Ilknur Bostanci

Erythrocyte zinc levels in children with bronchial asthma

Zinc deficiency may be suspected to play a role in the pathogenesis, control, and severity of asthma because of its antioxidant, antiapoptotic, and anti‐inflammatory effects. We aimed to investigate whether there was any relationship between erythrocyte zinc levels and childhood asthma. The erythrocyte zinc levels of 67 asthmatic and 45 healthy children were analyzed in this case–control study. The mean concentrations of erythrocyte zinc were 1215.8 ± 145.1 µg/dl in asthma patients and 1206.9 ± 119.5 µg/dl in controls with no significant difference (P = 0.472). The erythrocyte zinc level was below 1,000 µg/dl in 6 asthmatic patients (8.9%) and 2 control group patients (4.4%). There was no relationship between erythrocyte zinc levels and duration of follow‐up, severity, and control of the asthma (P > 0.05). On the other hand, patients hospitalized for an asthma attack had significantly lower erythrocyte zinc levels compared with nonhospitalized patients and the control group (P = 0.000 and P = 0.004 respectively). This studys findings indicate that asthmatic children are not a risk group for zinc deficiency. We emphasize that checking zinc levels in children who are hospitalized for an asthma attack may be useful. Pediatr Pulmonol. 2011; 46: 1189–1193.

The Relevance of Nasal Provocation Testing in Children with Nonallergic Rhinitis

Background: It is important to understand that allergic rhinitis, whether seasonal or perennial, may be difficult to distinguish clinically from the nonallergic forms of rhinitis. Objective: This study aimed to investigate the presence of local allergic rhinitis (LAR) in children who have allergic rhinitis symptoms in the absence of skin test positivity and specific IgE by performing a nasal provocation test (NPT). Methods: Our study followed a case-controlled, prospective design. Twenty-eight patients and 30 healthy children were included in the study in a pollen-free season. The NPTs with a grass mix, Dermatophagoides pteronyssinus (DP) and D. farinae (DF) allergens were performed with an interval of 1 week. The total symptom score and visual analog scale, nasal eosinophilia and pulmonary function tests were evaluated before and after each NPT. The change to nasal flow and resistance was recorded by anterior rhinomanometry. Results: The symptom frequencies before the NPTs were as follows: nasal congestion 100%; itching 82.1%; rhinorrhea 75% and sneezing 71.4%. The NPT was positive in 7 (25%) patients. In the NPT-positive group there was a statistically significant decrease in nasal flow at the concentrations of 10 and 100 IR/ml for DF (p = 0.026, p = 0.031, respectively). In the NPT-positive group total nasal resistance for DP was increased at the concentrations of 0.1 and 10 IR/ml, and for DF at 10 and 100 IR/ml (p = 0.049, p = 0.041, p = 0.022, p = 0.035, respectively). Conclusions: We emphasize that the diagnosis of LAR should be taken into consideration by pediatricians and pediatric allergy specialists.

Symmetrical Drug‐Related Intertriginous and Flexural Exanthema (Baboon Syndrome) Induced by Amoxicillin‐Clavulanate

Abstract:  Systemic drug‐related intertriginous and flexural exanthema (SDRIFE), also known as Baboon syndrome, is an uncommon, cutaneous reaction that occurs after the systemic administration of drug‐related allergens. We report the case of a 5‐year‐old boy with SDRIFE after systemic administration of amoxicillin‐clavulanate.

Serum Sickness–Like Reaction in Children Due to Cefditoren

Abstract:  We describe the case of a 7‐year‐old boy with urticaria, fever, and arthritis that appeared 10 days after starting cefditoren therapy for acute tonsillopharyngitis, which was diagnosed as a serum sickness‐like reaction due to this medication.

Importance of high sensitivity C-reactive protein in the evaluation of wheezing in children.

It is important to determine the presence of asthma in children under the age of 3 with recurrent wheezing. Inflammatory markers have been investigated in the diagnosis and treatment of asthma. The aim of the present study was to investigate the relationship between recurrent wheezing with or without modified asthma predictive index (mAPI) positivity and high‐sensitivity‐C reactive protein (hs‐CRP) level in children aged 6–36 months.

THE IMPORTANCE OF HIGH SENSITIVITY C REACTIVE PROTEIN IN THE EVALUATION OF CHILDREN WITH WHEEZING.

It is important to determine the presence of asthma in children under the age of 3 with recurrent wheezing. Inflammatory markers have been investigated in the diagnosis and treatment of asthma. The aim of the present study was to investigate the relationship between recurrent wheezing with or without modified asthma predictive index (mAPI) positivity and high‐sensitivity‐C reactive protein (hs‐CRP) level in children aged 6–36 months.

Two adolescent patients with high IgE levels and hypereosinophilia are associated with cockroach allergen.

Cockroach is an important indoor allergen especially in hot and moist environments. The main types of cockroaches causing the sensitivity are Blatella germanica, Periplanata americana ve Blatella orientalis. Although cockroach allergens are found throughout the home, including beds, furniture, and carpets, allergen levels are highest in the kitchen. Saliva, faecal material, secretions, cast skins, debris, and dead bodies are cockroach allergens. Sensitivity to cockroach allergen has been shown to be associated with exposure levels and is more prevalent in urban than in suburban areas. For good protection, it is necessary to use insecticides and clear out the indoor environment very well.1 IgE is a combination of two heavy and two light chain immunglobulin in 190 kg Dalton which contains less than 1 mcg/ml in normal monomeric plasma. Serum IgE concentrations are highly age dependent. Since IgE does not cross the placental barrier in a significant amount, cord serum IgE levels are low, usually less than 2 kU/L. Progressive increases in mean serum IgE levels occur up to age 10 to 15 years. After age 14, serum IgE levels greater than 333 Ku/L (800 mcg/L) are strongly associated with atopic disorder. Although high levels of serum IgE are common in allergic disease, total serum IgE has become less frequently used as an indicator for atopy because of the wide overlap in the IgE distributions of the atopic and non-atopic population.2 Eosinophils are generated in the bone marrow and can be found in the peripheral blood, where they represent 1% to 5% of the leukocytes with an upper limit of 0.4x109/L. Eosinophilia and IgE production is driven by allergen-activated Th2 cells that generate large amounts of Th2 cytokines (IL-4, IL-5, IL-13).3 Here we present two adolescent patients admitted to our allergy clinic because of high IgE levels and hypereosinophilia. In evaluation of these two patients we determined cockroach allergy. We stress that cockroach allergy should always be kept in mind in cases of high IgE levels and hypereosinophilia in adolescents.

Subjective and objective assessments of seasonal effect in children with seasonal allergic rhinitis

BACKGROUND Epidemiological and clinical studies suggest a relationship between rhinitis and asthma. Upper and lower airways may be influenced by a common inflammatory process. OBJECTIVE This study aimed to investigate the relationships between rhinitis symptom scores, and both nasal and bronchial airflow among children with seasonal allergic rhinitis (SAR) by means of spirometric and rhinomanometric measurement during and outside the pollen season. METHODS Twenty-nine children with both seasonal allergic rhinitis and asthma (AR+A), 30 children with SAR and no asthma (AR) and 36 non-allergic healthy children were evaluated prospectively during and outside the pollen season. Symptom severity was evaluated using both total symptom score and visual analog score (VAS). All participants also received rhinomanometric evaluation and pulmonary function testing. RESULTS In children with SAR the median total nasal flow, FEV1, FEF25-75 values were lower than control group during pollen season (p=0.01, p<0.001 and p<0.001 respectively). They had also higher total nasal resistance compared with control groups (p=0.01). Nasal symptom scores were higher among patients with concurrent asthma than patients who had only SAR out of pollen season (p<0.001). There was no significant difference between SAR participants with or without asthma and control group in terms of total nasal flow and total nasal resistance measured out of season (p=0.105 and p=0.19). FEF25-75 values of patients with and without asthma were significantly lower than those of controls out of season (p=0.022, p<0.001 respectively). CONCLUSION Our data suggests that as the presence of AR worsens asthma control, the presence of asthma may worsen symptoms of AR out of pollen season. We found that total nasal flow, FEV1, FEF25-75 values of patients with SAR were lower than those of controls out of season. FEF25-75 values of patients with asthma and without asthma were significantly lower than those of controls out of season. Thus, a careful evaluation of lower airways should be performed in even patients with seasonal allergic rhinitis alone.

Treatment of brucellosis in a young child with trimethoprim/sulfamethoxazole anaphylaxis

Brucellosis is a common zoonotic disease throughout the world. Brucella spp. transmit to humans through contact with fluids of infected animals, especially sheep, cattle, and goats. It is also transmitted by ingestion of fluid-derived products of infected animals, such as unpasteurized milk and cheese. Brucella spp. changes pH level of intracellular environment, so the first treatment approach is to administer antibiotics that have activity in acidic conditions. Anti-brucellosis treatment regimens include doxycycline for children older than eight years old and rifampicin and trimethoprim/sulfamethoxazole (TMP-SMX) combination therapy for children under eight years old, which may be able to act intracellularly under acidic conditions. A TMP-SMX allergy causing anaphylaxis has been reported previously. No alternative anti-brucellosis treatments have been reported in the literature for patients under eight years old with a TMP-SMX allergy. Here, we report a case of a child with brucellosis and a TMP-SMX allergy who was under eight years old at the time of diagnosis and was successfully treated with rifampicin, ciprofloxacin, and gentamicin.

Is There a Need for Repetition of Skin Test in Childhood Allergic Diseases? Repetition of Skin Test and Allergic Diseases

BACKGROUND Skin prick tests are widely used to determine sensitivity in allergic diseases. There is limited information about the natural history of skin sensitization tests and factors that affect them. It was aimed to determine the changes in skin test results and the factors affecting the reactivity of skin tests after a period of approximately four years in children with allergic disease. METHODS SPT of 170 patients among 2485 children with asthma and/or allergic rhinitis and/or atopic dermatitis, who underwent SPT between 2005 and 2007, were repeated after an interval of at least 3 years. RESULTS The mean age was 10.7 ± 3.1 (5-18) years and 70% of the patients were male. In total 66 (39.0% of the study population) had a different skin tests result in follow-up. Alterations: loss of sensitivity in 18 (11%) patients, the formation of a new sensitivity in 37 (22%) patients, and 11 (6%) both gained and lost sensitization. The presence of atopy in the family, the presence of allergic rhinitis and IgE elevation significantly predicted the incidence of new sensitization. The presence of sensitization to multiple allergens significantly predicted the incidence of loss of sensitization. CONCLUSIONS It is found that there was an alteration of sensitization in 4/10 children at the end of the average 4-year period. The presence of family atopy, the presence of allergic rhinitis and serum total IgE elevation were risk factors for the development of new sensitization. On the other hand sensitization to multiple allergens was risk factors for the loss of sensitization.