High fetal bisphenol A exposure enhances IL22 secretion: A proinflammatory cytokine.

BACKGROUND: Bisphenol A (BPA) is an industrial product, widely used in human consumed types of equipment that can be transmitted orally, by inhalation or through dermal absorption and is detectable in many body fluids including cord blood. A correlation between BPA concentration in maternal serum and cord blood has been demonstrated previously, suggesting a possible transfer of BPA via the transplacental path. OBJECTIVE: Our objective is to determine the impact of cord blood BPA level on cytokine responses. METHODS: In this cross-sectional study, healthy pregnant women who delivered healthy newborns followed by the Obstetrics and Gynecology Department between September 2016 to June 2017 were enrolled. Cord blood samples were obtained and BPA and IL4, IL5, IL10, IL17, IL22, IFN gama and TGF beta levels were studied by ELISA. RESULTS: Among 197 deliveries, 176 of them were included in the study. Due to lack of cut-off value, BPA levels were stratified as percentiles. No statistically significant difference was detected in comparison of cytokine levels based on BPA concentrations below and above the 25th and 50th percentiles. Significantly higher IL22 levels (p = 0.007) and increased ratio of IL22/TGFß (p = 0.04) were detected in those with BPA level above 75th percentile (>19.16 ng/ml) compared to the below group. CONCLUSIONS: This in vivo real-life study demonstrated that very high BPA levels in cord blood of expectant mothers enhances IL22 secretion in cord blood which is a proinflammatory cytokine. Studies evaluating long term immunological effects on those highly exposed newborns are necessitated.

Maintained disease control and steroid-sparing effect of subcutaneous immunotherapy in allergic rhinitis and asthma.

BACKGROUND: Allergen immunotherapy is the only currently available treatment strategy that modifies the immune response to the causative allergen and induces clinical improvement and a steroid-sparing effect. OBJECTIVE: In this real-life study, we aimed to evaluate and compare the efficacy of subcutaneous immunotherapy (SCIT) with one allergen or multiple allergens in children and adults with asthma and/or allergic rhinitis in terms of disease control and a steroid-sparing effect. METHODS: Demographics, the initial inhaled corticosteroid (ICS) and/or intranasal corticosteroid (INS) dose, and other drugs of patients receiving SCIT for at least 12 months were recorded. Data on the final dose/use of ICS/INS and asthma and/or allergic rhinitis control were gathered. RESULTS: Of 104 patients included, 57.1% and 64.5% of patients with asthma and allergic rhinitis, respectively, were able to discontinue ICS and INS after SCIT. The median time to INS and ICS dose reduction was 6 months. SCIT with one allergen or multiple allergens effectively reduced the ICS and INS dose and led to control of asthma and allergic rhinitis, with no significant difference between the groups. When the efficacy of SCIT was compared in children and adults, there was no significant difference in terms of a steroid-sparing effect or the control of asthma and allergic rhinitis. SCIT was effective in both children and adult patients. CONCLUSIONS: In this real-life observational study, we have demonstrated a marked steroid-sparing effect while maintaining control of asthma and allergic rhinitis in children and adults treated with one allergen or multiple allergens.

Characteristics of allergic proctocolitis in early infancy; accuracy of diagnostic tools and factors related to tolerance development.

OBJECTIVE: We aimed to overview clinical characteristics of FPIAP with the results of diagnostic tools like APT, SPT and fecal calprotectin levels and the factors associated with tolerance development. METHODS: All patients diagnosed FPIAP at the outpatient clinic between January 2015 and January 2019 were enrolled retrospectively. Data about clinical characteristics, APT or SPT results, fecal calprotectin levels, suspected triggering foods, diet and tolerance status were obtained from the hospital database program and analyzed. RESULTS: 169 infants with F/M ratio 78/91 were enrolled. The mean age of the study population was 3.68 months (1-35 months, mean age 3.68 ± 4.33). APT was performed 137 of the participants and 126 (92%) of them were positive to at least one food allergens, 14 (48.2%) patients had positivity to at least one of the food allergens on SPT. Specific IgE were done in 90 patients and 12 (13.3%) revealed positive results. Two groups of patients developing tolerance before and after 18 months of age were evaluated; mucoid diarrhea, family history allergic diseases, cow's milk sensitivity and multiple allergen triggers were statistically significant risk factors for delayed tolerance according to univariate logistic analysis. However, none of these factors were revealed statistical significance in multivariate logistic analysis. CONCLUSIONS: Our study revealed that APT may be a useful tool for programming the elimination diet in breastfeeding mothers. SPT, specific IgE and fecal calprotectin are not necessary for FPIAP management. Multivariate regression analysis showed that none of the evaluated parameters had statistically significant relationship with the tolerance development.

Cutaneous Allergic reactions to pine processionary caterpillar (Thaumetopoea Pityocampa): a complicated cutaneous reaction in an infant and review of the literature.

BACKGROUND: Thaumetopoea Pityocampa (TP) are frequent in the Mediterranean region especially affecting forest workers in pinewood areas. The common symptoms include swelling, rash or burns like any form of dermatitis. The reactions can be triggered by mechanical, chemical or allergic factors and the `allergic` reaction is caused by sensitization to a hair protein named `thaumetopoein`. This protein triggers the IgE mediated reaction resulting in the mast cell degranulation causing urticaria. Different kinds of allergic reactions like urticaria or anaphylaxis have been reported previously commonly in adults, especially in forest workers while severe reactions without direct contact are rare in pediatric population. CASE: A 28 month old healthy boy was admitted to Near East University Pediatric Allergy and Immunology Outpatient Clinic in March with complaints of pain, hyperemia and swelling on the left hand. His complaints had started the day before his admission just after walking around in their garden which is surrounded by pine trees. On admission, his physical examination revealed serious edema and hyperemia on his left hand limiting his finger movements with a few bullae on the skin. His temperature was 38 C and the other vital parameters were normal. Based on hyperemia, swelling and high acute phase reactants he was hospitalized with the differential diagnosis of soft tissue inflammation and cellulitis. The case was treated with iv antihistamines, systemic steroids and antibiotics. CONCLUSIONS: Pine processionary (PP) is an important irritant and allergen especially in endemic areas like Cyprus which is a Mediterranean Country. It must be kept in mind in case of local or generalized urticaria, dermatitis, bullae and other allergic reactions even if there had been no direct contact with PP. Systemic involvement with fever and elevated acute phase reactants in infancy may necessitate hospitalization and intravenous treatment. Hereby, we reported an infant who presented with fever in addition to severe cutaneous lesions following the exposure to TP without direct contact. This is the first case reported from North Cyprus.

Infection caused by Nocardia farcinica mimicking pulmonary metastasis in an adolescent girl.

Nocardia farcinica infections are rare and potentially life threatening. Herein, we describe a case of pulmonary nocardiosis caused by N. farcinica. This 13-year-old girl admitted with 1-year history of cough, intermittent fever, and recurrent hemoptysis. She was examined for multiple pulmonary nodules mimicking pulmonary metastasis that were detected with chest radiography and computed tomography of the thorax. Eventually, N. farcinica was yielded in culture of sputum and aspiration material of pulmonary nodules. No predisposing factor could be shown for Nocardia infection. Although infections caused by N. farcinica have tendency to disseminate, and are mostly resistant to antibiotics, the patient was successfully treated with prolonged intravenous antibiotic therapy followed with oral amoxicillin-clavulanate.

Subscapular abscess after blunt trauma.

Infection around the shoulder girdle is an infrequent and difficult diagnosis requiring a high index of suspicion and early evaluation by the physician. An infection within the area of the subscapularis muscle and the chest wall is extremely rare. To the best of our knowledge, only 4 cases of subscapular abscess have been reported. In this article, we present a 7-year-old boy with a subscapular abscess after blunt trauma.

Chlamydia pneumonia mimicking miliary tuberculosis.

Chlamydia trachomatis is a common cause of subacute, afebrile pneumonia with onset from 1 to 3 months of age. On physical examination, crepitant inspiratory rales are commonly heard. Infiltration is usually bilateral and interstitial; reticulonodular pattern and atelectasis have also been described, which distinct the disease from miliary tuberculosis. We report an infant who had a disseminated miliary pattern in the chest radiograph and computed tomographic scan of the thorax that was diagnosed as Chlamydia pneumonia with serologic investigations. We emphasized that Chlamydia trachomatis can cause a miliary reticulonodular pattern in radiological examinations of infants who were admitted with respiratory symptoms. We suggest that pneumonia due to C. trachomatis should be kept in mind in the differential diagnosis of infants examined because of a diffuse miliary pattern.

Contact dermatitis with henna tattoo.

Allergic and irritant reactions to henna are rare. Para-phenylenediamine, which is sometimes added to obtain a dark, blackish henna, causes the majority of contact dermatitis reported related with tattoos. Allergic contact dermatitis due to temporary paint-on tattoo with black henna is described in two adolescents.

Retrospective evaluation of 113 children with scoliosis.

To evaluate demographic features, preoperative pulmonary function tests and echocardiographic examinations of 113 children with scoliosis and to determine the associations between preoperative investigations and postoperative complications. Medical records, preoperative pulmonary function tests and echocardiographic examinations of 113 children with scoliosis who were operated between January 2004 and 2006 were evaluated retrospectively. Associations between preoperative pulmonary function tests, preoperative pulmonary symptoms and postoperative pulmonary complications were investigated. There were 37 male and 76 female patients. The mean ages of the patients at the time of the first and last surgery were 11.2 +/- 3.8 and 11.7 +/- 3.6 years respectively. The mean number of surgery performed for scoliosis was 1.5 +/- 1.4. Idiopathic scoliosis was the most common form constituting 42.5% of the patients. 68.1% of the patients had no preoperative pulmonary symptoms. Normal preoperative FVC, FEV(1), PEF and MEF(25-75) values were detected in 43.4%, 58.4%, 53.1% and 65.5% of the patients respectively. Echocardiograms were found normal in 34.5% of them. The most common cardiac valve anomaly was mitral valve prolapse which was detected in 25.7% of the patients. No significant associations were found between preoperative pulmonary function tests, preoperative pulmonary symptoms and postoperative pulmonary complications of children with scoliosis in our study.

Relation between serum IL-4, IL-13 and IFN-gamma levels and recurrence of wheezing episodes in infants with acute bronchiolitis.

Lower respiratory tract infections are the most important factors among various causes which trigger wheezing in the first year of life. The factors associated with episodic wheezing in children with acute bronchiolitis are still subjects of research. Infections, environmental factors, immunologic mechanisms are sorted as etiologic risk factors of episodic wheezing. We aimed to investigate the relationship between serum interleukin (IL)-4, IL-13 and gamma-interferon (IFN-gamma) levels and recurrence of wheezing episodes in infants with acute bronchiolitis. One hundred twenty infants between 3 and 36 months with acute bronchiolitis enrolled in the study. Personal histories, clinical and laboratory data of infants were recorded. The patients were followed for a year. Venous blood samples were obtained to determine serum IL-4, IL-13, and IFN-gamma levels during acute bronchiolitis episode. The number of wheezing episodes was significantly higher in infants with a positive family history of allergy. A statistically significant correlation was determined between serum IL-13 levels of infants and number of wheezing episodes. High serum IL-13 levels and a positive history of allergy may have important roles in the recurrence of acute bronchiolitis.

Efficacy of sulphasalazine on lung histopathology in a murine model of chronic asthma.

Sulphasalazine is a specific inhibitor of nuclear factor kappa B (NF-kappa B) which plays a key role in asthma. To determine the impact of sulphasalazine in the treatment of chronic asthma, BALB/c mice were sensitized and challenged with ovalbumin. Mice with experimentally induced asthma in group I received saline, group II sulphasalazine 200 mg/kg, group III sulphasalazine 300 mg/kg, and group IV dexamethasone 1 mg/kg intraperitoneally once a day in the last 7 days of the challenge period. Histological findings of the airways were evaluated by light and electron microscopies. Dexamethasone and sulphasalazine in both doses significantly improved all airway histopathologic parameters of asthma except numbers of goblet cells. Both doses of sulphasalazine improved thicknesses of basement membrane better than dexamethasone. Dexamethasone reduced the number of mast cells better than sulphasalazine (200 mg/kg). Further studies are needed to evaluate the efficacy of sulphasalazine in the treatment of asthma.

Helicobacter pylori infection and gastroesophageal reflux in asthmatic children.

The aim of this article is to investigate the prevalence of Helicobacter pylori (HP) infection, frequency of gastroesophageal reflux (GER), existence of atopy and levels of serum immunoglobulin E (IgE) in children with bronchial asthma. One hundred and thirty seven children who were diagnosed as bronchial asthma and/or wheezy child aged between 1 and 17 years were enrolled into the study. Peripheral venous blood samples were obtained to determine the total IgE and HP IgG antibody levels. GER was evaluated by the scintigraphic method and the presence of atopy was investigated by skin prick test. The study was conducted in 86 (62.8%) boys and 51 (37.2%) girls. HP IgG antibody levels were found negative in 125 (91.2%) and positive in 12 (8.8%) cases. GER was detected in 73 (53.7%) of the children. Forty-one (37.3%) children were accepted as atopic according to skin prick test results. The average total IgE levels of the participants was 168.89 +/- 270.76 IU/ml. A significant difference could not be determined related to GER, atopy frequency and serum IgE levels between the cases who had HP antibody positivity or not. The present findings suggest that the rate of HP antibody positivity is low in patients with bronchial asthma and a significant difference could not be determined in GER, and atopy between patients with positive and negative HP antibodies. High atopy frequency found in our patient group raises the question of whether allergic diseases can be protective against fecal-oral infectious diseases.

Late presentation of cystic adenomatoid malformation type 4 of lung in an asymptomatic child.

Congenital cystic adenomatoid malformation of lung is an uncommon embryonic developmental anomaly usually diagnosed perinatally. Rarely the presentation is delayed until childhood and adulthood. Herein we present a 10-years-old girl with a late presentation of congenital cystic adenomatoid malformation type 4 of lung who was diagnosed coincidentally.

Stevens-Johnson syndrome associated with brucella infection.

Stevens-Johnson syndrome is a potentially fatal condition that manifests mainly on the skin and mucosal surfaces but also affects other vital organs. There are no report of Stevens-Johnson syndrome caused by brucella infection in the literature. In this article, a previously healthy boy, diagnosed as Stevens-Johnson syndrome associated with brucella infection, is reported.

Follicular bronchiolitis associated with lung abscess in an eight-year-old girl.

Hemoptysis as a result of pulmonary or bronchial pathologies is a rare but potentially serious problem in childhood. The presented case is an eight-year-old previously healthy girl who was admitted to the emergency department because of recurrent hemoptysis. Because high resolution computerized tomography (HRCT) showed an abscess cavity, antibiotic therapy was continued about six weeks. Lobectomy was done when massive hemoptysis recurred. Histopathological examination revealed follicular bronchiolitis, which is a very rare entity, particularly in childhood. Although HRCT imaging is of great value in the diagnosis of this disease, in our case it failed to show any evidence of follicular bronchiolitis. In conclusion, the definitive diagnosis of follicular bronchiolitis always requires histopathologic examination of open lung biopsy.

A rare presentation of hydatid cyst in a child.

Cyst hydatid is the most widespread, serious cestode infection in the world. The most common organ affected by hydatid disease is the liver followed by the lungs and the two organs are affected simultaneously in about 5-13% of cases. The involvement of kidneys are rarely reported. Here we reported a patient with hydatid cysts in lung and kidney which the surgery was effective for both organs. The rarity of this case is the unusual combination of the cyst development in these organs without the involvement of liver.

Steroid sparing effect of sublingual immunotherapy: real life study in mono/polisensitized children with asthma.

AIM: Steroid-sparing effect of sublingual immunotherapy (SLIT) in mono/polisensitized asthmatic children were evaluated. MATERIALS AND METHODS: Children undergoing allergen-specific SLIT between 2010 and 2014 were included. Asthma control and usage/dose of inhaled corticosteroid (ICS) in the previous year was determined. Asthma control without ICS need ≥6 months was defined as 'ICS avoidance'. RESULTS: 90 children (mean ± SD age 8.92 ± 4.17 years) were enrolled, 56.7% (n = 60) being polysensitized. Mono, 2-simultaneous and multiple-pollen-mix allergen SLIT were prescribed in 84.4, 17.8 and 7.8%, respectively. ICS was avoided in 70%, with no significant difference in mono- versus poly-sensitized patients. ICS-avoidance rates in mono-allergen, pollen-mixture and 2-simultaneous-allergen SLIT were 93.6, 83.3 and 73.7%, respectively. Longer-duration SLIT resulted in significantly more ICS-avoidance (p:0.0001). CONCLUSION: SLIT with mono/multiple-mixed/simultaneous allergens in childhood asthma resulted in retained-avoidance of ICS. Steroid-sparing effect of SLIT in polysensitized children warrants further investigation.

Adverse effects of antiepileptic drugs on bone mineral density.

The aim of this study is to determine the frequency of changes in biochemical markers of bone metabolism in children who are receiving valproic acid, carbamazepine, and oxcarbazepine. Thirty healthy children and 68 children with idiopathic epilepsy treated with either carbamazepine (n = 23), valproic acid (n = 31), or oxcarbazepine (n = 14) for more than 1 year were enrolled into the study. Blood samples were obtained in order to determine biochemical parameters (calcium, phosphorus, alkaline phosphates, parathormone, and 25-hydroxyvitamin D). Bone mineral density was measured with the dual-energy x-ray absorptiometry method. There were no significant differences in the serum concentrations of calcium, phosphorus, aspartate aminotransferase, alanine aminotransferase, and albumin levels between the four groups. However, serum alkaline phosphatase concentrations were higher in the patient group as compared with the control subjects. In patients receiving antiepileptic drugs, bone mineral density values were significantly lower than the healthy control group. In conclusion, long-term antiepileptic drug treatment either with valproic acid, carbamazepine, or with oxcarbazepine which has unknown effects on skeletal mineralization, induces a state of decreased bone mineral density.

Chlamydia and Mycoplasma serology in respiratory tract infections of children.

One of the challenges in planning the treatment of respiratory tract infection in children is identifying the causative agent. The objective of the present study was to investigate the incidence of Mycoplasma and Chlamydia in the etiology of respiratory tract infections of children. The present study included 100 children, three months to 12 years of age, admitted to the outpatient department of pediatrics with such respiratory symptoms as fever, cough and respiratory distress. Following a detailed clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, peripheral blood smear and chest X-ray were obtained from each patient. At admission, IgG and IgM for Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis and Chlamydia psittaci were determined serologically. Positive antibody titer was found for Chlamydia and Mycoplasma in 18 (18%) of the patients. It was found that 2% of the patients had acute C. pneumoniae infection. When the subjects who had infections in the past or had re-infection were also considered; 6% were infected with C. pneumoniae, 3% with C. trachomatis, 1% with C. psittaci and 8% with M. pneumoniae. The presence of eosinophilia (> or = 4%) or the presence of siblings in the house were considered as factors favoring Chlamydial infections. High antibody titers for M. pneumoniae and C. pneumoniae were found more frequently after the age of two. Patients older than two years should be evaluated carefully for antibiotic treatments against atypical agents in pediatric lower respiratory tract infections.

High Usage of Complementary and Alternative Medicine among Turkish Asthmatic Children.

An increasing number of asthmatic patients are attracted by complementary and and alternative medicine (CAM). The aim of this study was to estimate the prevalence and describe the characteristics of CAM use by children with asthma in a paediatric allergy clinic in Istanbul, Turkey. The parents of asthmatic children were invited to participate in a cross-sectional survey study. Current asthma treatment, severity of asthma, emergency admittances and hospitalisations, education of parents, settlements, income of the family and parental use of CAM were investigated as predictors of CAM usage. Out of the 500 patients, 330 (66%) had used CAM therapy; most popular modalities were herbal medicine (45%), honey (41.6%), grape syrup (37.2%) and quail eggs (36.2%). The most common used herbal medicine in the study group were linden (21.6%) and ginger (21.2%). There was no significant difference in regard to the use of regular asthma treatment, the severity of asthma, the frequency of emergency admittance, hospitalisations due to asthma, education of parents and settlements between CAM users and non-CAM group. A significant inverse association was found in terms of family income and CAM usage. Parents' own use of CAM was also associated with significant increase in the use of CAM. In conclusion; the prevalance of reported CAM use among Turkish asthmatic children was found to be high (66%), with herbal medicine being the most popular modality. The results of this study shows that CAM use becomes more prevelant among asthmatic children from families with low income. It will be increasingly important for physicians who care for allergic children to be aware of high CAM usage.