Aysen Bingol Boz

Epidemiology and Burden of Rhinitis and Rhinoconjunctivitis in 9- to 11-Year-Old Children:

Background Rhinoconjunctivitis (RC) is regarded as the most common chronic disease of childhood; however, the currently available epidemiological studies on prevalence, burden, and risk factors of RC are insufficient. This analysis aimed to investigate potential risk factors, symptom frequency, and burden of RC. Methods Using the International Study of Asthma and Allergies in Childhood Phase II questionnaires, 6963 elementary school children aged 9–11 years were surveyed in five different city centers of Turkey. All participants were skin-prick tested with common aeroallergens. Results The prevalence of ever rhinitis, physician-diagnosed rhinitis, current rhinitis, and current RC were 51.6, 31.0, 43.5, and 23.1%, respectively; 19.8% of children with RC symptoms were atopic to at least one allergen. Among students with RC symptoms, 42.2, 23.9, 35.8, and 28.2% reported moderate–severe interference of daily activities, at least 1 day of absence from school, visit to a health care professional, and any drug usage for rhinitis, respectively. Nasal decongestants and oral antihistamines were the most frequently used treatment. Approximately 70% of RC patients reported perennial symptoms and 42.8% were classified as mild to intermittent. Multivariate logistic regression analysis revealed family history of asthma and/or allergic rhinitis (odds ratio [OR] = 1.863; confidence interval, [CI] = 1.583–2.191; p < 0.001), living in a house with mold and dampness in the 1st year of life (OR = 1.651; CI = 1.356–2.01; p < 0.001), maternal smoking in pregnancy (OR = 1.425; CI = 1.089–1.864; p = 0.011), low monthly income (OR = 1.685; CI = 1.422–1.998; p = 0.001), current wheezing (OR = 2.543; CI = 2.151–3.006; p = 0.001), and current atopic eczema (OR = 2.503; CI = 1.96–3.196; p = 0.001) as significant risk factors for current RC. Conclusion Along with the high prevalence of RC in childhood, underdiagnosis and undertreatment of the disease are also frequent. The socioeconomic burden of the disease can be reduced by increasing awareness and proper diagnosis/treatment.

Risk Factors for Current Wheezing and Its Phenotypes Among Elementary School Children

Accumulating evidence suggests, asthma includes many phenotypes with varying clinical and prognostic features. Epidemiological surveys documented a number of environmental risk factors for the development of asthma and interestingly these differ between and within countries, suggesting that the differences may be related with the different distribution of asthma phenotypes. This study aimed to investigate risk factors of current wheezing (CW) and different wheezing phenotypes in elementary school children.

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

Anaphylaxis is a serious and potentially lethal systemic reaction affecting more than one organ or system.

Similar prevalence, different spectrum: IgE-mediated food allergy among Turkish adolescents

BACKGROUND Scarcity of reliable data on food allergy prevalence exists in Turkey. We aimed to assess reported and confirmed IgE-mediated food allergy prevalence, and define the spectrum of allergenic food. METHODS We prospectively evaluated the ISAAC Phase II study population for food allergy. Participants that reported experiencing food allergy symptom in the last year and/or were skin prick test positive for a predefined list of food allergens, were interviewed via telephone, and those considered as having food allergy were invited to undergo clinical investigation, including challenge tests. RESULTS A total of 6963 questionnaires were available. Parental reported food allergy prevalence and skin prick sensitisation rate were 20.2 ± 0.9% and 5.9 ± 0.6%. According to the above-defined criteria, 1162 children (symptom positive n=909, skin prick test positive n=301, both positive n=48) were selected and 813 (70.0%) were interviewed via telephone. Out of 152 adolescents reporting a current complaint, 87 accepted clinical investigation. There were 12 food allergies diagnosed in nine adolescents, with food allergy prevalence of 0.16 ± 0.11%. The most common foods involved in allergic reactions were walnut (n=3) and beef meat (n=2), followed by hens egg (n=1), peanut (n=1), spinach (n=1), kiwi (n=1), cheese (n=1), hazelnut (n=1) and peach (n=1). CONCLUSIONS While parental reported food allergy prevalence was within the range reported previously, confirmed IgE-mediated food allergy prevalence among adolescents was at least 0.16%, and the spectrum of foods involved in allergy differed from Western countries, implying environmental factors may play a role.

A multi-center survey of childhood asthma in Turkey - I: The cost and its determinants

Successful management of childhood asthma requires a thorough idea of the economic impact of asthma and its determinants, as policy makers and physicians inevitably influence the outcome. The aim of this study was to define the cost of childhood asthma in Turkey and its determinants. In April 2006, a multi‐center, national study was performed where data regarding cost and control levels were collected. Asthmatic children (6–18 yr) with at least a 1‐yr follow‐up seen during a 1‐month period with scheduled or unscheduled visits were included. The survey included a questionnaire‐guided interview and retrospective evaluation of files. Cost and its determinants during the last year were analyzed. A total of 618 children from 12 asthma centers were surveyed. The total annual cost of childhood asthma was US

Does gastroesophageal reflux scintigraphy correlate with clinical findings in children with chronic cough

1597.4 ± 236.2 and there was a significant variation in costs between study centers (p < 0.05). Frequent physician visits [odds ratio (95% confidence intervals)] [2.3 (1.6–3.4)], hospitalization [1.9 (1.1–3.3)], asthma severity [1.6 (1.1–2.8)], and school absenteeism due to asthma [1.5 (1.1–2.1)] were major predictors of total annual costs (p < 0.05 for each). The comparable cost of asthma among Turkish children with that reported in developed countries suggests that interventions to decrease the economic burden of pediatric asthma should focus on the cost‐effectiveness of anti‐allergic household measures and on improving the control levels of asthma.

Perceptions of Parents and Physicians Concerning the Childhood Asthma Control Test

ObjectiveGastroesophageal reflux (GER), a common problem during childhood, leads to chronic troublesome symptoms including chronic respiratory symptoms. Therefore, timely diagnostic work-up for GER is essential in children when GER is suspected. In this study, we aimed to establish whether scintigraphic parameters have clinical importance in investigating the reflux in children. MethodsA total of 72 children older than 7 years with chronic cough of unknown etiology were enrolled for this study. The scintigraphic procedure was performed by using technetium-99m tin colloid (37–74 MBq). Cough and GER scores were used for children who were positive for GER both before and after GER treatment. ResultsOf 72 children, 65 children with a mean age of 10.3±2.3 (7–19) years had GER on gastroesophageal scintigraphy. Median reflux episode number was 7 (1–14). There was a significantly positive correlation between reflux episode number and cough (r = 0.446, P<0.001) and GER score (r = 0.432, P<0.001). The significant decrease was observed in cough (from 3.5±1.9 to 1.6±1.3) and GER scores (from 4.1±2.5 to 1.3±1.1) with GER treatment (P<0.001 for each). ConclusionScintigraphy should be used for the detection of GER in children who present with chronic cough. Increasing episode number in gastroesophageal scintigraphy might be a predictor for reflux-related symptom severity.

Characteristics and Prognosis of Childhood Atopic Dermatitis: A Multicenter Study in Turkey

Background. The Childhood Asthma Control Test (C-ACT) has been proposed to be a simple, patient-based test that is able to reflect the multidimensional nature of asthma control. In this analysis, the aim was to evaluate the perceptions of physicians and caregivers concerning C-ACT and its predictive value for future asthma-related events. Method. In a multicenter prospective design, 368 children aged 4–11 years with asthma who were either well- or not well-controlled were included in the study. The study participants were evaluated during three visits made at 2-month intervals and the Turkish version of C-ACT was completed each month. Parents completed questionnaires concerning their perception of asthma (before and after the study) and the C-ACT (after the study). Physicians completed a survey about their perception of a control-based approach and the C-ACT. Results. The C-ACT scores increased from visit 1 to visit 3, with improvement seen in all domains of the test. At the end of the study period, the parents more strongly agreed that asthma could be controlled completely and that asthma attacks and nocturnal awakenings due to asthma were preventable (p < .05). Most of the parents reported that the C-ACT helped them to determine asthma treatment goals for their children and also that the C-ACT improved communication with their physicians. The physicians indicated that a control-centered approach was more convenient (95%) and simpler (94.5%) than a severity-centered approach and provided better disease control (93.4%). A higher C-ACT score was associated with a decreased risk of asthma attack and emergency department admittance in the 2 months following the administration of C-ACT. Conclusion. Our findings indicated that the C-ACT improved both parental outlook on asthma control and the communication between the physician and parents. There was a good correlation between the C-ACT score and the level of asthma control achieved, as described by the physician. Additionally the C-ACT score was predictive of future asthma-related events. These findings suggest that the C-ACT may have an important role in asthma management in the future.

A case of allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis.

Background:Childhood atopic dermatitis (AD) is classically accepted as initial finding of atopic march; however, nonatopic cases do not follow this course. The aim of this study was to determine the characteristics and prognosis of AD in childhood in Turkey. Methods:The study included 531 children with AD that presented to pediatric allergy departments in 11 different regions of Turkey. Age at diagnosis, total serum and inhalant-specific immunoglobulin E (IgE) levels and allergen skin prick test results were recorded retrospectively. Clinical characteristics like additional allergic diseases at presentation or during follow-up were recorded as well as duration of follow-up. Results:Mean age at diagnosis was 37.8 ± 36.2 months. Mean IgE level was 318.3 ± 677.8 IU/ml (median 100 IU/ml). Skin prick tests yielded positive results in 47% of children. At presentation, 31.6% of children reported additional allergic disease, while 11.7% developed allergic disease during follow-up. Among all, 46.6% had additional allergic disease at any point. IgE levels were significantly higher in children with additional allergic diseases (p = 0.001). Allergen skin prick test positivity and family history of allergic diseases increased the risk of additional allergic diseases significantly (OR = 3.90, 95% CI = 2.3–6.6 and OR = 1.89, 95% CI = 1.3–2.8, respectively). Conclusions: Allergic sensitization is not present in all cases of AD. Coexistence of additional allergic diseases is not as high as expected but more common in children who have been demonstrated to have atopic sensitization with high IgE levels and allergen skin prick test positivity.

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

Allergic bronchopulmonary aspergillosis usually occurs in children with underlying airway disease such as asthma and cystic fibrosis. While the colonization and infection of pre‐existing tuberculosis lesions by aspergillus species is well known, occurrence of allergic bronchopulmonary aspergillosis following pulmonary tuberculosis in children has not been reported yet. Here, an 11‐year‐old girl who developed allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis is reported and the mechanisms of causality are also speculated. Pediatr Pulmonol. 2009; 44:86–89.