Can Naci Kocabaş

Complementary and alternative medicine in children with asthma

BACKGROUNDnThe popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children.nnnOBJECTIVEnTo evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma.nnnMETHODSnThe parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM.nnnRESULTSnOf the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mothers and fathers education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their childs asthma in the future (P = 0.001).nnnCONCLUSIONSnAsthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.

Successful bone marrow transplantation for DOCK8 deficient hyper IgE syndrome

Dear Editor, We report a girl with AR-DOCK8 deficiency treated successfully with allogeneic bone marrow transplantation (BMT). She was born to consanguineous parents (cousins) originating from and living in eastern Turkey. The first two children of the family were not diagnosed as immunodeficient despite hypereosinophilia and high IgE levels. They had neonatal onset pruritic eczematous dermatitis, food allergies, recurrent and severe pneumonias (LRTI) when they died at five and six yr old, respectively. Sibling 6 (the propositus) who was born after three healthy children, presented with severe neurological disease: beginning nearly 6–8 months ago with mild ataxia and gradual deterioration with restlessness, spasticity, progressive hearing, speech and vision loss, hyperactive deep tendon reflexes, Babinsky and clonus. Radiological diagnosis of progressive multifocal leukoencephalopathy (PML) with serial MRI was supported by high JCV-DNA in serum and cerebrospinal fluid (2200 copies/mL). He also was diagnosed with hyper IgE syndrome (HIES) caused by the dermatitis of neonatal onset, severe food allergies, LRTIs and high peripheral blood eosinophilia and serum IgE. There were no pneumatoceles despite recurrent pulmonary infections and cold abscesses nor joint hypermobility. We treated him with i.v. immunoglobulin (IVIG) 400 mg/kg/day for 15 days with no clinical response. As the response to rh-interferon-gamma (rhIFN-c) stimulation is shown in Tyk-2 deficient patient (1), we gave rhIFN-c to this patient with PML using 50 lg/m, ·3/wk, by sc route. He died at the age of seven yr with sepsis in our intensive care unit. The last child (DOB: 25 October 2006) of this family also presented with neonatal rash. She developed severe eczema with lichenification since the first months of life. She had multiple food, environmental and drug allergies, including lentil anaphylaxis. At the age of 18 months, she underwent further investigations after the diagnosis of her brother s JCV infection. She presented with severe disseminated ichthyosiform eczema, ectropion of the eyelids, recurrent LRTI, oral, cutaneous and ungual candidiasis. Fortunately, her brain CT was normal and the serum and CSF did not reveal JCV infection as her brother. High levels of IgE (>10 000 IU/mL) and hypereosinophilia (>5000/lL) were persistent. Serum immunoglobulin levels (G: 1580, M: 71 and A: 8.7 mg/dL) were normal except for low IgA for age while lymphocyte phenotyping revealed CD4+ T cell lymphopenia (absolute: 250/lL) with CD3+ T cell 28%, CD19+B cell 60%, CD16+56+ NK cell 5% in the peripheral blood. Her serum anti-HBs, antipolio, anti-HSV, anti-CMV, anti-EBV, anti-IgM and anti-IgG antibodies and isohemagglutinins were absent. The girl was also clinically diagnosed as autosomal recessive-HIES and treatment was initiated with IVIG, itraconazole, sulfamethoxazoletrimethoprim and rhIFN-c for prophylaxis and immune modulation. She was not responding to topical steroids, emollients and oral antihistamines. Genomic DNA of the patient, parents and her brother who died with JCV infection were evaluated for the DOCK8 gene as the possible cause for the phenotype at the Department of Immunology and Molecular Pathology of Royal Free Hospital (London, UK). Engelhardt et al. identified a homozygous large deletion up to and including exon 25 of the DOCK8 gene (c.?_3121?del), deleting the first half of the gene (JACI 2009;124:1289, patients with codes of ARH016.6, ARH016.7) (2). It could not be understood where the exact beginning of the deletion was; the first deleted exon they detected was exon 3, but as they did not analyze exon 1 and 2, it was concluded that the deletion began before or at the start of the DOCK8 gene. Because of recurrent sibling deaths, she was considered for hematopoietic stem cell Pediatr Transplantation 2012: 16: 398–399 2012 John Wiley & Sons A/S.

Prevalence of asthmatic phenotypes and bronchial hyperresponsiveness in Turkish schoolchildren: an International Study of Asthma and Allergies in Childhood (ISAAC) phase 2 study.

BACKGROUNDnNumerous epidemiologic studies have revealed that bronchial asthma affects populations without regard to frontiers. However, standardized methodological approaches are necessary to compare these populations.nnnOBJECTIVEnTo investigate objective markers of childhood asthma on an epidemiologic basis and to include Turkish children in international comparisons.nnnMETHODSnParental questionnaires were collected and skin prick tests performed on fourth grade primary schoolchildren, aged 8 to 11 years, residing in Ankara, Turkey. Pulmonary function tests and bronchial challenge with hypertonic saline (HS) were conducted in children selected from this cohort with a stratified random sampling according to the presence of current wheezing.nnnRESULTSnA total of 3,041 questionnaires were included in the evaluation. Skin prick tests were performed on 2,774 children (97.1%). A total of 347 children from this cohort underwent pulmonary function and bronchial challenge tests. In 18 (5.1%) of the 347 children, bronchial challenge tests could not be successfully completed. The prevalence values were 11.5% for current wheezing, 6.9% for physician-diagnosed asthma, and 7.7% for physician-diagnosed recurrent bronchitis. Population-based weighted prevalence of bronchial hyperresponsiveness (BHR) was 21.8%. Frequency of responses to HS was 38.6% among physician-diagnosed asthma cases and 30.5% among patients with current wheezing. Skin test positivity was present in 38.7% of the children with a diagnosis of asthma or asthmatic bronchitis, 35.0% of current asthmatic patients, and 19.2% of patients with current wheezing.nnnCONCLUSIONSnObjective markers, in addition to the questionnaire-based prevalence figures, need to be used in epidemiologic surveys for asthma, especially in countries with inadequate health care facilities or problems with interpretation of the wheeze concept.

Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers

Abstract Objective: To address the problems about correct use of inhaler devices, adherence to inhaler corticosteroid treatment and the effects of these problems on the control of asthma. Methods: Children with asthma were evaluated for the correct use of inhaler devices and adherence to therapy using a questionnaire. Effect of these on control of asthma was defined. Results: A hundred and seventy-one patients and/or their families were interviewed. The mean age was 8.29u2009±u20094.65 years (1–19) and 62.6% were male. Metered dose inhaler (MDI) with spacer was used by 119 (69.5%) patients and 52 (30.5%) used dry powder inhalers (DPIs). The devices were used correctly by 68.1% of patients using MDI and 34.6% of patients using DPI (pu2009<u20090.001). The most common improper step was “breathe in from the spacer 5–6 times or 10u2009s” for MDI (24.4%) and “exhale to residual volume” for DPI (51.9%). Frequency of correct use was higher in patients trained 3 times (pu2009<u20090.001). Asthma was controlled more frequently among correct users (pu2009<u20090.001). Partial or poor adherence was showed 22.8% of patients. Patients with mothers who had lower educational status had higher frequency of incorrect use of inhaler device (pu2009=u20090.007). Conclusion: It was found that asthma control was better among correct users. Repetitive training about using devices may contribute improving inhaler technique. Especially children whose mothers had low education level and patients using DPI should be evaluated more carefully.

Prevalence of confirmed immediate type drug hypersensitivity reactions among school children.

Despite drug‐related hypersensitivity reactions are an important health problem, epidemiologic data on drug allergy and hypersensitivity are limited, and studies including diagnostic work‐up are scarce. The aim of this study was to determine the actual frequency of immediate type drug hypersensitivity using diagnostic tests in school children with parent‐reported drug allergies.

Prevalence of confirmed IgE-mediated food allergy among adolescents in Turkey.

Although food allergy is an important health problem in Western countries, the prevalence varies among geographic regions. There is limited data on the prevalence of food allergy especially for adolescent age group, and the data from Turkey and Mediterranean region are even scarce.

Consistency of GINA criteria and childhood asthma control test on the determination of asthma control

To cite this article: Erkoçoğlu M, Akan A, Civelek E, Kan R, Azkur D, Kocabaş CN. Consistency of GINA criteria and childhood asthma control test on the determination of asthma control. Pediatric Allergy Immunology 2012: 23: 34–39.

Characteristics of anaphylaxis in children referred to a tertiary care center.

Anaphylaxis is a potentially life-threatening condition. There are limited data about the etiology and the clinical characteristics in developing countries. This study aimed to investigate the clinical characteristics of anaphylaxis patients attending our pediatric allergy clinic. We conducted a prospective analysis of patients who were admitted to our allergy clinic for anaphylaxis from 2010 to 2012. Ninety-six patients were evaluated during the study period. The mean age was 7.4 ± 5.2 years. Venom, food, and drugs were the most common causative agents responsible for 31 (32.3%), 30 (31.3%), and 26 (27.1%) of the cases, respectively. Foods implicated most frequently were peanuts and nuts (n = 9; 30.0%), cows milk (n = 7; 23.3%), and egg white (n = 6; 20.0%). The clinical manifestations during anaphylaxis in order of frequency were cutaneous (97.9%), respiratory (86.5%), gastrointestinal (42.7%), neurological (37.5%), and cardiovascular symptoms (30.2%). A biphasic course was noticed in five cases (5.2%). Of the 91 patients, 79 (86.8%) received H1-antihistamines, 73 (80.2%) received corticosteroids, 40 (44.4%) received adrenaline, 38 (41.8%) received fluid replacement therapy, 18 (19.8%) received β2-mimetics, and 8 (8.8%) received H2-antihistamines. According to severity, 7.3% of patients had mild, 59.4% had moderate, and 33.3% had severe anaphylaxis. Food and bee venom allergy were the most common etiologies. Adrenaline, the first-line treatment of anaphylaxis, was administered in only 44.4% of our cases.

Evaluation of Respiratory Viral Pathogens in Acute Asthma Exacerbations during Childhood

Objective. Common upper respiratory tract viruses are the most frequent and important causes of asthma exacerbations in both children and adults. Prospective epidemiologic studies report that up to 80% of childhood exacerbations are associated with viral upper respiratory tract infections. Materials and methods. The study group consisted of 104 children with asthma aged 3–17 years who received treatment for asthma exacerbations in our clinic between September 2009 and 2010. Nasopharyngeal and nasal swabs were obtained from all patients during an acute attack, and from the control group (31 subjects). These specimens were investigated for the presence of viral respiratory pathogens using a real-time multiplex PCR method. The patients were compared for the presence of respiratory pathogens and factors related to the severity of the asthma exacerbation. Results. A pathogenic respiratory virus was detected in 53.8% of patients in the acute exacerbation group. The most commonly encountered viral agent was Rhinovirus (35.6%). Patients who had an acute exacerbation with or without a detectable viral pathogen were compared according to the severity of the exacerbation, the need for systemic steroids, and hospitalization rates. No statistically significant difference was found. Conclusion. Although viral upper respiratory tract infections are the most common cause of asthma exacerbations, the severity level of the exacerbation seems to be independent of whether a respiratory virus has been detected.

The effects of aflatoxin B1 on the development of kwashiorkor in mice

Seventy Swiss albino mice (6-week-old male) were selected for the investigation into aflatoxin B1s role in the cause of kwashiorkor. The mice were divided randomly into four groups. They were grouped within each group by being fed either low or normal protein level diets supplemented with very small amounts of aflatoxin B1 (0.5 mg/day). The control groups were fed aflatoxin B1-free diets containing either normal or low protein levels. All groups were monitored for 7 weeks. The increase in body weight was found to be low in groups I and II, given diets contaminated with aflatoxin B1. Although groups II and IV, which were given low dietary protein, showed remarkable decreases in serum total protein and albumin levels (group II: total protein 4.1±-0.1 g/dL, albumin 2.6±-0.8 g/dL and group IV: total protein 4.6±-1.3 g/dL, albumin 2.8±-0.82 g/dL) when compared with the groups fed a normal dietary protein level (group I: total protein 5.9±-1.3 g/dL, albumin 3.4±-0.7 g/dL and group III: total protein 5.4±-1.6 g/dL, albumin 3.5±-1.2 g/dL; P B-0.05). The statistical difference between these two groups was found not to be significant (P -0.05). However, decreases in total protein and albumin levels were a little more prominent in group II. In addition, histopatological changes of the liver was remarkable in the group fed a low protein diet and aflatoxin B1 when compared with the group fed only a low protein diet and no aflatoxin B1. More significantly, however, was the increase in liver weight in both groups fed a low protein diet (groups II and IV). Our conclusion is that aflatoxin B1 could not have contributed to the development of kwashiorkor.