Omalizumab treatment in adolescents with chronic spontaneous urticaria: Efficacy and safety

BACKGROUND: Omalizumab is useful as an add-on treatment in patients unresponsive to high doses of second-generation antihistamines. This study aimed to evaluate the efficacy and safety of omalizumab treatment in adolescents with refractory chronic spontaneous urticaria (CSU). METHODS: CSU patients aged 12-18 years old with the diagnosis of symptomatic CSU and unresponsive to classical treatment were included in the study. All patients had an urticaria-activity-score (UAS7) of ≥ 16 or and were treated with 300 mg omalizumab every four weeks. The degree of response was classified into complete, partial and non-responders due to UAS7. RESULTS: A total of 29 patients were evaluated. The median age and symptom onset age of the patients was 15.2 (IQR, 12.8-16.5) years and 14.0 (IQR, 11.8-15.9) years, respectively. The median duration of urticaria was eight (IQR, 4-24) months at admission. Eleven (37.9%) patients had angioedema and ten (34.5%) patients had concomitant allergic diseases. The median age at the beginning of treatment with omalizumab was 15.4 (IQR, 12.9-16.9) years. The median symptom duration was 12 (IQR, 6.5-27.5) months before the omalizumab treatment. Twenty-eight (96.5%) of the patients (89.6% complete, 6.9% partial) achieved response; however, one patient was a non-responder (3.5%). The adverse effect was observed in one (3.4%) patient as angioedema after the third dose. Twenty-three patients were followed up for a median of 18 (IQR, 13-27) months. Relapse was observed in three (13%) patients. CONCLUSIONS: Omalizumab is considered as an effective and safe treatment for CSU in adolescents. Relapses mostly occur within the first year after the cessation of treatment

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Physicians prescribe adrenaline autoinjectors, do parents use them when needed?

Background: Anaphylaxis is a sudden, severe, and potentially life-threatening allergic reaction, affecting a portion of allergic patients. Adrenaline is the first-line medication for anaphylaxis and available in many parts of the world as adrenaline autoinjectors (AAIs). Objective: Aim of this study was to determine attitudes and knowledge levels of patients/parents regarding the use of AAIs, frequency, and rate of appropriate AAI use and to give a standardized and better education by improving on mistakes during administration. Method: 190 patients aged 1-18 years who were prescribed AAIs for any reason between 2012 and 2017 in Hacettepe University Pediatric Allergy Unit. Demographic data were collected during face-to-face interview or by telephone. Parents completed a mini-survey regarding use, carriage, and storage of AAI. Results: Some 190 patients (64.7% male) aged 7.83 (4.99-12.08) years, median (inter-quartile), were included in the study. The indications for AAI prescription were food allergy (78.9%); venom allergy (14.2%); idiopathic anaphylaxis (3.7%); mastocytosis (2.1%); and drug allergy (1.0%). One-fourth of AAI-prescribed patients experienced anaphylaxis requiring the use of AAI within the past five years. However, only 30% of the patients dared to use AAI; only three-quarters of whom had managed to use it correctly. Conclusion: After prescription of AAI and initial training, patients and parents' concerns and fears should be taken into consideration and necessary support should be provided. At every opportunity and each clinical visit, not only should training sessions be repeated but also the patients and parents should be psychologically supported

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Actual drug allergy during childhood: Five years’ experience at a tertiary referral centre

BACKGROUND: Drug hypersensitivity reactions (DHR) are common in the paediatric population, representing a public health problem. Recent studies have confirmed that the frequency of drug allergy is overestimated by both parents and physicians. The aim of this study is to determine the prevalence and risk factors of actual drug allergies in children admitted to a tertiary referral allergy centre. METHODS: Medical records covering the period of 2005-2010 of children with a history of DHR were reviewed. Demographic features of the patients and results of skin and drug provocation tests were noted. The European Network for Drug Allergy (ENDA) questionnaire was filled by using medical records and making phone calls with parents. RESULTS: Ninety-six patients with 140 DHRs were evaluated. Seventeen children had confirmed drug allergy by positive skin tests (n = 11) and drug provocation tests (n = 5). One patient underwent severe anaphylaxis and subsequent cardiac arrest during infusion of the drug, and therefore diagnostic tests were not performed. Actual drug allergy was more frequent in children with chronic diseases (58.8% vs. 26.5%,p = 0.018) and histories of anaphylaxis during DHR (58.8% vs. 24%, p = 0.001). The patients' history of anaphylaxis [OR: 5.789, 95%CI: 1.880-17.554, p = 0.002], sweating [OR: 7.8, 95%CI: 1.041-58.443,p = 0.046] and dyspnoea [OR: 5.230, 95%CI: 1.836-14.894, p = 0.002] during suspicious DHRs increased the risk for actual drug allergy. CONCLUSION: Actual drug allergy was determined in 17.7% of the patients with a suspicious DHR. Having a history of anaphylaxis during suspected drug reactions as well as symptoms of sweating and dyspnoea increased the risk for actual drug allergy

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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

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