The importance of skin prick test in differentiating cat sensitivities and allergies in children.

BACKGROUND: The incidence of cat allergies in children has increased over the years. Children with cat allergies have mostly reported respiratory symptoms. The skin prick test (SPT) is the most preferred method to demonstrate sensitization to allergens. However, not all children who develop cat sensitization due to environmental exposure become allergic to cats. In our study, we aimed to determine the frequency of sensitization to cat and cat allergy, cat-related symptoms, and the cut-off value for the SPT that may indicate cat allergy. METHODS: Patients aged 2-18 years, who applied to the Health Sciences University Izmir Dr Behçet Uz Pediatrics and Surgery Training and Research Hospital and Balikesir University Application and Research Hospital Pediatric Allergy outpatient clinics between January 01, 2019 and December 31, 2020, were included in the study. Patients who underwent SPT and found to be sensitized to cat allergen, were evaluated retrospectively. Clinical and laboratory findings of the patients were recorded. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value for the SPT. RESULTS: Sensitization to cat was detected in 140 (4%) out of 3499 patients who underwent SPT. The median age of the patients was 12 years (min-max: 5-18) and 67.1% were male. Eighty-eight (62.9%) patients were symptomatic upon contact with cats, predominantly with nasal symptoms. These patients had significantly larger cat SPT wheal size than asymptomatic patients. The cut-off value was determined as 5.5 mm with a sensitivity of 72.7% and a specificity of 61.5% (95% CI, 60.5%-78.4%). Symptoms resolved in about half of our patients by reducing contact with cats. DISCUSSION: The present study is the first to report the frequency and clinical findings of cat sensitizations and allergies in Turkish children. For effective treatment, cat allergy must be diagnosed. In this regard, the use of a practical, readily accessible 5.5 mm cut-off point on the SPT may be helpful.

CD4+CD25+CD127loFOXP3+ cell in food allergy: Does it predict anaphylaxis?

BACKGROUND: Food allergy (FA), hence the incidence of food anaphylaxis, is a public health problem that has increased in recent years. There are still no biomarkers for patients with FA to predict severe allergic reactions such as anaphylaxis. OBJECTIVE: There is limited information on whether regulatory T (Treg) cell levels are a biomarker that predicts clinical severity in cases presenting with FA, and which patients are at a greater risk for anaphylaxis. METHODS: A total of 70 children were included in the study: 25 who had IgE-mediated cow's milk protein allergy (CMPA) and presented with non-anaphylactic symptoms (FA/A-), 16 who had IgE-mediated CMPA and presented with anaphylaxis (FA/A+) (a total of 41 FA cases), and a control group consisting of 29 children without FA. The study was conducted by performing CD4+CD25+CD127loFOXP3+ cell flow cytometric analysis during resting at least 2 weeks after the elimination diet to FA subjects. RESULTS: When the FA group was compared with healthy control subjects, CD4+CD25+CD127loFOXP3+ cell rates were found to be significantly lower in the FA group (p < 0.001). When the FA/A- and FA/A+ groups and the control group were compared in terms of CD4+CD25+CD127loFOXP3+ cell ratios, they were significantly lower in the FA/A- and FA/A+ groups compared to the control group (p < 0.001). CONCLUSIONS: Although there was no significant difference between the FA/A+ group and the FA/A- group in terms of CD4+CD25+CD127loFOXP3+ cells, our study is important, as it is the first pediatric study we know to investigate whether CD4+CD25+CD127loFOXP3+ cells in FA predict anaphylaxis.

Prevalence of Viruses in Acute Asthma Exacerbations in Childhood in a Hospital in West Part of Turkey.

Acute asthma exacerbations (AAE) are episodes characterized by potentially life-threatening and rapidly deteriorating asthma symptoms. Viral respiratory infections are one of the major triggers in the pathophysiology of childhood asthma exacerbations. In this study, we aimed to determine the distribution of viral agents among pediatric AAE patients. One hundred and three AAE patients, aged 5 or older, hospitalized between from February 2017 through February 2020 at Pediatric Immunology and Allergic Diseases Unit were included in this study. Fifty patients (48.5%) were female, and the mean age of the patients was 108.2 months. Viruses were detected in 58 (%56.3) of the patients, in 5 of whom more than one virus type was detected. The most commonly detected virus was human rhinovirus (n=43, 67.1%). Other types included respiratory syncytial virus (n=8; 12.5%), influenza (n=6; 9.3%), human metapneumovirus (n=4; 6.2%), adenovirus (n=1; 1.5%), enterovirus (n=1; 1.5%), and parainfluenza (n=1; 1.5%). Viral agents were detected in 29 out of the 47 patients with allergic asthma, with human rhinoviruses comprising the majority (18 patients). The mean length of hospital stay was 7.89 days. Human rhinovirus is the most common virus that triggers AAE, with similar distributions in allergic and non-allergic asthma. We found no correlation between virus type and the length of hospital stay.

The quantity of unheated milk tolerated as a predictor of tolerance to baked milk.

BACKGROUND: Tolerance of baked milk indicates a good prognosis in IgE-mediated cow's milk allergy. OBJECTIVE: The present study aims to investigate the predictors of baked milk tolerance, particularly the amount of milk tolerated in the first oral food challenge (OFC) test, in children with IgE-mediated cow's milk allergy. METHODS: The study included 35 cases who were diagnosed with IgE-mediated cow's milk allergy upon open OFC testing in the Pediatric Allergy Clinic. Four weeks after the diagnosis, skin prick test (SPT) and OFC were performed with baked milk. Cases who did and did not develop reactions during OFC with baked milk were compared regarding clinical and laboratory parameters. RESULTS: Twelve cases (33.3%) did not develop a reaction during OFC with baked milk. Those who had low levels of casein sIgE, ß-lactoglobulin sIgE, and ß-lactoalbumin sIgE; small SPT wheal diameter for baked milk and ß-lactoalbumin; and a large amount of unheated milk tolerated in the first OFC were found to be tolerant to baked milk (p < 0.05). For predicting baked milk tolerance, a cut-off level of the amount of unheated milk tolerated in OFC was calculated as 620 mg [with the area under the curve (AUC) 0.88 (95% confidence interval 0.77-0.99) in ROC curve analysis]. CONCLUSIONS: If a child with cow's milk allergy is able to tolerate more than 620 mg of milk protein during challenge with unheated milk, this may show that this child will tolerate baked milk, meaning that the child will be able to tolerate cow's milk in the future.

Are infants with food allergy candidates for respiratory allergy?

AIM: Allergic sensitization in infancy generally develops against food allergens. We aimed to investigate the frequency of aero-allergens sensitization at older ages in infants with food allergy. MATERIAL AND METHODS: This retrospective cross-sectional study was conducted in Dr. Behçet Uz Children's Allergy Clinic. Infants with confirmed IgE-mediated food allergy between January 1st, 2004, and December 31st, 2016, were evaluated for aero-allergen sensitivities through skin prick tests (SPT) after at least two years after diagnosis, and the data were compared with a healthy control group. RESULTS: A total of 187 cases, 87 of which were patients, were included in the study. The cause of food allergies was cow's milk only in 24 (27.6%) cases, egg only in 26 (29.9%) cases, both cow's milk and egg in 33 (37.9%) cases, fish only in two cases (2.3%), and both fish and egg in two (2.3%) cases. The mean age at which the aero-allergen SPT was performed was 65 (46-180) months in the patient group and 72 (48-132) months in the healthy control group. In the patient group, 39 (44.8%) had aero-allergen sensitization, whereas, in the healthy control group, five (5%) had aero-allergen sensitization. Aero-allergen sensitization was more frequent in the patient group (p<0.05). There was no statistically significant difference in the type and number of food allergies and the development of aero-allergen sensitization (p>0.05). CONCLUSION: In infants with food allergies, sensitization may develop with aero-allergens at an early age. Clinical follow-up of these patients may be important in terms of allergic respiratory diseases.

Does raising awareness in families reduce environmental tobacco smoke exposure in wheezy children?

INTRODUCTION: Environmental tobacco smoke (ETS) is thought to increase the severity and number of attacks in wheezy children. Objective assessments are needed to change the behavior of families to reduce the exposure of wheezy children to ETS. AIM: To determine whether informing families about their children's urinary cotinine levels curtailed the exposure of children to ETS. MATERIAL AND METHODS: A survey was used to determine the ETS exposure level, and the urinary cotinine level of each patient was tested. Children with positive urinary cotinine levels were included in the second part of the study. The families were randomly divided into two groups: an intervention group that was advised about urinary cotinine levels by telephone and a non-intervention group that was not so advised. The groups were followed-up 2 months later, and urinary cotinine levels were measured once again. RESULTS: The intervention group contained 65 children of average age of 24.4 ±8.9 months, of whom 46 (70.8%) were male. The non-intervention group contained 69 children of average age of 25.3 ±9.8 months (p > 0.05), of whom 52 (75.4%) were male. The urinary cotinine levels at the time of the second interview were lower in both groups. The number of cigarettes that fathers smoked at home decreased in the intervention group (p = 0.037). CONCLUSIONS: Presenting objective evidence on ETS exposure to families draws attention to their smoking habits. Measurement of cotinine levels is cheap, practical, and noninvasive. Combined with education, creating awareness by measuring cotinine levels may be beneficial.

Tuberculosis masked by immunodeficiency: a review of two cases diagnosed with chronic granulomatous disease.

Chronic granulomatous disease (CGD) is a genetically heterogeneous primary immunodeficiency that is characterized by recurrent and life-threatening infections resulting from defects in phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system and granuloma formation due to increased inflammatory response. The most commonly involved organs are the lungs, skin, lymph nodes, and liver due to infection. It may present with recurrent pneumonia, hilar lymphadenopathy, empyema, abscess, reticulonodular patterns, and granulomas due to lung involvement. In recent years, mycobacterial disease susceptibility has been reported in CGD cases. This article presents two male cases, one of whom is aged 18 months and the other is aged 5 years, who were diagnosed with CGD and tuberculosis during examination due to extended pneumonia. This report is presented because CGD should be considered not only in the presence of skin abscesses and Aspergillus infections, but also in the differential diagnosis for cases with BCG-itis and/or tuberculosis. It should be kept in mind that mycobacterial infections can occur during the course of the disease.

Effect of socioeconomic status on allergic diseases and atopy in school children.

Sipahi S, Nacaroglu HT, Can D, Günay I, Ünsal-Karkiner CS, Kamali H, Özdemir A, Günay T. Effect of socioeconomic status on allergic diseases and atopy in school children. Turk J Pediatr 2017; 59: 670-677. Higher family socioeconomic status (SES) has been suggested as a risk factor for allergic diseases. We investigated the effect of SES on the prevalence of allergic diseases and atopy. The study included 13-14-year-old primary school students in Kemalpasa, Turkey. The International Study of Asthma and Allergies in Childhood phase 1 questionnaire was administered to all students to identify allergic diseases. Those identified as having allergic diseases underwent a skin prick test (SPT). Group I included students with allergic diseases and a positive SPT. Group II comprised students with allergic disease who were SPT negative. The control group was randomly selected from the students with no allergic diseases. Three weighted SES scores were calculated for each student (equally weighted, education-weighted, and social class-weighted). SES was classified as lower, middle, or upper according to the weighted SES scores. Allergic diseases were detected in 657 of the 1,373 children who participated in the study. A higher percentage of children with allergic diseases and atopy were in the lower SES group in all weighted SES analyses compared with controls (Group I: 59%, 83.1%, 67.5%; Group II: 62.9%, 80%, 63.5%; control group: 12.4%, 12.9%, 21.2%). Significantly more children with allergic and atopic diseases (Groups I and II) were in the lower SES group compared with the control group (p < 0.001). In contrast to the hygiene hypothesis, we found the incidence of atopic disease was higher in families with lower SES.

Can mean platelet volume be used as a biomarker for asthma?

INTRODUCTION: Platelets play important roles in airway inflammation and are activated in inflammatory lung diseases, including asthma. AIM: We evaluated the mean platelet volume (MPV), used as a marker of platelet activation, in asthmatic patients during asymptomatic periods and exacerbations compared to healthy controls to determine whether MPV can be used as an indicator of inflammation. MATERIAL AND METHODS: Our patient group consisted of 95 children with exacerbation of asthma who were admitted to our allergy clinic. The control group consisted of 100 healthy children matched for age, gender, and ethnicity. Mean platelet volume values of the patient group obtained during exacerbation of asthma were compared to those of the same group during the asymptomatic period and with the control group. We investigated factors that can affect the MPV values of asthma patients, including infection, atopy, immunotherapy treatment, and severity of asthma exacerbation. RESULTS: The patient group consisted of 50 (52.6%) boys and 45 (47.4%) girls with a mean age of 125 ±38 months old. Mean MPV values in the exacerbation period, the healthy period, and in the control group were 8.1 ±0.8 fl, 8.1 ±1.06 fl, and 8.2 ±0.9 fl, respectively; there were no significant differences between groups (p > 0.05). The severity of asthma, severity of asthma exacerbation, immunotherapy, coinfection, eosinophil count, and IgE level also had no effect on MPV (p > 0.05). CONCLUSIONS: Although platelets play a role in the pathophysiology of asthma, MPV measurement is insufficient to detect inflammation through platelets.

Risk of systemic allergic reactions to allergen immunotherapy in a pediatric allergy clinic in Turkey.

OBJECTIVES: Even though allergen immunotherapy is an effective treatment method that has been used on rhinitis, asthma and venom anaphylaxis for over 100 years, systemic reactions (SRs) limit the use of this treatment method. We classified SRs associated with subcutaneous immunotherapy (SCIT) according to the World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. Risk factors for the SRs were assessed. METHODS: In this study 67,758 injections to 1350 children with allergic rhinitis and/or asthma were analyzed throughout January 1999-December 2014. RESULTS: A total of 51 systemic reactions were observed in 39 patients (0.075% per injection, %3 per patient). Mean age of SRs observed patients was 13±2.6 years (range 9.5-16 years) and 64.1% were male, 35.9% were female. 51.3% of SRs were grade 1, 38.5% grade 2, 7.7% grade 3 and 2.6% grade 4. SRs were early onset in 41% of the patients and delayed onset in 59%. 76.9% of SRs were seen during maintenance therapy and 56.4% during peak pollen season. In 28.2% of cases previous local reactions and in 30.8% previous grade 1 reactions were determined. There was no fatal outcome from any of the SRs. CONCLUSION: SCIT related SRs are generally of mild severity. Although only 10% of the SRs were grade 3 or 4, there is a still a small risk of severe reactions. 76.9% of SRs were observed during maintenance therapy. Delayed-onset SRs rate in our study is 59%. So both clinicians and parents should be alert about the delayed reactions after SCIT.

Is There Any Parameter Helpful for Predicting a Suitable Candidate for Mite Immunotherapy?

Few biomarkers that can predict the clinical response to allergen immunotherapy (AIT) have been identified. The aim of the present study was to investigate parameters that could be used "in predicting the clinical response to AIT" in children with asthma caused by house dust mites. We evaluated 107 children with mild persistent asthma who were sensitised only to mite aeroallergens. The study group included 47 patients who underwent a 4-to-5-year course of subcutaneous immunotherapy with standardised mite allergenic extract. Sixty patients who had not undergone AIT but were allergic to house mites were included in the control group. The clinical features and laboratory parameters of patients who did and did not sustain remission were compared. Remission was achieved in 74.5% of the 47 patients in the study group and in 20% of those in the control group. In the study group, one parameter predictive of a clinical response to AIT was identified by multivariate logistic analysis. This parameter was the serum total IgE level (tIgE) at the time of diagnosis (OR 131.64 and CI 0.858-20193; p = 0.032). Serum tIgE levels ≤ 339 kU/L at diagnosis were associated with an effective clinical response to AIT, with a sensitivity of 64.5% and specificity of 88.9%. We conclude that measurement of the serum tIgE level can be used as a predictive test prior to AIT in patients sensitized to mite aeroallergens.

Local and systemic reactions to subcutaneous allergen immunotherapy: Ten years' experience in a pediatric clinic.

BACKGROUND: Local and especially systemic reactions are important problems in subcutaneous immunotherapy (SCIT). Local and systemic reactions develop in 0.7% to 4% and 0.2% of all injections, respectively. OBJECTIVE: To evaluate the frequency of and risk factors for reactions developing in pediatric patients undergoing SCIT. METHODS: Local and systemic reactions developing after 14,308 injections between 2003 and 2013 were retrospectively evaluated in the current study using the Subcutaneous Immunotherapy Systemic Reaction Grading System, as recommended by the World Allergy Organization. The type of allergic disease, allergens producing a sensitivity, allergen immunotherapy content, adjuvant content, and the effects of treatment phase on the frequency of adverse effects were investigated. RESULTS: Of 319 patients, local reactions occurred in 11.9%, wide local reactions occurred in 5%, and systemic reactions occurred in 4.7%. A local reaction was observed in 0.38% of all injections, whereas a systemic reaction was observed in 0.1% of all injections. Local reactions were most frequent in the build-up phase, and systemic reactions were most frequent in the maintenance phase (P = .01). Side reactions were more common in patients undergoing SCIT with multiple allergens (P = .002) and house dust mite (P = .001). No statistically significant difference was found between adjuvant content and adverse effect frequency (P = .32). CONCLUSIONS: The frequencies of local and wide local reactions during SCIT were lower than expected. Although systemic reactions were frequently seen, no fatal reaction was observed in the current study. House dust mite SCIT and multiple allergen use increased the risk of reaction.

Pulmonary vascular anomalies: a review of clinical and radiological findings of cases presenting with different complaints in childhood.

Congenital pulmonary vascular abnormalities arise from several etiologies. These anomalies are difficult to categorize and sorted into distinct classifications. Major pulmonary vascular abnormalities can be ranked as interruption of the main pulmonary artery or its absence, emergence of the left pulmonary artery in the right pulmonary artery, pulmonary venous drainage abnormalities, and pulmonary arteriovenous malformations (PAVMs). Some of the cases are asymptomatic and diagnosed by coincidence, whereas a few of them are diagnosed by typical findings in the newborn and infancy period, symptoms, and radiological appearances. Early diagnosis is important, since death may occur as a result of pulmonary and cardiac pathologies developed in patients with pulmonary vascular anomalies. In this case presentation, the clinical and radiological findings of patients that presented with different complaints and were diagnosed with pulmonary vascular anomalies were introduced.

Side Effects of Leukotriene Receptor Antagonists in Asthmatic Children.

BACKGROUND: Leukotriene receptor antagonists (LTRAs) are drugs which have been widely used more than ten years. As the use of LTRAs increases, our knowledge with respect to their side effects increases as well. OBJECTIVES: The objective of our study was to evaluat the observed side effects of LTRAs used in patients with astma. PATIENTS AND METHODS: 1024 patients treated only with LTRAs owing to asthma or early wheezing were included in the study for a five-year period. The observed side effects of LTRAs in these patients were retrospectively investigated. The side effects were divided into two parts as psychiatric and non-psychiatric. RESULTS: Among the 1024 cases included in the study, 67.5% of the patients out of 41 with side effects were male, 32.5% were female and the average age was 6.5 years. The rate of patients with asthma was 63.41% and 36.58% of the patients had early wheezing. It was determined that sex, age and diagnosis (early wheezing or asthma) of the patients were ineffective in the emergence of side effects. The average period for the emergence of side effects was the first month. It was observed that hyperactivity was the most frequently observed psychiatric side effect and that abdominal pain was the non-psychiatric side effect. CONCLUSIONS: The side effects of LTRAs were common in children. Therefore, patients must be informed at the beginning of the treatment and they must be evaluated at certain intervals.

Chicken or the egg: the dilemma of allergic rhinitis versus adenoid hypertrophy.

BACKGROUND: There is no consensus as to whether allergic rhinitis (AR) is a cause of adenoid hypertrophy (AH). This study evaluated the role of allergy in AH, and it explored the role of nasal endoscopy and the history of diagnosing AR in children empirically. MATERIALS AND METHODS: This study enrolled 155 children consecutively in Izmir Behcet Uz Children`s Hospital between January and September 2013. RESULTS: Of the patients, 101 (65.2%) had a positive skin prick test. Multiple allergen sensitivity was identified in 76 (75.2%) of these patients. The history items of itching and sneezing had predictive value for empirically diagnosing AR in children. Of the nasal examination findings, only the nasal secretion characteristics had significant predictive value. AH and AR had a significant negative correlation. CONCLUSION: In this study, AH and AR were inversely related. The characteristics of the nasal secretions, itching, sneezing, were predictors of AR in children.

DRESS syndrome associated with type 2 diabetes in a child.

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon, life-threatening drug reaction. The basic findings are skin rash, multiorgan involvement, and eosinophilia. Most of the aromatic anticonvulsants, such as phenytoin, phenobarbital and carbamazepine can induce DRESS. Herein we report a 14-year-old patient with DRESS syndrome related to carbamazepine use. The patient presented with signs of involvement of the skin, lungs, liver, and microscopic hematuria. Carbamazepine treatment was discontinued; antihistamines and steroids were started. Hyperglycemia, commencing on the first dose of the steroid given, persisted even after the discontinuation of steroids and improvement of other signs. There were no signs of pancreatitis or type 1 diabetes clinically in laboratory tests. Her blood glucose levels were regulated at first with insulin and later with metformin. Within 1 year of follow-up, still regulated with oral antidiabetics, she has been diagnosed with type 2 diabetes. Formerly, long-term sequelae related to "drug rash with eosinophilia and systemic symptoms syndrome" such as hepatic and renal failure, type 1 diabetes mellitus, Grave's disease, autoimmune hemolytic anemia, and lupus have also been reported. However, up to date, no cases with type 2 diabetes have been reported as long-term sequelae. To our knowledge, this is the first case in the literature presenting with type 2 diabetes as long-term sequelae.

Chilaiditi Syndrome in Two Cases Presented with Respiratory Distress Symptoms.

Chilaiditi syndrome is a rare syndrome known hepatodiaphramatic interposition of as colon or small intestine. As this pathology is usually asymptomatic, it is incidentally identified in adults and rarely reported in children. Herein, two children cases are presented with respiratory distress, who were diagnosed as Chilaiditi syndrome by chest radiography.

Hypersensitivity pneumonia in a schoolchild admitted to the hospital's asthma clinic.

Bird fancier's lung (BFL), also called bird-breeder's lung or pigeon-breeder's disease (PBD), is a hypersensitivity pneumonitis (HP) that is rare in children. A 9-year-old male patient complained of cough, dyspnea and chest pain, in his examination his lips were cyanosed and his SaO2 was 86% at room air. Bilateral crepitant rales and sibilant rhochi were also detected. In his thoracic computerized tomography, the ground glass areas were noted in both lungs. In his medical history, it was discovered that he lived above an office in which birds and bird manure were merchandised. Precipitant antibody level was determined. Since the levels of precipitant antibody were high and symptoms reappeared with natural provocation, our patient was diagnosed with PBD. The case diagnosed as BFL was presented in this study as an HP which should be considered in the differential diagnosis of children with respiratory distress syndrome and asthma clinic.

Eosinophilic cellulitis (Wells' syndrome) caused by a temporary henna tattoo.

Eosinophilic cellulitis (Wells' syndrome) is an uncommon condition of unknown etiology. Wells' syndrome is usually seen in adulthood but very rare in childhood. Although pathogenesis of the disease is not very clear, it is a hypersensitivity reaction developing against a variety of exogenous and endogenous antigenic stimuli. Paraphenylenediamine is a strong allergen frequently used as a temporary henna tattoo, which makes the color darker. Here, a 9-year-old male patient with Wells' syndrome is presented, which developed following a temporary henna tattoo and shown by the patch test sensitivity to paraphenylenediamine.