components, which are quite significant in terms of diagnosis and adopting the most suitable method of treatment. Our laboratory is also one of the few in its league which are capable of rapidly measuring these components.

Provocation tests:

These tests are performed to clarify if a specific allergen is causing reported complaints in special cases. An experienced team of medical specialists closely monitor the patient upon applying the allergen in far less quantities than is required to induce reaction. Bronchial provocation tests are performed to identify hypersensitivity of the bronchi. Food or drug provocation tests are also performed orally. Drug provocation tests are particularly commonly practiced at hospitals for the purpose of determining alternatives in case of drug allergy.