The relationship between childhood leukaemia and childhood asthma: A pharmacoepidemiological study from the Netherlands.

BACKGROUND: It has been suggested that childhood asthma lowers the risk of childhood leukaemia. Studies have found an inverse association between these conditions. However, most studies on this relationship are based on questionnaires and telephone interviews, introducing recall bias. Therefore, we conducted a matched case-control study based on drug prescription data to assess the relationship between both conditions. METHODS: In a large database, covering more than one million individuals, we identified cases of children who had been prescribed 6-mercaptopurine (6-MP). This drug is used in the outpatient maintenance therapy of childhood leukaemia. We matched every child with leukaemia on sex and age (±6 months) to children without leukaemia (controls). The variable of having had asthma was defined as receiving at least two prescriptions for an inhaled corticosteroid within 12 months. RESULTS: We identified 59 children aged 2-18 who had been prescribed 6-MP (cases), and they were matched to 21,918 controls. Of the children with childhood leukaemia, three (5%) had childhood asthma, whereas in the control group 4889 (22%) had childhood asthma (odds ratio [OR] 0.19; 95% confidence interval 0.06-0.60). CONCLUSION: In this study on the relationship between childhood asthma and childhood leukaemia, we found a strong inverse association.

Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis.

This review presents an overview of the available literature regarding intranasal corticosteroids (INCs) for the treatment of allergic rhinitis (AR). Various treatment options exist for AR including INCs, antihistamines and leucotriene antagonists. INCs are considered to be the most effective therapy for moderate-to-severe AR, as they are effective against nasal and ocular symptoms and improve quality of life. Their safety has been widely observed. INCs are effective and safe for short-term use. Local adverse events are observed but generally well-tolerated. The occurrence of (serious) systemic adverse events is unlikely but cannot be ruled out. There is a lack of long-term safety data. INC may cause serious eye complications. The risk of INCs on the hypothalamic-pituitary-adrenal axis, on bone mineral density reduction or osteoporosis and on growth in children, should be considered during treatment. Pharmacological characteristics of INCs (e.g. the mode of action and pharmacokinetics) are well known and described. We sought to gain insight into whether specific properties affect the efficacy and safety of INCs, including nasal particle deposition, which the administration technique affects. However, advances are lacking regarding the improved understanding of the effect of particle deposition on efficacy and safety and the effect of the administration technique. This review emphasizes the gaps in knowledge regarding this subject. Advances in research and health care are necessary to improve care for patients with AR.

Low Relevancy of Outcome Measurements of Studies of Pediatric Pain in the Emergency Department.

Many children visiting the emergency department (ED) experience pain. Several pharmacological and nonpharmacological interventions are used for pain control. Little is known about the outcome measurements in studies about pain in children in the ED.Furthermore, it is not known if complete pain relief was reached. METHODS: PubMed, the Cochrane Database of Systematic Reviews, and EMBASE were searched for articles on clinical trials for pain relief in children in the ED. Inclusion criteria contained predictable and identifiable pain such as after trauma or during procedures. RESULTS: Of 620 articles found, 45 fulfilled the criteria. Twenty studies (44%) used pharmacological interventions, and 25 (56%) studied nonpharmacological interventions. In 24 studies (53%), a statistically significant pain reduction was described in the intervention group. In 21 studies (47%), a clinically relevant reduction in pain was found. In only 1 study, the reported aim was to reach absence of pain. CONCLUSION: Half of the interventions decreased pain in children in the ED. However, most studies did not aim at complete pain relief. Even in intervention groups with statistically significant decrease in pain, children still had pain. Children in the ED deserve better.Complete pain relief should be the goal of any intervention for these children in the ED.Studies on pain treatment in the ED should have complete pain relief as primary end point.

Asthma control and quality of life in adolescents: The role of illness perceptions, medication beliefs, and adherence.

Objective: Asthma control and quality of life (QoL) are important disease outcomes for asthma patients. Illness perceptions (cognitive and emotional representations of the illness) and medication beliefs have been found to be important determinants of medication adherence, and subsequently disease control and QoL in adults with asthma. In adolescents, this issue needs further elucidation. Therefore, the aim of this study was to explore the relationship between illness perceptions, medication beliefs, medication adherence, disease control, and QoL in adolescents with asthma.Methods: In this cross-sectional study, we used baseline data of adolescents with asthma (age 12-18 years) who participated in the ADolescent Adherence Patient Tool (ADAPT) study. Questionnaires were administrated online, and included sociodemographic variables and validated questionnaires measuring self-reported illness perceptions, medication beliefs, medication adherence, disease control, and QoL.Results: Data of 243 adolescents with asthma were available; age 15.1 ± 2.0 years and 53% females. More than half of these adolescents (62%; n = 151) reported to be non-adherent (Medication Adherence Report Scale ≤23) and 77% (n = 188) had uncontrolled asthma. There was a strong positive correlation between disease control and QoL (r = 0.74). All illness perceptions items were correlated with disease control and QoL, with the strongest correlation between 'identity' (symptom perception) and QoL (r=-0.66). Medication adherence was correlated to medication beliefs (r = 0.38), disease control (r = 0.23), and QoL (r = 0.14), whereas medication beliefs were only associated with adherence.Conclusions: Stimulating positive illness perceptions and medication beliefs might improve adherence, which in turn might lead to improved disease control and better QoL.

The temporal order of fluctuations in atopic disease symptoms and attention-deficit/hyperactivity disorder symptoms: a time-series study in ADHD patients.

In a recent meta-analysis, we found that atopic diseases, like asthma and allergic rhinitis, occur more frequently prior to the onset of attention-deficit/hyperactivity disorder (ADHD). Our aim was to determine the temporal order of the association between daily fluctuations in atopic disease symptoms and in ADHD symptoms in individual participants. In this observational study among 21 participants, age 7-16 years, we performed a replicated time-series analysis of symptom fluctuations in asthma and/or allergic rhinitis and ADHD. Data were collected through parents who filled in a daily online questionnaire during up to 50 days. In each individual, we investigated the temporal order of fluctuations in atopic disease symptoms and ADHD symptoms using a vector autoregressive (VAR) model while using sleep problems and medication use as covariates. For 16 out of 21 participants, we constructed a VAR model. For a majority of the participants, significant associations were detected between atopic disease symptoms and ADHD symptoms. The results were heterogeneous; the direction, sign, and timing of the relationship between ADHD, atopy, sleep problems, and medication use varied between individuals. This study provides additional evidence that the symptom expression of atopy and ADHD are related. However, the connection between both diseases in children is found to be heterogeneous within our study population.

Corticosteroid phobia (corticophobia) in parents of young children with atopic dermatitis and their health care providers.

BACKGROUND: Adherence to topical corticosteroids is low among atopic dermatitis patients and their parents. This can lead to treatment failure and decreased quality of life. OBJECTIVE: To assess and compare the worries and beliefs concerning topical corticosteroids among parents of children with atopic dermatitis, involved health care professionals, and between different professionals. Also, we identify factors associated with corticosteroid phobia (corticophobia) in professionals. METHODS: Parents and health care professionals were invited to complete a questionnaire about corticophobia (Topicop). Higher questionnaire scores, expressed as a percentage, indicate more severe corticophobia. Professionals were asked to answer the questions as though they were using topical corticosteroids on their own child. RESULTS: The scores for 29 parents and 31 public health care nurses were equal: 44%. The score for 51 general practitioners was 39%. The score for 33 public health care physicians and of 47 pediatricians was 31%. The differences between parents and these professionals were statistically significantly different (P = 0.001). Type of profession and having a child with atopic dermatitis were significantly associated factors for the score. CONCLUSION: Corticophobia is present among parents of children with atopic dermatitis and among health care professionals involved in caring for children with atopic dermatitis. Health care nurses express the same level of corticophobia as parents. The presence of corticophobia among health care professionals may affect parental perspectives and topical corticosteroids adherence negatively.

Methylphenidate use and school performance among primary school children: a descriptive study.

BACKGROUND: There is no conclusive evidence that stimulants have beneficial effects on major associated outcome parameters, particularly school performance. We assessed the differences in school performance among children using methylphenidate at the end of primary school in relation to various parameters of methylphenidate use. METHODS: We linked children from a pharmacy prescription database with standardized achievement test results at the end of primary school. We explored differences in test scores between current methylphenidate users versus never users and methylphenidate users who stopped treatment at least 6 months before the test, early versus late starters, different dosage of methylphenidate, and concurrent antipsychotic or asthma treatment. RESULTS: Out of the 7736 children, 377 (4.9%) children were treated with methylphenidate at the time of the test. After adjusting for confounders the methylphenidate users (532.58 ± .48) performed significantly lower on the test than never users (534.72 ± .11). Compared with late starters of methylphenidate treatment (536.94 ± 1.51) we found significantly lower test scores for the early starters (532.33 ± .50). CONCLUSION: Our study indicates that children using methylphenidate still perform less at school compared to their peers. Our study also suggests that earlier start of methylphenidate treatment is associated with a lower school performance compared to children starting later with the treatment. This result could either indicate a limited effect of long term treatment or a more strongly affected group of early starters.

Association between medication prescription for atopic diseases and attention-deficit/hyperactivity disorder.

BACKGROUND: Data on the association between atopic diseases and attention-deficit/hyperactivity disorder (ADHD) have been inconclusive. OBJECTIVE: To assess whether children with drug-treated ADHD are more likely to receive treatment for asthma, allergic rhinitis, or eczema before the start of ADHD medication use compared with controls and to examine the effect of parents receiving medication for ADHD and atopic diseases on ADHD medication use in their offspring. METHODS: We conducted a retrospective nested case-control study among children (6-12 years of age) using the Groningen University prescription database. Cases were defined as children with at least 2 prescriptions of methylphenidate within 12 months. For each case, 4 controls were matched on age, sex, and regional area code. Parental prescription data were linked to cases and controls to assess the influence of parents receiving medication for ADHD and atopic diseases on ADHD medication use in their offspring. RESULTS: We identified 4257 cases and 17,028 matched controls. Drug treatment for asthma, allergic rhinitis, and eczema was more common in cases than controls (adjusted odds ratios [aORs], 1.4 [95% confidence interval (CI), 1.3-1.6], 1.4 [95% CI, 1.1-1.8], and 1.3 [95% CI, 1.1-1.5], respectively). Medication for allergic rhinitis and asthma among parents was associated with ADHD treatment in their children (aORs, 1.3 [95% CI, 1.1-1.5] and 1.2 [95% CI, 1.1-1.3], respectively). CONCLUSION: This study provides further evidence to support the hypothesis that atopic diseases are associated with ADHD. The parental-offspring association suggests a possible genetic and/or environmental component.

"I just forget to take it": asthma self-management needs and preferences in adolescents.

BACKGROUND: Medication adherence rates often decline as children become teenagers. Effective adherence-enhancing interventions for adolescents are lacking. The objective of this study was to assess adolescent asthmatics needs and preferences regarding medication counseling and support, with focus on new media. METHODS: Three focus groups including 21 asthmatic adolescents recruited from both primary and secondary care were held to explore needs and preferences regarding asthma-self management. Questions concerned adherence behavior and needs and preferences in adherence support with focus on new media (mobile technology, social media, health games). RESULTS: Forgetting was mentioned as major reason for not using medication as prescribed. Adolescents also mentioned lack of perceived need or beneficial effects. Parents mainly play a role in reminding to take medication and collecting refills. The suggested strategies to support self-management included smartphone applications with a reminder function and easy access to online information. Participants were positive about sharing of experiences with other teenagers. CONCLUSION: Forgetfulness is a major reason for non-adherence in adolescents. Furthermore, our results suggest use of peer support may be helpful in promoting good medication use. Future interventions should be aimed at providing practical reminders and should be modifiable to individual preferences.

Attitudes towards medication use in a general population of adolescents.

UNLABELLED: Adolescents are becoming more independently responsible for their medication regimen; therefore, adolescence is a crucial period to address medication beliefs, as many of the beliefs may persist into adulthood and can impair adherence and willingness to continue a prescribed therapy. Within this study, we aimed to explore adolescents' general perceptions towards medicines. Adolescent students attending secondary schools in the Netherlands were invited through the school's virtual learning environment to fill in an online questionnaire. Medication beliefs were assessed using the Beliefs About Medicines Questionnaire-General assessing general harm and general overuse beliefs. Within a 2-week period, 434 adolescent students responded to the questionnaire; 47.2 % thought that doctors overprescribed medication, and 20.5 % perceived medication as harmful in general. Being religious was associated with stronger harm (odds ratio (OR) 2.0, 95 % confidence interval (CI) 1.2-3.2) and overuse beliefs (OR 1.4, 95 % CI 0.9-2.1). Adolescents of native background had less concerns about overuse (OR 0.4, 95 % CI 0.2-0.8). Adolescents who actually consulted physicians had lower overuse beliefs (OR 0.6, 95 % CI 0.4-1.0). CONCLUSION: Adolescents more strongly believe in the general overuse of medicines than in general harm. Religious and ethnic background influence medication beliefs, as does previous experiences with the health-care system. Gaining more insight in adolescent patients' medication use behavior and identifying patients at risk for negative medication beliefs associated with poor adherence in clinical practice might be a first step towards a lifelong good medication use.

Use of antibiotics in rural and urban regions in The Netherlands: an observational drug utilization study.

BACKGROUND: Large livestock farms might increase the infection risk for the nearby human population because of an increased risk for disease outbreaks and because antibiotic-resistant bacteria are more likely to be present. We hypothesized that populations residing in rural areas have more contact with cattle compared with populations in urban areas, and will use more antibiotics or more frequently require a new course of antibiotics. METHODS: Using data from the prescription database IADB.nl, we compared antibiotic use by patients living in rural areas to the use by patients living in urban areas. We also followed cohorts of antibiotic users and determined the patients who required a second antibiotic within 14 days after beginning the first antibiotic. RESULTS: The yearly prevalence of antibiotic use was greater in rural areas compared with urban areas (2009: 23.6% versus 20.2% (p < 0.001), especially in the younger age groups. More adult patients residing in rural areas required a second course of antibiotic treatment within 14 days after starting the first treatment. CONCLUSION: Individuals use more antibiotics, and adults more frequently require a second antibiotic prescription within 14 days, in rural areas compared with urban areas. Although the differences were small and the risks for the general rural population were not high, this difference should be investigated further.

Association of childhood attention-deficit/hyperactivity disorder with atopic diseases and skin infections? A matched case-control study using the General Practice Research Database.

BACKGROUND: Data to support the hypothesis of a relationship between attention-deficit/hyperactivity disorder (ADHD) and allergies are conflicting. OBJECTIVE: To assess whether children with ADHD are more likely to have a history of atopic disorders, skin infections, and medical prescriptions than children without ADHD. METHODS: We conducted a nested case-control study among boys using the UK General Practice Research Database (GPRD). Cases were defined as children with first-time diagnosis of ADHD who were treated with methylphenidate. Four controls who had neither ADHD nor ADHD drug prescriptions in their medical records were matched to each case on age and general practice. RESULTS: We identified 884 boys with a first-time diagnosis of drug-treated ADHD and 3,536 controls. The independent odds ratios adjusted for age and presence of low birth weight or preterm delivery were 1.4 (95% confidence interval [CI], 1.2-1.7; P < .001) for a medical history of asthma, 1.5 (95% CI, 1.3-1.9; P < .001) for impetigo, and 1.5 (95% CI, 1.3-1.7; P < .001) for any antihistamine drug prescriptions. Other exposures that were more common in cases than controls, though not independently, were cow's milk intolerance and any prescription from the drug categories antiasthmatics, respiratory corticosteroids, topical steroids, antibacterials, or antifungals. CONCLUSION: Despite possible limitations inherent to observational studies, this study lends support to the emerging evidence that childhood ADHD is associated with atopic diseases and impetigo. Further interdisciplinary research is needed to understand the underlying mechanisms and to evaluate targeted preventive, diagnostic, and therapeutic interventions.

[Cryptosporidiosis in a toddler]. / Cryptosporidiose bij een dreumes.

BACKGROUND: Usually, a virus is the cause of gastroenteritis in children. If the diarrhoea persists for a long time or the course is atypical, another causative agent may be the cause. CASE DESCRIPTION: We present the case history of a 15-month-old boy with atypical gastroenteritis in which he had prolonged diarrhoea and vomiting. We found a cryptosporidium as the causative agent. CONCLUSION: Especially young children, the elderly, patients with IgA deficiency or other immune disorders are at risk of severe and prolonged diarrhoea with dehydration caused by cryptosporidium. The disease is self-limiting but can sometimes become chronic. In the Netherlands no medical treatments are available. Farm animals and surface water are the main reservoirs of cryptospores. Because the sporozoites are resistant to chlorine and alcohol, elimination is difficult.

Conservative Treatment of Parapneumonic Effusion in Children: Experience From a 10-Year Consecutive Case Series.

BACKGROUND: In children with parapneumonic effusion (PPE), it remains unclear when conservative treatment with antibiotics suffixes or when pleural drainage is needed. In this study we evaluate clinical features and outcomes of children with PPE. METHODS: A retrospective, multicentre cohort study at 4 Dutch pediatric departments was performed, including patients 1-18 years treated for PPE between January 2010 and June 2020. RESULTS: One hundred thirty-six patients were included (mean age 8.3 years, SD 4.8). 117 patients (86%) were treated conservatively and 19 (14%) underwent pleural drainage. Patients undergoing pleural drainage had mediastinal shift more frequently compared with conservatively treated patients (58 vs. 3%, difference 55%; 95% CI: 32%-77%). The same accounted for pleural septations/pockets (58 vs. 11%, difference 47%; 95% CI: 24%-70%), pleural thickening (47 vs. 4%, difference 43%; 95% CI: 20%-66%) and effusion size (median 5.9 vs. 2.7 cm; P = 0.032). Conservative management was successful in 27% of patients (4 of 15) with mediastinal shift, 54% of patients (13 of 24) with septations/pockets, 36% of patients (5 of 14) with pleural thickening, and 9% of patients (3 of 32) with effusions >3 cm, all radiological signs generally warranting pleural drainage. In patients treated conservatively, median duration of hospitalization was 5 days (IQR 4-112) compared with 19 days (IQR 15-24) in the drainage group ( P < 0.001), without significant difference in readmission rate (11 vs. 4%, difference 6%; 95% CI: -8%-21%). CONCLUSION: This study suggests that the greater amount of children with PPE could be treated conservatively with antibiotics only, especially in absence of mediastinal shift, pleural septations/pockets, pleural thickening or extensive effusions.

Inhaled fluticasone propionate does not influence salivary cortisol when measured with tandem mass spectrometry.

Long-term treatment with inhaled corticosteroids (ICS) may potentially lead to adrenal insufficiency in children with asthma. A sufficient adrenal response can be tested using protocols involving salivary cortisol measurements. In this study, we investigated in healthy volunteers whether inhalation of fluticasone propionate, a frequently prescribed ICS, interferes with salivary cortisol measurement (with tandem mass spectrometry as well as an immuno-assay). We found that inhalation of fluticasone propionate immediately before saliva collection does not interfere with the salivary cortisol measurement when measured by mass spectrometry. These results suggest that patients with asthma using ICS can be included in research protocols based on salivary cortisol mass spectrometry measurements.

[Children with atopic eczema deserve better care]. / Kinderen met eczeem verdienen betere behandeling.

Constitutional eczema in children is common. It itches and has a negative impact on quality of life. Although there are good treatments, in practice many children appear to be undertreated. Possible causes of this are: insufficient knowledge about background and treatment and insufficient cooperation between care providers. In addition, many parents are unjustly afraid of the adverse effects of hormone ointments. Some caregivers are just as afraid of hormone ointments as parents. A comment from one of them can damage the confidence of parents in the effectiveness and safety of these ointments.In our opinion, children with eczema deserve better. That is why we propose to organize regional care, education and cooperation for children with eczema. Not only general practitioners and dermatologists should participate; pharmacists and pharmacy assistants, youth health care physicians and nurses and paediatricians should also join. Information material must be uniform.

[Guideline 'Imaging with ionizing radiation': risks, communication and shielding]. / Richtlijn 'Beeldvorming met ioniserende straling'.

The guideline 'imaging with ionizing radiation' provides information about the risks when using ionizing radiation and the communication thereabout. Because most radiological investigations are performed at one time, the chance of adverse effects, is small, even in children and pregnant women. In case of complex or multiple investigations, the medical physicist can be consulted to estimate the risks. The working group recommends using population diagrams when discussing possible risks. The working group recommends giving patients/caregivers room to express their concerns and questions. The working group advices using supporting material. The working group advocates the development of nationally uniform information material. If the patient/caregiver still has concerns, the working group recommends calling in experts such as radiologists, medical physicists, and radiographers.

Adverse Drug Reactions of Intranasal Corticosteroids in the Netherlands: An Analysis from the Netherlands Pharmacovigilance Center.

BACKGROUND: Intranasal corticosteroids are one of the cornerstone treatment options for allergic rhinitis and chronic sinusitis complaints. Safety information in the summary of product characteristics may not be representative for observations in daily clinical practice. The Netherlands Pharmacovigilance Center (Lareb) collects post-marketing safety information, using spontaneous reporting systems. OBJECTIVE: Our objective was to analyse reports of adverse drug reactions associated with intranasal corticosteroids reported in the Dutch spontaneous reporting database of the Netherlands Pharmacovigilance Center Lareb to obtain insight into real-world safety data. METHODS: We retrospectively examined all adverse drug reactions of intranasal corticosteroids reported to the Netherlands Pharmacovigilance Center Lareb, entered into the database from 1991 until 1 July, 2020. RESULTS: In total, 2263 adverse drug reactions after intranasal corticosteroid use were reported in 1258 individuals. Headache (n = 143), epistaxis (n = 124) and anosmia (n = 57) were reported most frequently. Nasal septum perforation (reporting odds ratio 463.2; 95% confidence interval: 186.7-1149.7) had the highest reporting odds ratio, followed by nasal mucosal disorder (reporting odds ratio 104.5; 95% confidence interval 36.3-301.3) and hyposmia (reporting odds ratio 90.8; 95% confidence interval 45.1-182.7). Moreover, 101 (4.5%) reports were classified as serious by Lareb, including reports of Cushing's syndrome, adrenal cortical hypofunction and growth retardation. CONCLUSIONS: Many side effects are consistent with the safety information in the summary of product characteristics of intranasal corticosteroids. Several serious (systemic) side effects are reported and it is important to realise that intranasal corticosteroids may contribute to the development. Healthcare providers and patients should be aware of the potential (individual) adverse drug reactions of intranasal corticosteroids. This information could help in discussing treatment options.

Could adverse reactions of antibiotic drugs in children be detected in a prescription database?

PURPOSE: To explore the possibility to detect adverse drug reactions (ADRs) from a pharmacy prescription database by examining the use of proxy-drugs during the treatment. METHODS: From a pharmacy prescription database we selected all children of 0-6 years old who started an antibiotic drug between 1999 and 2006. In the period of 5 days before till 12 days after the initiation of the antibiotic, we examined the number of prescriptions of 5 groups of proxy-drugs associated with adverse reactions: propulsives, skinmedication, antihistaminics, drugs against candidiasis and diarrhea. We did this also for cases where the children did not use any other drugs on the start day (t = 0) and the 5 days before, to focus on the use of proxy-drugs not related to the infection. RESULTS: A total of 105,804 antibiotic courses were selected. The use of the proxy-drugs was the highest at the first day with no significant increase in the days thereafter. In case of no use of any other drugs from day -5 till day 0 a significant increase of antihistaminic use on day 7 and 8 and of skin medication use on day 7 was found. CONCLUSIONS: Examining prescriptions of proxy drugs is not an optimal method to detect adverse reactions. An increase of antihistaminic use and skin medication use around day 7 in patients who had no other prescriptions 5 days before and on the first day of the course could be an indication for a skin reaction or allergy.

Reducing corticosteroid phobia in pharmacy staff and parents of children with atopic dermatitis.

Background Besides physicians, pharmacy staff has an important role to inform patients on appropriate medication use. However, they might also experience corticophobia themselves, affecting patient counseling and subsequently patient's disease management. Objective Implementation of an intervention for pharmacy staff to improve knowledge and stimulate positive perceptions towards TCS use, in order to reduce corticophobia in pharmacy staff and parents of young AD patients. Setting Nine community pharmacies in the Netherlands. Method We developed an intervention consisting of education of pharmacy staff followed by counseling of parents. The intervention was implemented in pharmacies and intervention effectiveness was studied using a pre-post design with an intervention period of 3 months. At baseline and follow-up (3 months), pharmacy staff and parents completed a questionnaire. Main outcome measure Corticophobia, both beliefs and worries, measured with the TOPICOP questionnaire. Higher scores indicate a more negative attitude. Result Baseline and follow-up data were available for 19 pharmacy staff members and 48 parents who attended a counseling session in the pharmacy. In both groups there was as decrease in negative beliefs and worries towards TCS (p < 0.05). Mean total TOPICOP scores decreased from 42 to 35% and from 33 to 25% for parents and pharmacy staff respectively. Conclusion Our results show the prevalence of corticophobia among parents. Education of pharmacy staff and targeted patient counseling seems to be effective in reducing corticophobia.