The frequency of sleep-disordered breathing in preschool children with asthma and its effects on control of asthma.

CONCLUSION: The frequency and score of SDB were higher in patients with uncontrolled asthma. Frequency and score of SDB were significantly affected by the severity of asthma. SDB must be evaluated in preschool children with uncontrolled asthma. CONCLUSION: Sleep-disordered breathing (SDB) is more common in asthmatic patients than in non-asthmatic persons, and SDB affects negatively to control asthma. A limited number of studies are discovered on the effect of SDB in preschool asthmatic children. In this study, we aimed to investigate the prevalence of SDB and its effect on control and severity of asthma in preschool children. A pediatric sleep questionnaire was completed by parents of asthmatic children. Patients who received a score of 0.33 or higher were diagnosed with SDB. Control and severity of asthma was assessed by a pediatric allergy specialist based on the Global Initiative for Asthma (GINA) criteria. The study included 249 patients, with a mean±SD age of 4.37±1.04 (range: 2-5.9) years; 69% were boys; 56.6% children had uncontrolled asthma and 28.7% had SDB. The SDB score was significantly different between controlled and uncontrolled asthma (0.19 vs 0.28; P < 0.001). The frequency of uncontrolled asthma in patients with and without SDB was 74.3% and 49.4%, respectively (P < 0.010). Based on the severity of asthma, the frequency of SDB among patients with mild, moderate, and severe asthma was 23.4%, 35.2%, and 47.4%, respectively (P = 0.010).

The frequency of sleep-disordered breathing in preschool children with asthma and its effects on control of asthma

Sleep-disordered breathing (SDB) is more common in asthmatic patients than in non-asthmatic persons, and SDB affects negatively to control asthma. A limited number of studies are discovered on the effect of SDB in preschool asthmatic children. In this study, we aimed to investigate the prevalence of SDB and its effect on control and severity of asthma in preschool children. A pediatric sleep questionnaire was completed by parents of asthmatic children. Patients who received a score of 0.33 or higher were diagnosed with SDB. Control and severity of asthma was assessed by a pediatric allergy specialist based on the Global Initiative for Asthma (GINA) criteria. The study included 249 patients, with a mean±SD age of 4.37±1.04 (range: 2–5.9) years; 69% were boys; 56.6% children had uncontrolled asthma and 28.7% had SDB. The SDB score was significantly different between controlled and uncontrolled asthma (0.19 vs 0.28; P < 0.001). The frequency of uncontrolled asthma in patients with and without SDB was 74.3% and 49.4%, respectively (P < 0.010). Based on the severity of asthma, the frequency of SDB among patients with mild, moderate, and severe asthma was 23.4%, 35.2%, and 47.4%, respectively (P = 0.010). Conclusion: The frequency and score of SDB were higher in patients with uncontrolled asthma. Frequency and score of SDB were significantly affected by the severity of asthma. SDB must be evaluated in preschool children with uncontrolled asthma (AU)

Anaphylactic shock following minor abdominal trauma as the initial presentation of Echinococcus cyst: a case report.

BACKGROUND: Anaphylaxis is a potentially life-threatening condition caused by a variety of triggers. However, anaphylaxis following an abdominal trauma is an exceptionally rare condition and could be the first and only sign of hepatic hydatid cyst, especially when no obvious etiology is present. Here, we present such a rare case and discuss relevant diagnostic and management strategy in light of the literature. CASE REPORT: This case report refers to a 17 year-old previously healthy girl admitted in our pediatric emergency department (ED) for syncope after a minor blunt abdominal trauma. She was hypotensive on admission and shortly after she developed urticaria and angioedema. She was diagnosed with anaphylaxis and treated immediately. Possible etiologies including drug or food ingestion, insect bite, and previous allergy/anaphylaxis history were excluded. After stabilization abdominal imaging was performed, which revealed a ruptured large hepatic hydatid cyst in the vicinity of biliary tree. Albendazole treatment was started and surgical resection was performed after clinical stabilization, which confirmed the cyst rupture into the biliary ducts. Patient recovered without complications after surgery and was discharged uneventfully. CONCLUSION: This case report highlights that hydatid cyst rupture should be included in the differential diagnosis of anaphylaxis without obvious etiology, particularly in regions where hydatid disease is endemic. Ruptured hydatid cyst leading to anaphylaxis requires timely diagnosis, management and emergent intervention.

Evaluation of Unscheduled Return Visits to the Pediatric Emergency Department and Risk Factors for Admission After Return Visit.

OBJECTIVE: Unscheduled return visits to the emergency department (unscheduled RTED) increase both the workload and overcrowding in the emergency department. The aim in the present study is to identify the patient groups that require more careful and closer follow-up to reduce the rates of unscheduled RTED and hospital admissions after a return visit. METHODS: Among the patients admitted to the emergency department of our hospital between 2016 and 2017, those who made an unscheduled RTED within 72 hours after their first visit to the emergency department were evaluated retrospectively. RESULTS: Of the 137,787 eligible children, 3294 (2.8%) made unscheduled RTEDs within 72 hours. The median age was 28 months, and 1848 (57.6%) were male patients. The admission rate at the return visit was significantly higher among children younger than 2 years, in the patients presenting with respiratory complaints and severe acute conditions, and in those who presented to the emergency department for the first time during the department's busiest hours. The risk of admission upon a return visit to the emergency department was 2.7 times higher in the male sex, 5.4 times higher in children younger than 2 years, 5.9 times higher in patients with respiratory complaints, 4.9 times higher in patients with gastrointestinal tract complaints, and 27,000 times higher in patients with severe acute conditions. CONCLUSIONS: Unscheduled RTED and hospitalization rates can be reduced with more careful evaluation of young children, patients with respiratory and gastrointestinal complaints and those who apply during emergency department busiest hours.

Immediate local anesthetic reactions and diagnostic test results in pediatric patients.

BACKGROUND/OBJECTIVES: Adverse reactions to local anesthetics are relatively common, but proven IgE-mediated allergy is extremely rare. We aimed to determine the frequency of local anesthetic allergy in pediatric patients. PATIENTS AND METHODS: The medical records of 73 patients who presented to our clinic with a history of suspected allergic reaction to local anesthetics and underwent diagnostic testing between 2012 and 2020 were retrospectively analyzed. Diagnoses were based on case histories, skin tests, and subcutaneous challenge tests. RESULTS: A total of 75 test series were carried out on the 73 patients (43 boys; median [IQR] age 9.25 [7.26-14.25] years, range 3-17.8 years). The most commonly tested drugs were lidocaine (n = 38; 50.6%) and prilocaine (n = 15; 20%). Local anesthetic allergy was confirmed in one (1.3%) of the 73 patients by positive subcutaneous challenge test with mepivacaine. CONCLUSION: There are limited data in the current literature regarding local anesthetic allergies and diagnosis test results in pediatric patients. Proven local anesthetic allergy is less common than expected by society and physicians, and therefore diagnostic tests are needed for patients with no contra-indications such as severe or life-threatening reactions.

Evaluation of Hypersensitivity Reactions with Leuprolide Acetate and Triptorelin Acetate in Children.

Introduction: Gonadotropin releasing hormone analogues (GnRHa) are commonly used to treat central precocious puberty (CPP). Generally, they are well-tolerated; however adverse reactions have been reported. Local adverse events occur in 10-15% of the patients who were treated with GnRHa. Anaphylactoid reactions with GnRHa are very rarely seen. The aim of this study is to report our clinical experience with hypersensitivity reactions seen in pediatric patients receiving leuprolide acetate (LA) and triptorelin acetate (TA) in CPP at the single pediatric tertiary medical center and to evaluate the incidence rate of hypersensitivity reactions. Methods: This retrospective study included children with CPP who were treated with GnRHa (LA and TA) at our hospital between January 2013 and December 2020. We analyzed clinical characteristics of patients who experienced adverse reactions and analyzed the incidence rate. Results: Seven side effects (adverse reactions) (0.69%) were observed among total of 1010 CPP patients who were treated with TA and LA. Sterile abscesses were observed in 3 patients (0.29%). None of the patients had an anaphylaxis. Tremors of both hands, a vomiting episode, an urticarial rash, and musculoskeletal stiffness were observed in one patient each. Conclusion: In our study, mild reactions were seen in 7 patients. GnRHa can be safely used and well-tolerated medications; but exceedingly rare, severe reactions can be developed.

Clinical Phenotypes of Severe Cutaneous Drug Hypersensitivity Reactions.

Drug hypersensitivity reactions are clinically heterogenous ranging from mild to severe. Most drug hypersensitivity reactions are accompanied by cutaneous manifestations. Fever, mucous membrane involvement, large blisters, facial oedema, pustulosis and visceral involvement are clinical features that lead to suspicion of severe adverse drug reactions. Severe cutaneous adverse drug reactions (SCARs) include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis. Serum sickness like reactions, drug induced vasculitis and generalized bullous fixed drug eruptions are less severe clinical entities. SCARs are uncommon but associated with significant morbidity and mortality. Physician should be aware of specific red flags and danger signs to immediately identify these reactions. Immediate drug withdrawal is mandatory. Early diagnosis and appropriate treatment significantly affect the prognosis of the disease. The purpose of our review is to discuss clinical phenotypes of severe cutaneous drug hypersensitivity reactions.

Genetic variability human respiratory syncytial virus subgroups A and B in Turkey during six successive epidemic seasons, 2009-2015.

Human respiratory syncytial virus (HRSV) is most important viral respiratory pathogen of acute lower respiratory tract infections in infants and young children worldwide. The circulating pattern and genetic characteristics in the HRSV attachment glycoprotein gene were investigated in Turkey during six consecutive seasons from 2009 to 2015. HRSVA was dominant in the all epidemic seasons except 2011-2012 season. Partial sequences of the HVR2 region of the G gene of 479 HRSVA and 135 HRSVB were obtained. Most Turkish strains belonged to NA1, ON1, and BA9, which were the predominant genotypes circulating worldwide. Although three novel genotypes, TR-A, TR-BA1, and TR-BA2, were identified, they were not predominant. Clinical data were available for 69 HRSV-positive patients who were monitored due to acute lower respiratory tract illness. There were no significant differences in the clinical diagnosis, hospitalization rates, laboratory findings and treatment observed between the HRSVA and HRSVB groups, and co-infections in this study. The major population afflicted by HRSV infections included infants and children between 13 and 24 months of age. We detected that the CB1, GB5, and THB strains clustered in the same branch with a bootstrap value of 100%. CB-B and BA12 strains clustered in the same branch with a bootstrap value of 65%. The BA11 genotype was clustered in the BA9 genotype in our study. The present study may contribute on the molecular epidemiology of HRSV in Turkey and provide data for HRSV strains circulating in local communities and other regions worldwide.

Frequency of selective immediate responders to aminopenicillins and cephalosporins in Turkish children.

BACKGROUND: Beta-lactam antibiotics (BLA) are the most commonly prescribed antibiotics and are responsible for the majority of immediate hypersensitivity reactions to drugs in children. Cross-reactivity is important in hypersensitivity to BLAs because these drugs all share a common beta-lactam structure and some share similar side chains. OBJECTIVE: The aim of this study was to evaluate the clinical characteristics of patients who are diagnosed with immediate-type BLA hypersensitivity and frequency of patients with side chain hypersensitivity, "selective responders." METHODS: The study included patients who were diagnosed with immediate-type BLA hypersensitivity between January 2011 and May 2016 in a pediatric allergy outpatient clinic. The patients who had negative penicillin test (minor determinant mixture, benzylpenicilloylpoly-L-lysine, penicillin G) results and could tolerate penicillin V and/or BLAs with dissimilar side chains but had positive skin and/or provocation test results with the suspected drug were diagnosed as selective responders. RESULTS: During the study period, 357 patients (55.2% girls) were admitted to our clinic with suspected immediate-type BLA hypersensitivity. Parents of 11 patients did not give consent for an allergy workup with the suspected drug. Forty-five of the patients were diagnosed (45/346 [13%]) based on skin test or drug provocation test results. The most common susceptible agent was amoxicillin-clavulanate. Of the patients, 71.4% with a reaction to sulbactam-ampicillin /or amoxicillin-clavulanate and 93.7% with a reaction to cephalosporin were classified as selective responders. CONCLUSION: Among children with immediate BLA hypersensitivity, selective responders constituted an important group. Most of the patients with reactions to aminopenicillin and cephalosporins safely tolerated penicillin V and BLAs with dissimilar side chains after negative allergy workup results.

Clinical and etiologic evaluation of the children with chronic urticaria.

BACKGROUND: Chronic urticaria (CU) is a skin disorder defined as daily or almost daily exhibition of pruritic and transient wheals that last for 6 weeks. CU is divided into two subtypes: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). OBJECTIVES: To evaluate the clinical features, possible causes, associated findings, and laboratory results of different subtypes of CU in children according to a new classification. METHODS: In this study, we evaluated the clinical features, laboratory investigations, and provocation tests of children with different subtypes of CU according to a new classification. RESULTS: Two hundred and twenty-two children (59.9% girls) were enrolled in the study. Of the study patients, 59.9% and 40.1% were diagnosed as having CSU and CIndU, respectively. Antithyroid antibody levels were positive in 7.1% of the patients with CSU, 32.8% of the children had positive 14C-urea breath test results, and 6.5% of the patients had positive stool examination results for parasites. Autologous serum skin test results were positive in 53.5% of the patients with CSU. Of the patients with CIndU, 77.5% had symptomatic dermographism, 16.8% had cold urticaria, 2.2% had cholinergic urticaria, 2.2% had solar urticaria, and 1.1% had aquagenic urticaria. CONCLUSION: Children with CSU represent the majority of patients with CU, and more than a half of these patients might have autoimmune urticaria. Symptomatic dermographism was the most common type of CIndU.

Subjective and objective assessments of seasonal effect in children with seasonal allergic rhinitis.

BACKGROUND: Epidemiological and clinical studies suggest a relationship between rhinitis and asthma. Upper and lower airways may be influenced by a common inflammatory process. OBJECTIVE: This study aimed to investigate the relationships between rhinitis symptom scores, and both nasal and bronchial airflow among children with seasonal allergic rhinitis (SAR) by means of spirometric and rhinomanometric measurement during and outside the pollen season. METHODS: Twenty-nine children with both seasonal allergic rhinitis and asthma (AR+A), 30 children with SAR and no asthma (AR) and 36 non-allergic healthy children were evaluated prospectively during and outside the pollen season. Symptom severity was evaluated using both total symptom score and visual analog score (VAS). All participants also received rhinomanometric evaluation and pulmonary function testing. RESULTS: In children with SAR the median total nasal flow, FEV1, FEF25-75 values were lower than control group during pollen season (p=0.01, p<0.001 and p<0.001 respectively). They had also higher total nasal resistance compared with control groups (p=0.01). Nasal symptom scores were higher among patients with concurrent asthma than patients who had only SAR out of pollen season (p<0.001). There was no significant difference between SAR participants with or without asthma and control group in terms of total nasal flow and total nasal resistance measured out of season (p=0.105 and p=0.19). FEF25-75 values of patients with and without asthma were significantly lower than those of controls out of season (p=0.022, p<0.001 respectively). CONCLUSION: Our data suggests that as the presence of AR worsens asthma control, the presence of asthma may worsen symptoms of AR out of pollen season. We found that total nasal flow, FEV1, FEF25-75 values of patients with SAR were lower than those of controls out of season. FEF25-75 values of patients with asthma and without asthma were significantly lower than those of controls out of season. Thus, a careful evaluation of lower airways should be performed in even patients with seasonal allergic rhinitis alone.

The patterns and clinical relevance of contact allergen sensitization in a pediatric population with atopic dermatitis.

BACKGROUND/AIM: Data about contact allergen sensitization (CAS) in children with atopic dermatitis (AD) are limited. The purpose of this study was to identify the frequency and patterns of CAS in children with AD by using a ready-to-use patch test system. MATERIALS AND METHODS: After receiving the history of CAS in the patients, the severity of AD and IgE-mediated allergen sensitization were determined. RESULTS: Of 134 children with AD, 33.8% (n = 45) had at least 1 positive reaction. The most frequent positive reaction was to nickel sulfate (NS) (37.8%, 17/45), followed by methylchloroisothiazolinone (20.0%, 9/45) and thimerosal (15.6%, 7/45). The total Scoring Atopic Dermatitis (SCORAD) score was significantly higher in the NS-sensitized group (P = 0.036). The patients with NS sensitization had moderate-severe AD more frequently than those without any reaction (P = 0.020). When the SCORAD score was evaluated in detail, extent of eczema, score of sleep loss, and pruritus were significantly higher in the patients with NS sensitization than those without any reaction (P = 0.002, P = 0.001, and P = 0.002, respectively). CONCLUSION: Our study confirms the necessity of CAS in the management of AD. In particular, NS sensitization should be considered for children with severe AD or larger extent of eczema and trunk involvement.