Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Investigation of the Relationship Between Disease Activity Scores, Serum Parameters and Skin Prick Test in Patients with Atopic Dermatitis and Chronic Spontaneous Urticaria: A Cross-Sectional Study
Atopik Dermatit ve Kronik Spontan Ürtikerde Hastalık Aktivite Skoru, Serum Parametreleri ve Deri Prick Testi Arasındaki İlişkinin Araştırılması: Kesitsel Çalışma
Yeşim AKPINAR KARAa, Hatice KAYA ÖZDENb
aClinic of Dermatology, Koru Hospital, Ankara, Türkiye
bClinic of Dermatology, Kocaeli Derince Training and Research Hospital, Kocaeli, Türkiye
Turkiye Klinikleri J Dermatol. 2022;32(3):137-44
doi: 10.5336/dermato.2022-88440
Article Language: EN
Full Text
ABSTRACT
 Objective: Atopic dermatitis and chronic spontaneous urticaria are allergic skin diseases with recurrent attacks. In this study, disease activity score and laboratory parameters were investigated in patients with atopic dermatitis and chronic spontaneous urticaria. Material and Methods: A total of 68 patients including 33 atopic dermatitis and 35 chronic spontaneous urticaria patients from the dermatology outpatient clinics were enrolled in this study. Serum levels of total immunoglobulin E (IgE), blood eosinophil and basophil counts; prevalence of sensitization to aeroallergens, and disease activity scores were compared between the two groups. Results: A higher eosinophil count in the peripheral blood was observed in atopic dermatitis patients compared to chronic spontaneous urticaria patients. Disease activity scores (SCORAD index) were positively correlated with the eosinophil count and total IgE levels. Furthermore, it was found that the basophil count increased while total IgE levels and SCORAD index scores decreased in the chronic period of the disease. Total IgE levels and SCORAD index scores were higher in atopic dermatitis patients with a positive skin prick test. In chronic spontaneous urticaria patients, it was observed that basophil counts and total IgE levels were correlated, but there was not a correlation between disease activity scores, skin prick test results, and levels of other laboratory parameters. Conclusion: The relationship of serum parameters, especially IgE levels, with the disease activity was found to be significant only in atopic dermatitis.

Keywords: Atopic dermatitis; urticaria; basophil; IgE
ÖZET
 Amaç: Atopik dermatit ve kronik spontan ürtiker, tekrarlayan atakları olan alerjik deri hastalıklarıdır. Bu çalışmada, atopik dermatitli ve kronik spontan ürtikerli hastalarda hastalık aktivite skoru ve laboratuvar parametreleri araştırıldı. Gereç ve Yöntemler: Bu çalışmaya, 33 atopik dermatit ve 35 kronik spontan ürtiker hastası olmak üzere toplam 68 hasta dâhil edildi. İki grup arasında total immunglobulin E (IgE), serum eozinofil ve bazofil değerleri, aeroalerjenlere karşı duyarlılık ve hastalık aktivite skorları karşılaştırıldı. Bulgular: Kronik spontan ürtiker hastalarına kıyasla atopik dermatitli hastalarda periferik kanda daha yüksek eozinofil sayısı gözlendi. Hastalık SCORAD indeks, eozinofil sayısı ve total IgE seviyeleri ile pozitif korelasyon gösterdi. Ayrıca hastalığın kronik döneminde bazofil sayısının arttığı, total IgE düzeyleri ve SCORAD indeks skorlarının azaldığı belirlendi. Deri prick testi pozitif olan atopik dermatitli hastalarda, total IgE seviyeleri ve SCORAD indeks skorları daha yüksekti. Kronik spontan ürtiker hastalarında bazofil sayıları ile toplam IgE düzeyleri arasında korelasyon olduğu; ancak hastalık aktivite skoru, deri prick test sonuçları ve diğer laboratuvar parametre düzeyleri arasında korelasyon olmadığı tespit edildi. Sonuç: Serum IgE düzeylerinin hastalık aktivitesi ile ilişkisi sadece atopik dermatitte anlamlı bulundu.

Anahtar Kelimeler: Atopik dermatit; ürtiker; bazofil; IgE
REFERENCES:
  1. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023):1109-22. [Crossref]  [PubMed] 
  2. Wollenberg A, Kraft S, Oppel T, Bieber T. Atopic dermatitis: pathogenetic mechanisms. Clin Exp Dermatol. 2000;25(7):530-4. [Crossref]  [PubMed] 
  3. Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol. 2010;35(8):869-73. [Crossref]  [PubMed] 
  4. Kaplan AP, Greaves M. Pathogenesis of chronic urticaria. Clin Exp Allergy. 2009;39(6):777-87. [Crossref]  [PubMed] 
  5. Sánchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, et al; WAO Scientific and Clinical Issues Council. Diagnosis and treatment of urticaria and angioedema: a worldwide perspective. World Allergy Organ J. 2012;5(11):125-47. [Crossref]  [PubMed]  [PMC] 
  6. Młynek A, Zalewska-Janowska A, Martus P, Staubach P, Zuberbier T, Maurer M. How to assess disease activity in patients with chronic urticaria? Allergy. 2008;63(6):777-80. [Crossref]  [PubMed] 
  7. Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol. 2001;10(1):11-8. [Crossref]  [PubMed] 
  8. Rorsman H. Basophil leucocytes in urticaria, asthma and atopic dermatitis. Acta Allergol. 1958;12(2-3):205-16. [Crossref]  [PubMed] 
  9. Degreef H, Cerio R. Mechanisms in allergic skin disorders, therapy of atopic dermatitis. J Acad Dermatol Venereol. 1997;8(Suppl 1):2-10. [Crossref] 
  10. Kato M, Kephart GM, Talley NJ, Wagner JM, Sarr MG, Bonno M, et al. Eosinophil infiltration and degranulation in normal human tissue. Anat Rec. 1998;252(3):418-25. [Crossref]  [PubMed] 
  11. Kägi MK, Joller-Jemelka H, Wüthrich B. Correlation of eosinophils, eosinophil cationic protein and soluble interleukin-2 receptor with the clinical activity of atopic dermatitis. Dermatology. 1992;185(2):88-92. [Crossref]  [PubMed] 
  12. Determinants of total and specific IgE in infants with atopic dermatitis. ETAC Study Group. Early Treatment of the Atopic Child. Pediatr Allergy Immunol. 1997;8(4):177-84. [Crossref]  [PubMed] 
  13. Hon KL, Lam MC, Leung TF, Wong KY, Chow CM, Fok TF, et al. Are age-specific high serum IgE levels associated with worse symptomatology in children with atopic dermatitis? Int J Dermatol. 2007;46(12):1258-62. [Crossref]  [PubMed] 
  14. Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am. 2015;35(1):161-83. [Crossref]  [PubMed]  [PMC] 
  15. Wu KG, Li TH, Chen CJ, Cheng HI, Wang TY. Correlations of serum Interleukin-16, total IgE, eosinophil cationic protein and total eosinophil counts with disease activity in children with atopic dermatitis. Int J Immunopathol Pharmacol. 2011;24(1):15-23. [Crossref]  [PubMed] 
  16. Schäfer T, Heinrich J, Wjst M, Adam H, Ring J, Wichmann HE. Association between severity of atopic eczema and degree of sensitization to aeroallergens in schoolchildren. J Allergy Clin Immunol. 1999;104(6):1280-4. [Crossref]  [PubMed] 
  17. Orfali RL, Shimizu MM, Takaoka R, Zaniboni MC, Ishizaki AS, Costa AA, et al. Atopic dermatitis in adults: clinical and epidemiological considerations. Rev Assoc Med Bras (1992). 2013;59(3):270-5. [Crossref]  [PubMed] 
  18. Hu Y, Liu S, Liu P, Mu Z, Zhang J. Clinical relevance of eosinophils, basophils, serum total IgE level, allergen-specific IgE, and clinical features in atopic dermatitis. J Clin Lab Anal. 2020;34(6):e23214. [Crossref]  [PubMed]  [PMC] 
  19. Kiiski V, Karlsson O, Remitz A, Reitamo S. High serum total IgE predicts poor long-term outcome in atopic dermatitis. Acta Derm Venereol. 2015;95(8):943-7. [Crossref]  [PubMed] 
  20. Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis? J Allergy Clin Immunol. 2004;114(1):150-8. [Crossref]  [PubMed] 
  21. Staumont-Sallé D, Dombrowicz D, Capron M, Delaporte E. Eosinophils and urticaria. Clin Rev Allergy Immunol. 2006;30(1):13-8. [Crossref]  [PubMed] 
  22. Phipps S, Ying S, Wangoo A, Ong YE, Levi-Schaffer F, Kay AB. The relationship between allergen-induced tissue eosinophilia and markers of repair and remodeling in human atopic skin. J Immunol. 2002;169(8):4604-12. [Crossref]  [PubMed] 
  23. Tedeschi A, Kolkhir P, Asero R, Pogorelov D, Olisova O, Kochergin N, et al. Chronic urticaria and coagulation: pathophysiological and clinical aspects. Allergy. 2014;69(6):683-91. [Crossref]  [PubMed] 
  24. Asero R, Cugno M, Tedeschi A. Eosinophils in chronic urticaria: supporting or leading actors? World Allergy Organ J. 2009;2(9):213-7. [Crossref]  [PubMed]  [PMC] 
  25. Altrichter S, Frischbutter S, Fok JS, Kolkhir P, Jiao Q, Skov PS, et al. The role of eosinophils in chronic spontaneous urticaria. J Allergy Clin Immunol. 2020;145(6):1510-6. [Crossref]  [PubMed] 
  26. Chang KL, Yang YH, Yu HH, Lee JH, Wang LC, Chiang BL. Analysis of serum total IgE, specific IgE and eosinophils in children with acute and chronic urticaria. J Microbiol Immunol Infect. 2013;46(1):53-8. [Crossref]  [PubMed] 
  27. Kessel A, Helou W, Bamberger E, Sabo E, Nusem D, Panassof J, et al. Elevated serum total IgE--a potential marker for severe chronic urticaria. Int Arch Allergy Immunol. 2010;153(3):288-93. [Crossref]  [PubMed] 
  28. Baek YS, Jeon J, Kim JH, Oh CH. Severity of acute and chronic urticaria correlates with D-dimer level, but not C-reactive protein or total IgE. Clin Exp Dermatol. 2014;39(7):795-800. [Crossref]  [PubMed] 
  29. Eckman JA, Hamilton RG, Gober LM, Sterba PM, Saini SS. Basophil phenotypes in chronic idiopathic urticaria in relation to disease activity and autoantibodies. J Invest Dermatol. 2008;128(8):1956-63. [Crossref]  [PubMed] 
  30. de Montjoye L, Darrigade AS, Giménez-Arnau A, Herman A, Dumoutier L, Baeck M. Correlations between disease activity, autoimmunity and biological parameters in patients with chronic spontaneous urticaria. Eur Ann Allergy Clin Immunol. 2021;53(2):55-66. [Crossref]  [PubMed] 
  31. Oliver ET, Sterba PM, Saini SS. Interval shifts in basophil measures correlate with disease activity in chronic spontaneous urticaria. Allergy. 2015;70(5):601-3. [Crossref]  [PubMed] 
  32. Kolkhir P, Church MK, Altrichter S, Skov PS, Hawro T, Frischbutter S, et al. Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity, and poor response to treatment. J Allergy Clin Immunol Pract. 2020;8(1):318-25.e5. [Crossref]  [PubMed] 
  33. Wong MM, Keith PK. Presence of positive skin prick tests to inhalant allergens and markers of T2 inflammation in subjects with chronic spontaneous urticaria (CSU): a systematic literature review. Allergy Asthma Clin Immunol. 2020;16:72. [Crossref]  [PubMed]  [PMC] 
  34. Oncham S, Udomsubpayakul U, Laisuan W. Skin prick test reactivity to aeroallergens in adult allergy clinic in Thailand: a 12-year retrospective study. Asia Pac Allergy. 2018;8(2):e17. [Crossref]  [PubMed]  [PMC] 
  35. Bains P, Dogra A. Skin prick test in patients with chronic allergic skin disorders. Indian J Dermatol. 2015;60(2):159-64. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com