Diagnosis of primary immunodeficiency diseases in pediatric patients hospitalized for recurrent, severe, or unusual infections

Background: Primary immunodeficiency diseases (PID) usually presents itself with recurrent, severe, and unusual infections, along with autoimmunity and various other malignancies. But, the diversity of PID often makes the diagnosis of patients difficult for physicians other than clinical immunologists. This study aimed to describe the characteristics of patients diagnosed with PIDs during the inpatient treatment for infectious diseases, and to highlight the cases in which a PID diagnosis should be considered.Methods: The clinical, immunological, and molecular features of 81 pediatric patients treated for infectious diseases, who were diagnosed with a PID during hospitalization was retrospec-tively analyzed. The diagnosis was based on the PID criteria of the International Union of Immunological Societies.Results: The five main PID sub-types were identified. Predominantly, antibody deficiencies were the most common (61.7%) group. The average delay in diagnosis was 34.6 months, and the positive family history rate was 24.7%, while the consanguineous marriage rate was 45.7%. Around thirty-five (43%) patients were found to have mutated PID-related genes. While lower respiratory tract infections were the most common symptom, a fever of unknown origin was another remarkable diagnosis. Eight (9.9%) patients underwent allogeneic hematopoietic stem cell transplantation.Conclusions: Clinicians should consider a PID diagnosis, especially in the cases of recurrent, severe, or atypical infections. Increased knowledge of the alarm features of PID can promote early diagnosis (AU)

COmparisoN of TastES of Available NutriTional integrated or non-integrated formulas for infants older than 1 year of age with cow’s milk allergy: A multicenter, prospective, single blind, cross-sectional observational clinical study (CONTEST Study)

Palatability of the infant formulas lacking cow milk protein formulas is reported by parents to be an important drawback. The purpose of this study is to examine decisions made by mothers of infants having cow milk protein allergy, and physicians concerning the palatability of unflavored extensively hydrolyzed formulas and amino acid-based formulas. We conducted a multi-center, randomized, single-blinded, observational taste study involving 149 pediatri-cians from gastroenterology and allergy subspecialties at 14 tertiary healthcare units from different regions of Turkey and involving 94 mothers of infants with cow milk protein allergy. Blinding was performed for seven formulas available in the market, which were the most commonly prescribed for feeding: four AAFs (Neocate-Numil®, Aptamil Pregomin AS-Numil®, Alfamino-Nestle®, Comidagen-Mamma®), one AAF specifically designed to address the growing nutritional and lifestyle needs of children >1 year (Neocate Junior-Numil®), 2 eHFs (Bebelac Pepti Junior-Numil®, Similac Alimentum-Abott®). Considering all three formula characteris-tics, Neocate junior-Numil® ranked as the number 1 product among seven products by moth-ers (63.8%) and physicians (69.8%). The ratings of mothers were significantly higher than the physicians (8.1 points and 6.1 points, respectively; p < 0.001). No difference was found in terms of taste, smell, and appearance for Neocate junior-Numil® between the mothers’ and physicians’ ratings. Since caregivers have responsibility for careful selection of replacement products for infants with cow milk protein allergy, it is noteworthy that increased awareness and confidence in the palatability characteristics of these products should motivate mothers and physicians to comply with replacement treatment in the long term (AU)

Clinical and immunological features of 44 common variable immunodeficiency patients: the experience of a single center in Turkey

INTRODUCTION AND OBJECTIVES: Common variable immunodeficiency (CVID) is one of the most prevalent forms of primary immunodeficiency characterized by hypogammaglobinemia. Its heterogeneous clinical features include recurrent respiratory tract infections and other complications such as gastrointestinal, autoimmunity, and lymphoproliferative disorders. The aim of this article is to evaluate the general characteristics of CVID patients. MATERIALS AND METHODS: Clinical and immunological features of 44 CVID patients were evaluated retrospectively with long-term follow-up. Patients who participated in the study were diagnosed according to the criteria of the European Society for Immunodeficiency Diseases (ESID). RESULTS: The median age at onset of symptoms was 2.75 years (range 6 months to 17 years), and the median age at diagnosis was 7.75 years (range 4-20 years). The average delay in diagnosis was 4.6 years (range 1-14 years). Positive family history was 18.2%. Before treatment, patients' median total serum IgG was 271.5mg/dL, median IgA was 7.5mg/dL, and median IgM was 21mg/dL. Infections were the most common clinical manifestation, and 63.6% of patients presented with sinopulmonary infection as the first manifestation. Bronchiectasis developed in 23 CVID subjects, while bronchiectasis was detected prior to CVID diagnosis in eight patients. All patients received immunoglobulin replacement therapy, and one patient died because of granulomatous lymphocytic interstitial lung disease (GLILD). CONCLUSIONS: CVID is a heterogeneous group of immunologic disorders with unknown etiology. There are significant differences in the clinical presentation and prevalence of CVID-related complications among countries. Local guidelines for diagnosis and clinical follow-up are needed

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Clinical and immunological features of 44 common variable immunodeficiency patients: the experience of a single center in Turkey.

INTRODUCTION AND OBJECTIVES: Common variable immunodeficiency (CVID) is one of the most prevalent forms of primary immunodeficiency characterized by hypogammaglobinemia. Its heterogeneous clinical features include recurrent respiratory tract infections and other complications such as gastrointestinal, autoimmunity, and lymphoproliferative disorders. The aim of this article is to evaluate the general characteristics of CVID patients. MATERIALS AND METHODS: Clinical and immunological features of 44 CVID patients were evaluated retrospectively with long-term follow-up. Patients who participated in the study were diagnosed according to the criteria of the European Society for Immunodeficiency Diseases (ESID). RESULTS: The median age at onset of symptoms was 2.75 years (range 6 months to 17 years), and the median age at diagnosis was 7.75 years (range 4-20 years). The average delay in diagnosis was 4.6 years (range 1-14 years). Positive family history was 18.2%. Before treatment, patients' median total serum IgG was 271.5mg/dL, median IgA was 7.5mg/dL, and median IgM was 21mg/dL. Infections were the most common clinical manifestation, and 63.6% of patients presented with sinopulmonary infection as the first manifestation. Bronchiectasis developed in 23 CVID subjects, while bronchiectasis was detected prior to CVID diagnosis in eight patients. All patients received immunoglobulin replacement therapy, and one patient died because of granulomatous lymphocytic interstitial lung disease (GLILD). CONCLUSIONS: CVID is a heterogeneous group of immunologic disorders with unknown etiology. There are significant differences in the clinical presentation and prevalence of CVID-related complications among countries. Local guidelines for diagnosis and clinical follow-up are needed.

Diagnosis and management of cow's milk protein allergy in Turkey: Region-specific recommendations by an expert-panel

Cow's milk protein allergy (CMPA) is the most common type of food-allergy in younger children. Prognosis is usually good, with most children developing tolerance before school age. Children may present with a wide spectrum of symptoms that range from mild to severe; skin reactions such as angioedema and urticaria and gastrointestinal symptoms are the most common presentations of CMPA. Approximately one-third of CMPA patients suffer from multiple food-allergies; severe conditions such as anaphylactic shock (9%), eosinophilic esophagitis (4.7%), and food-protein induced enterocolitis (1%) may also develop in some children. Timely and accurate diagnosis and management is essential for proper growth and development of children with CMPA. In this expert consensus report, we aimed to adapt current understandings in the CMPA field to the specific conditions in Turkey and health system to help physicians with their day-to-day decision making

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The utility of TNF-alfa, IL-6 and IL-10 in the diagnosis and/or follow-up food allergy

Background: Several pro-inflammatory and anti-inflammatory mediators play a role in the immunopathogenesis of food allergy (FA). The aim of this study was to investigate the utility of serum biomarkers like interleukin (IL)-10, TNF-alfa, and IL-6 in the diagnosis and/or follow-up of FA. Methods: Sixty (25 females, 41.6%) newly diagnosed FA patients [IgE mediated (group-1, n = 37), non-IgE (group-2, n = 23)] with a median age of nine (1-33) months were enrolled. Twenty-four healthy children with a median age of eight (1-36) months constituted the control group (CG). In all the subjects, serum TNF-alfa, IL-6 and IL-10 levels were evaluated at the time of diagnosis and reassessed four weeks after therapeutic elimination diet (TED). Results: The mean white blood cell count and median absolute eosinophile count of the CG were significantly lower than group-1 (p values were 0.019 and 0.006, respectively). The mean absolute neutrophile count and the median IL-6 were significantly higher in group-1 when compared with group-2 (p values were 0.005 and 0.032, respectively. Median TNF-alfa and IL-6 levels were significantly higher in the pre-TED among all patients (p values were 0.005 and 0.018, respectively). In group-1, median TNF-α and IL-6 levels decreased significantly after TED (p values were 0.01 and 0.029, respectively). Conclusions: Our findings support the role of inflammation in the pathogenesis of FA. Serum TNF-alfa and IL-6 levels may be useful markers for follow-up in FA, especially among IgE-mediated FA patients. Evaluation of IL-10 results was not sufficient for an interpretation of clinical tolerance

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Diagnosis and management of cow's milk protein allergy in Turkey: Region-specific recommendations by an expert-panel.

Cow's milk protein allergy (CMPA) is the most common type of food-allergy in younger children. Prognosis is usually good, with most children developing tolerance before school age. Children may present with a wide spectrum of symptoms that range from mild to severe; skin reactions such as angioedema and urticaria and gastrointestinal symptoms are the most common presentations of CMPA. Approximately one-third of CMPA patients suffer from multiple food-allergies; severe conditions such as anaphylactic shock (9%), eosinophilic esophagitis (4.7%), and food-protein induced enterocolitis (1%) may also develop in some children. Timely and accurate diagnosis and management is essential for proper growth and development of children with CMPA. In this expert consensus report, we aimed to adapt current understandings in the CMPA field to the specific conditions in Turkey and health system to help physicians with their day-to-day decision making.

The utility of TNF-α, IL-6 and IL-10 in the diagnosis and/or follow-up food allergy.

BACKGROUND: Several pro-inflammatory and anti-inflammatory mediators play a role in the immunopathogenesis of food allergy (FA). The aim of this study was to investigate the utility of serum biomarkers like interleukin (IL)-10, TNF-α, and IL-6 in the diagnosis and/or follow-up of FA. METHODS: Sixty (25 females, 41.6%) newly diagnosed FA patients [IgE mediated (group-1, n=37), non-IgE (group-2, n=23)] with a median age of nine (1-33) months were enrolled. Twenty-four healthy children with a median age of eight (1-36) months constituted the control group (CG). In all the subjects, serum TNF-α, IL-6 and IL-10 levels were evaluated at the time of diagnosis and reassessed four weeks after therapeutic elimination diet (TED). RESULTS: The mean white blood cell count and median absolute eosinophile count of the CG were significantly lower than group-1 (p values were 0.019 and 0.006, respectively). The mean absolute neutrophile count and the median IL-6 were significantly higher in group-1 when compared with group-2 (p values were 0.005 and 0.032, respectively. Median TNF-α and IL-6 levels were significantly higher in the pre-TED among all patients (p values were 0.005 and 0.018, respectively). In group-1, median TNF-α and IL-6 levels decreased significantly after TED (p values were 0.01 and 0.029, respectively). CONCLUSIONS: Our findings support the role of inflammation in the pathogenesis of FA. Serum TNF-α and IL-6 levels may be useful markers for follow-up in FA, especially among IgE-mediated FA patients. Evaluation of IL-10 results was not sufficient for an interpretation of clinical tolerance.

Reduced Akkermansia muciniphila and Faecalibacterium prausnitzii levels in the gut microbiota of children with allergic asthma

Introduction and objectives: The amounts of Akkermansia muciniphila and Faecalibacterium prausnitzii in gut microbiota are reduced in patients with allergic diseases compared to healthy controls. We aimed to quantify levels of A. muciniphila and F. prausnitzii amounts using real-time quantitative PCR (qPCR) in the gut microbiota of children with allergic asthma and in healthy controls. Materials and methods: In total, 92 children between the ages of three and eight who were diagnosed with asthma and 88 healthy children were included in the study and bacterial DNA was isolated from the stool samples using the stool DNA isolation Kit. qPCR assays were studied with the microbial DNA qPCR Kit for A. muciniphila and microbial DNA qPCR Kit for F. prausnitzii. Results: Both bacterial species showed a reduction in the patient group compared to healthy controls. A. muciniphila and F. prausnitzii were found to be 5.45 ± 0.004, 6.74 ± 0.01 and 5.71 ± 0.002, 7.28 ± 0.009 in the stool samples of the asthma and healthy control groups, respectively. Conclusions: F. prausnitzii and A. muciniphila may have induced anti-inflammatory cytokine IL-10 and prevented the secretion of pro-inflammatory cytokines like IL-12. These findings suggest that A. muciniphila and F. prausnitzii may suppress inflammation through its secreted metabolites

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Reduced Akkermansia muciniphila and Faecalibacterium prausnitzii levels in the gut microbiota of children with allergic asthma.

INTRODUCTION AND OBJECTIVES: The amounts of Akkermansia muciniphila and Faecalibacterium prausnitzii in gut microbiota are reduced in patients with allergic diseases compared to healthy controls. We aimed to quantify levels of A. muciniphila and F. prausnitzii amounts using real-time quantitative PCR (qPCR) in the gut microbiota of children with allergic asthma and in healthy controls. MATERIALS AND METHODS: In total, 92 children between the ages of three and eight who were diagnosed with asthma and 88 healthy children were included in the study and bacterial DNA was isolated from the stool samples using the stool DNA isolation Kit. qPCR assays were studied with the microbial DNA qPCR Kit for A. muciniphila and microbial DNA qPCR Kit for F. prausnitzii. RESULTS: Both bacterial species showed a reduction in the patient group compared to healthy controls. A. muciniphila and F. prausnitzii were found to be 5.45±0.004, 6.74±0.01 and 5.71±0.002, 7.28±0.009 in the stool samples of the asthma and healthy control groups, respectively. CONCLUSIONS: F. prausnitzii and A. muciniphila may have induced anti-inflammatory cytokine IL-10 and prevented the secretion of pro-inflammatory cytokines like IL-12. These findings suggest that A. muciniphila and F. prausnitzii may suppress inflammation through its secreted metabolites.

The protective role of Helicobacter pylori neutrophil-activating protein in childhood asthma

Background: Helicobacter pylori quantity and HP-NAP gene expression were evaluated in the faeces of healthy and asthmatic children. Methods: H. pylori DNAs and RNAs were isolated from the stool samples of 92 asthmatic children (AC; 3-8 years) and 88 healthy controls (HC). Quantitative PCR was used to determine the quantity of H. pylori and HP-NAP expression relative to the 16S rRNA (reference gene). Gene expression was analysed using the delta delta-Ct method. Results: H. pylori DNA was detected in the stool samples of 18 (20.4%) of the 88 HC (p < 0.0001, OR = 0.79) and none of AC. No meaningful statistical differences were found between individuals with positive and negative family histories for asthma in AC and HC (p > 0.05). H. pylori quantity was higher in seven of 18 H. pylori-positive samples, but HP-NAP expression levels were low in four of these seven samples. Based on a multivariate logistic regression analysis of these three variables together, only males displayed a significant difference based on gender differences (p < 0.02) and it was determined that, based on the OR value of 0.46 and the 95% CI range of 0.241-0.888, male gender was an independent protective factor in asthma. Conclusions: HP-NAP levels vary to the relative concentrations of bacteria in the stationary or late logarithmic phases. Different napA expression levels may be caused by different endogenous napA gene expression or different environmental conditions (AU)

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The protective role of Helicobacter pylori neutrophil-activating protein in childhood asthma.

BACKGROUND: Helicobacter pylori quantity and HP-NAP gene expression were evaluated in the faeces of healthy and asthmatic children. METHODS: H. pylori DNAs and RNAs were isolated from the stool samples of 92 asthmatic children (AC; 3-8 years) and 88 healthy controls (HC). Quantitative PCR was used to determine the quantity of H. pylori and HP-NAP expression relative to the 16S rRNA (reference gene). Gene expression was analysed using the delta delta-Ct method. RESULTS: H. pylori DNA was detected in the stool samples of 18 (20.4%) of the 88 HC (p<0.0001, OR=0.79) and none of AC. No meaningful statistical differences were found between individuals with positive and negative family histories for asthma in AC and HC (p>0.05). H. pylori quantity was higher in seven of 18 H. pylori-positive samples, but HP-NAP expression levels were low in four of these seven samples. Based on a multivariate logistic regression analysis of these three variables together, only males displayed a significant difference based on gender differences (p<0.02) and it was determined that, based on the OR value of 0.46 and the 95% CI range of 0.241-0.888, male gender was an independent protective factor in asthma. CONCLUSIONS: HP-NAP levels vary to the relative concentrations of bacteria in the stationary or late logarithmic phases. Different napA expression levels may be caused by different endogenous napA gene expression or different environmental conditions.

The reliability and validity of Turkish version of Childhood Asthma Control Test.

INTRODUCTION: The reliability and validity of Turkish version of Childhood Asthma Control Test (C-ACT). PURPOSE: The management of asthma is an important as well as difficult issue of physician's daily practice particularly in busy clinical settings. C-ACT was created to identify asthma control levels in children aged 4-11 years. Our aim was to evaluate the reliability, validity and responsiveness of C-ACT in a Turkish sample of children with asthma. METHOD: In this multicenter study, 368 children were enrolled. C-ACT was completed every month by parents and patients who were evaluated in 3 visits within 2 month intervals. At each visit, physicians interpret the control level and decided for the treatment step as established in GINA guidelines. RESULTS: The internal consistency reliability of the Turkish version of C-ACT (C-ACT1 to C-ACT5) was found to be 0.82, 0.83, 0.82, 0.82 and 0.80, respectively (reliability statistics, Cronbach's alpha). Test-retest reliability was 0.71. There was significant correlation between C-ACT and physician's assessment of asthma control at visit 1 (r = 0.65, P < 0.001). CONCLUSIONS: Turkish version of C-ACT is an accurate and reliable tool to evaluate asthma control in children aged 4-11 years. Its widespread use may facilitate appropriate assessment of asthma control and may lead to decrease the number of uncontrolled patients.

Anaphylaxis in Turkish children: a multi-centre, retrospective, case study.

BACKGROUND: Anaphylaxis is a serious and potentially lethal systemic reaction affecting more than one organ or system. OBJECTIVE: We aimed to describe the demographic characteristics, clinical features, causes, settings, and administered therapy in Turkish children. METHODS: This retrospective, case note study included all children referred to the outpatient clinics of the Pediatric Allergy Departments of the participating study centres from 1 July 1999 to 30 June 2009 for investigation of anaphylaxis or who were seen by us at the moment of the reaction during the same period and who met the clinical criteria of anaphylaxis. RESULTS: Two hundred and twenty-four cases of anaphylaxis were reported in 137 children (88 boys, P = 0.0001). The mean ± SD age at the referral was 7.7 ± 4.2 years (range: 4 months-17 years). Ninety-eight episodes (43.8%) occurred at home. The symptoms were cutaneous in 222 (99.1%) episodes, respiratory in 217 (96.9%), neuro-psychiatric in 118 (52.7%), cardiovascular in 92 (41.1%), and gastrointestinal in 88 (39.3%). Biphasic reaction was reported in seven episodes (3.1%, 95% CI: 1.5-6.3). Death occurred in one case (0.4%, 95% CI: 0.08-2.4). Treatment was available in 158 episodes (70.5%). Of them, 148 (93.7%) received antihistamines, 132 (83.5%) corticosteroids, 51 (32.3%) epinephrine, and 17 (10.8%) beta-2-mimetics. The causative agents were foods in 86 (38.4%) episodes, hymenoptera venom in 84 (37.5%), drugs and medications in 47 (21.0%), and latex in 5 (2.2%). In two episodes (0.9%), the causative agent was unidentified. Allergy to the trigger was known prior to anaphylaxis in 116 (51.8%) episodes. An epinephrine auto-injector had been prescribed for 70 children (51.1%). CONCLUSIONS AND CLINICAL RELEVANCE: Anaphylaxis was seen significantly more in boys. Most of the reactions occurred at home. Foods were the most frequent cause. Epinephrine, the first-line treatment of anaphylaxis, was administered in only a third of the children.

Paediatricians’ perspectives on the use of pneumococcal vaccine in healthy and asthmatic children

Background: Pneumococcal polysaccharide vaccines were developed in recent decades to reduce the burden of pneumococcal diseases. Little is known about paediatricians’ perspectives on the use of pneumococcal vaccine. Objective: We aimed to examine physicians’ self-reported beliefs and attitudes about the pneumococcal vaccine and their daily clinical practice concerning immunisation against pneumococci in healthy and asthmatic children before the introduction of a nationwide vaccination program. Methods: A questionnaire survey was applied to the paediatricians attending a national paediatrics congress in 2008. Results: Of the 265 paediatricians, 167 responded to the questionnaire. Most (74.5%) believed that antimicrobial resistance could be reduced with the use of the vaccine. 88.5% of the paediatricians declared the pneumococcal vaccine to be a safe vaccine and agreed that the polysaccharide conjugate vaccine-7 should be added to the national vaccination programme. Nearly half of the paediatricians believed that asthmatic children vaccinated with pneumococci had fewer and less severe asthma attacks. 40.0% of the responders stated that the pneumococcal vaccine should be reserved for severe asthmatic children. As the duration of experience increases, the number of patients evaluated per week decreases, and the physicians working in the outpatient clinics tend to vaccinate all children. Conclusion: Despite the paediatricians’ belief in the necessity and importance of the pneumococcal vaccine, none of the examined factors influenced their clinical practice. As the asthma guidelines become clearer regarding the effect of pneumococcal diseases in asthmatics, the perspective of paediatricians may evolve towards greater immunisation

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Paediatricians' perspectives on the use of pneumococcal vaccine in healthy and asthmatic children.

BACKGROUND: Pneumococcal polysaccharide vaccines were developed in recent decades to reduce the burden of pneumococcal diseases. Little is known about paediatricians' perspectives on the use of pneumococcal vaccine. OBJECTIVE: We aimed to examine physicians' self-reported beliefs and attitudes about the pneumococcal vaccine and their daily clinical practice concerning immunisation against pneumococci in healthy and asthmatic children before the introduction of a nationwide vaccination program. METHODS: A questionnaire survey was applied to the paediatricians attending a national paediatrics congress in 2008. RESULTS: Of the 265 paediatricians, 167 responded to the questionnaire. Most (74.5%) believed that antimicrobial resistance could be reduced with the use of the vaccine. 88.5% of the paediatricians declared the pneumococcal vaccine to be a safe vaccine and agreed that the polysaccharide conjugate vaccine-7 should be added to the national vaccination programme. Nearly half of the paediatricians believed that asthmatic children vaccinated with pneumococci had fewer and less severe asthma attacks. 40.0% of the responders stated that the pneumococcal vaccine should be reserved for severe asthmatic children. As the duration of experience increases, the number of patients evaluated per week decreases, and the physicians working in the outpatient clinics tend to vaccinate all children. CONCLUSION: Despite the paediatricians' belief in the necessity and importance of the pneumococcal vaccine, none of the examined factors influenced their clinical practice. As the asthma guidelines become clearer regarding the effect of pneumococcal diseases in asthmatics, the perspective of paediatricians may evolve towards greater immunisation.

Skin test hypersensitivity for childhood asthma in Istanbul during a period of 16 years.

BACKGROUND: For diagnosis of allergic disorders, besides history and physical examination, many in vivo and in vitro laboratory tests are used. Skin prick test (SPT) is an easily performed and valuable test in children. Our aim was to evaluate the SPT results of asthmatic children according to age and gender, in Istanbul and its neighborhood, followed for a period of 16 years. MATERIAL AND METHODS: Consecutive 5080 asthmatic children, aged 1 to 18 years, admitted to Pediatric Allergy Policlinics of Istanbul University Cerrahpasa Medicine Faculty from 1987 to 2003, were screened retrospectively for 10 frequently exposed allergens. RESULTS: 3086 cases (61 %) had SPT reactivity for one and/or for multiple allergens; the SPT reactivity percentages of the exposed allergens was 50 % (2554 cases) for house dust mites DP, 49 % (2462 cases) for house dust mites DF, 15 % (784 cases) for cat dander, 10 % (525 cases) for dog dander, 4 % (228 cases) for lamb wool, 10 % (504 cases) for wheat, 3 % (162 cases) for egg white, 6 % (345 cases) for hazelnut pollen, 6 % (318 cases) for Candida Albicans, 6 % (326 cases) for Aspergillus Fumigatus. CONCLUSION: While house dust mites were determined as the predominant allergen for each age groups in this study, allergy against cat dander was the third important allergen in sequence, as cat is a domestic pet which is frequently kept at home in Turkey.

Skin test hypersensitivity for childhood asthma in Istanbul during a period of 16 years

Background: For diagnosis of allergic disorders, besides history and physical examination, many in vivo and in vitro laboratory tests are used. Skin prick test (SPT) is an easily performed and valuable test in children. Our aim was to evaluate the SPT results of asthmatic children according to age and gender, in Istanbul and its neighborhood, followed for a period of 16 years. Material and methods: Consecutive 5080 asthmatic children, aged 1 to 18 years, admitted to Pediatric Allergy Policlinics of Istanbul University Cerrahpasa Medicine Faculty from 1987 to 2003, were screened retrospectively for 10 frequently exposed allergens. Results: 3086 cases (61 %) had SPT reactivity for one and/or for multiple allergens; the SPT reactivity percentages of the exposed allergens was 50% (2554 cases) for house dust mites DP, 49% (2462 cases) for house dust mites DF, 15% (784 cases) for cat dander, 10 % (525 cases) for dog dander, 4% (228 cases) for lamb wool, 10% (504 cases) for wheat, 3% (162 cases) for egg white, 6% (345 cases) for hazelnut pollen, 6% (318 cases) for Candida Albicans, 6% (326 cases) for Aspergillus Fumigatus. Conclusion: While house dust mites were determined as the predominant allergen for each age groups in this study, allergy against cat dander was the third important allergen in sequence, as cat is a domestic pet which is frequently kept at home in Turkey

Antecedentes: Para el diagnóstico de los trastornos alérgicos, además de la exploración física y de la historia clínica se emplean muchas pruebas de laboratorio in vivo e in vitro. La prueba por punción cutánea (prick test) (PC) es una prueba fácil de realizar y valiosa en niños. Nuestro objetivo era evaluar los resultados de las PC en niños asmáticos de Estambul y su periferia según su edad y sexo, con un seguimiento de 16 años. Material y métodos: Se efectuó un estudio retrospectivo mediante PC con 10 alergenos de exposición frecuente a 5.080 niños asmáticos, de 1 a 18 años de edad, consecutivamente tratados en la Policlínica de Alergología Pediátrica de la Facultad de Medicina Cerrahpasa de la Universidad de Estambul entre 1987 y 2003. Resultados: 3.086 casos (el 61%) mostraron reactividad a la PC con uno o más alergenos; los porcentajes de reactividad a la PC con los alergenos frecuentes fueron: el 50% (2.554 casos) para los ácaros del polvo doméstico de la especie D.p., el 49% (2.462 casos) para los ácaros del polvo doméstico de la especie D.f., el 15% (784 casos) para epitelio de gato, el 10% (525 casos) para epitelio de perro, el 4% (228 casos) para la lana de cordero, el 10% (504 casos) para el trigo, el 3% (162 casos) para la clara de huevo, el 6% (345 casos) para el polen de avellano, el 6% (318 casos) para la Candida albicans, y el 6% (326 casos) para el Aspergillus fumigatus. Conclusión: Aunque los ácaros del polvo domésticos se establecieron como el alergeno predominante en todos los grupos de edad del estudio, la alergia a epitelio de gato fue el tercer alergeno en importancia, ya que el gato es un animal doméstico presente en muchos hogares turcos

Psychological problems in Turkish asthmatic children and their families.

BACKGROUND: Asthma is a chronic respiratory disorder characterized by recurrent episodes of impaired breathing. The disease causes psychological problems due to hospitalization, long-term medication use, and restricted social life. OBJECTIVE: The aim of this study was to investigate the relationship between the severity and duration of asthma and psychological problems in asthmatic children, as well as the probability of maternal anxiety. METHODS: Thirty-seven children with mild asthma, 55 with moderate asthma and eight with severe asthma were compared with 50 healthy children. The severity of asthma was evaluated using the Pearlman-Bierman classification. Psychological adjustment was measured using the Achenback child Behavior checklist and Spielberger's scale. RESULTS: Emotional factors and family dynamics were found to be triggering factors for disease attacks in 16% of children with mild asthma, 38% of those with moderate asthma and 63% of those with severe asthma (p < 0.05). There was no significant difference in the mean maternal anxiety score between the disease severity groups (p > 0.05). The mean depression score was significantly higher in children with moderate and severe asthma than in those with mild asthma (p < 0.05). Disease duration showed no effect on depression and anxiety. CONCLUSION: Both asthmatic children and their mothers are negatively affected by the disease.

Psychological problems in turkish asthmatic children and their families

Background: Asthma is a chronic respiratory disorder characterized by recurrent episodes of impaired breathing. The disease causes psychological problems due to hospitalization, long-term medication use, and restricted social life. Objective: The aim of this study was to investigate the relationship between the severity and duration of asthma and psychological problems in asthmatic children, as well as the probability of maternal anxiety. Methods: Thirty-seven children with mild asthma, 55 with moderate asthma and eight with severe asthma were compered with 50 healthy children. The severity of asthma was evaluated using the Pearlman-Bierman classification. Psychological adjustment was measured using the Achenback child Behavior checklist and Spielberger's scale. Results: Emotional factors and family dynamics were found to be triggering factors for disease attacks in 16 % of children with mild asthma, 38 % of those with moderate asthma and 63 % of those with severe asthma (p < 0.05). There was no significant difference in the mean maternal anxiety score between the disease severity groups (p > 0.05). The mean depression score was significantly higher in children with moderate and severe asthma than in those with mild asthma (p < 0.05). Disease duration showed no effect on depression and anxiety. Conclusion: Both asthmatic children and their mothers are negatively affected by the disease (AU)

Antecedentes: El asma es un trastorno respiratorio crónico caracterizado por episodios recurrentes de dificultad para respirar. La enfermedad causa algunos problemas psicológicos por la necesidad de hospitalización, el uso de medicación a largo plazo y la limitación de la vida social. Objetivo: El objetivo de este estudio era investigar la relación entre la gravedad y la duración del asma y los problemas psicológicos en niños asmáticos y la probabilidad de ansiedad de las madres. Métodos: Se comparó a 37 niños con asma leve, 55 con asma moderada y 8 con asma grave con 50 niños sanos. La gravedad del asma se evaluó utilizando la clasificación de Pearlman-Bierman. La adaptación psicológica se midió empleando la lista de comprobación de comportamiento infantil de Achenback y la escala de Spielberger. Resultados: Se comprobó que los factores emocionales y la dinámica familiar eran factores desencadenantes de las crisis de asma en el 16 por ciento de los pacientes con asma leve, el 38 por ciento de los enfermos con asma moderada y el 63 por ciento de los pacientes con asma grave (p 0,05).En los grupos con asma moderada y grave se observó que la puntuación media de depresión era significativamente mayor que en el grupo con asma leve (p < 0,05). Se apreció que la duración de la enfermedad no influía en la depresión y la ansiedad. Conclusión: La enfermedad afecta negativamente a los niños asmáticos y a las madres (AU)