Mehmet Sadık Demirsoy

Challenge‐proven nonsteroidal anti‐inflammatory drug hypersensitivity in children

Few studies investigated hypersensitivity to nonsteroidal anti‐inflammatory drugs (NSAIDs) in children. The objective was to determine the frequency of true NSAID hypersensitivity (NSAID‐H) and whether there were any parameters in the history of children that would predict NSAID‐H. Secondly, an investigation was conducted into whether NSAID‐hypersensitive children could tolerate safe alternatives. Differing from previous studies, the researchers followed the recent diagnostic algorithm proposed for acute reactions in NSAID‐H.

Make-up of the epinephrine autoinjector: the effect on its use by untrained users.

To cite this article: Bakirtas A, Arga M, Catal F, Derinoz O, Demirsoy MS, Turktas I. Make‐up of the epinephrine autoinjector: the effect on its use by untrained users. Pediatric Allergy Immunology 2011; 22: 729–733.

A Real-Life Study on Acquired Skills from Using an Adrenaline Autoinjector

Background: Training programs performed by allergists have increased the ability of patients’ recognition and management of anaphylaxis. We aim to investigate the permanence of effect of an anaphylaxis training program and to determine the factors affecting it beyond training given by allergists. Methods: Children and/or their caregivers who had been prescribed an adrenaline autoinjector at least 1 year before were invited to take part in the study. The knowledge about anaphylaxis was assessed using a questionnaire and the skills were practically tested. Results: Sixty-four (50 caregivers/14 children >12 years of age) of 80 patients who accepted the invitation were included in the study. Fifty-nine patients obtained the autoinjector after initial prescription. Among them, 42 (71%) still had the device at the time of the study. The most common reason for not having the autoinjector was no longer feeling it was necessary (54.6%). Of the cases, 39.4% were competent in autoinjector use. There was a significant relation between adrenaline autoinjector competency and regular allergy visits (p = 0.010), believing that it is necessary (p = 0.04), having an adrenaline autoinjector (p = 0.003), and previous history of severe anaphylaxis (p = 0.010). Autoinjector competency score decreased as time elapsed from the last visit (rho = –0.382; p = 0.002) and the first instruction (rho = –0.317; p = 0.01). Regular visits (p = 0.009) and history of severe anaphylaxis (p = 0.007) were found as independent factors having an effect on adrenaline autoinjector competency. Conclusions: Training of patients/caregivers by allergists does not guarantee the permanence of acquired skills on anaphylaxis in the long run. Regular follow-up visits should be fostered.

Allergic rhinitis may impact the recovery of pulmonary function tests after moderate/severe asthma exacerbation in children

During an asthma exacerbation, pulmonary function test parameters (PFTs) return to their baseline values within a few weeks. Factors affecting the recovery of PFTs other than the severity of exacerbation are not well known.

When should we perform a repeat training on adrenaline auto-injector use for physician trainees?

BACKGROUND Studies demonstrate that both doctors and patients may use adrenaline auto-injector improperly and the usage skills are improved by training. In this study, we aimed to determine the appropriate frequency of training to maintain skills for adrenaline auto-injector use. METHODS We invited all interns of 2011-2012 training period. At baseline, all participants were given theoretical and practical training on adrenaline auto-injector use. The participants were randomly assigned into two groups. We asked those in group 1 to demonstrate the use of adrenaline auto-injector trainer in the third month and those in group 2 in the sixth month. RESULTS One hundred and sixty interns were enrolled. Compared with the beginning score, demonstration of skills at all the steps and total scores did not change for the group tested in the third month (p=0.265 and p=0.888, respectively). However; for the group examined in the sixth month; the demonstration of skills for proper use of the auto-injector at all steps and the mean time to administer adrenaline decreased (p=0.018 and p<0.001, respectively). Besides, the group which was tested in the third month was better than the group which was tested in the sixth month in terms of demonstrating all steps (p=0.014), the total score (p=0.019), mean time of change to administer adrenaline (p<0.001) and presumptive self-injection into thumb (p=0.029). CONCLUSIONS Auto-injector usage skills of physician trainees decrease after the sixth month and are better in those who had skill reinforcement at 3 months, suggesting continued education and skill reinforcement may be useful.

Predictive factors to differentiate between allergic and nonallergic rhinitis in children

Although symptoms and signs of allergic rhinitis (AR) and nonallergic rhinitis (NAR) are similar, treatment and follow‐up are different. We aimed to find predictive factors that can be used in primary health care to differentiate AR from NAR.

Role of hygienic factors in the etiology of allergic disorders in children

BACKGROUND/AIM We investigated the role of body flora and chronic inflammatory infections in the etiology of allergic disorders in Turkish children. MATERIALS AND METHODS Forty pediatric asthma patients with positive skin prick tests and 40 age-matched healthy subjects with negative skin prick tests were enrolled in this cross-sectional study. Serum H. pylori IgG, viral hepatitis serology, IL-10, and TGF-beta levels were measured. Stool and throat cultures were taken and tested for occurrence of microorganisms. RESULTS A significantly higher percentage of nonatopic subjects tested positive for anti-H. pylori antibodies compared to atopic subjects (60% vs. 20%). Serum IL-10 levels were also significantly higher in nonatopic subjects. No significant differences in direct microscopy and culture specimens of stools were observed. Examination of throat flora showed significantly higher occurrences of Neisseria and beta-hemolytic Streptococcus in nonatopic subjects, but higher occurrences of gram-positive bacilli in atopic subjects. CONCLUSION Higher prevalence of anti-H. pylori antibody and higher serum levels of IL-10 in nonatopic subjects suggest that chronic infection and inflammation may protect against atopic disease. Higher occurrences of Neisseria and beta-hemolytic Streptococcus in throat cultures from nonatopic subjects are novel findings that lend further support to the hygiene hypothesis.

Angioedema without urticaria in childhood.

There has been no separate study investigating angioedema without urticaria (Aw/oU) exclusively in children so far. The purpose of this study was to investigate the frequency, clinical presentation, etiology, management and follow‐up of Aw/oU in children.

Comparison of moderate to severe systemic reactions with honeybee and wasp in children.

The effect of the type of Hymenoptera on the severity of systemic reactions (SRs) is a controversial issue. The aim of the present study was to evaluate demographic, clinical, diagnostic, and therapeutic features of moderate‐to‐severe SRs in children with venom hypersensitivity and to compare the role of the honeybee and wasp stings in these reactions.

The Relationship Between Bronchial Hyperreactivity and Asthma Phenotypes in Children Between 3-6 Years Old

Objective: Most of the preschool-age children who have recurrent wheezing episodes are asthmatic and some of them are episodic wheezers. It is not easy to distinguish the asthmatic children among the wheezers based on clinical and laboratory findings. We aimed to differentiate the asthma phenotypes by investigating airway hyperreactivity differences in children between 3-6 years old. Material and Methods: Children who were followed up for recurrent wheezing at the department of Pediatric Allergy and Asthma were included in the study. They were classified as episodic (viral) wheezers and persistent wheezers. Bronchial provocation tests with methacholine and adenosine 5’-monophosphate were performed in both groups. Results: Among the 74 patients, 36.5% (n=27) of the children were episodic and 63.5% (n=47) of the children were persistent wheezers. The number of bronchoconstriction responders to bronchial provocation tests was higher in the persistent wheezers than in the episodic viral wheezers (p<0.001). The methacholine dose that caused a 15% decrease in transcutaneous oxygen pressure (PC15PtcO2) was lower in the persistent wheezers than in the episodic wheezers. The degree of airway hyperresponsiveness was therefore more severe in the persistent wheezers. However, there was no difference between the two groups in terms of the dose of PC15PtcO2 AMP. There was no correlation between the PC15PtcO2 methacholine and PC15PtcO2 AMP in either group. The optimal cut-off to discriminate the episodic and 2 Ünlüsoy Aksu A ve ark.Amac: Okul oncesi yas grubunda, tekrarlayan vizing ataklari olan cocuklarin buyuk bir kismi astimdir. Bu cocuklarin bir kisminda da vizing ataklari gecicidir. Bu cocuklar arasinda, pratikte klinik ve laboratuvar bulgularina dayanarak ayrim yapmak kolay olmamaktadir. Calismada; 3-6 yas arasi, tekrarlayan vizing ataklari olan cocuklarda, hava yolu duyarliligi farklarini arastirarak, fenotipler arasinda ayirici taniya yardimci olabilecek bir parametre bulmayi amacladik. Gerec ve Yontemler: Gazi Universitesi Tip Fakultesi Cocuk Alerji ve Astim Bolumu’nde, tekrarlayan hisilti ataklari nedeniyle izlenen hastalar calismaya dahil edilmistir. Epizodik (viral) vizingli ve persistan vizingli hastalar olarak iki grup olusturulmustur. Her iki gruba metakolin ve adenozin 5’-monofosfat (AMP) ile brons provokasyon testleri uygulanmistir. Bulgular: Yetmis dort hastanin % 36.5’i (n=27) epizodik vizingli, %63.5’i (n=47) persistan vizingli cocuklardir. Brons provokasyon testlerine bronkokonstriksiyon yaniti alinan cocuklarin sayisi; persistan vizing grubunda, epizodik viral vizing grubuna gore daha fazla bulunmustur (p<0.001). Transkutan oksijen basincinda %15’lik azalmaya yol acan (PC 15 PtcO 2 ) metakolin dozunun persistan vizingli cocuklarda, epizodik viral vizingli cocuklara gore daha dusuk olmasi; hava yolu duyarliliginin persistan vizingli cocuklarda daha siddetli oldugunu gostermistir. Ancak PC 15 PtcO 2 AMP dozu acisindan 2 grup arasinda fark saptanmamistir. Her 2 grup icin de, PC 15 PtcO 2 metakolin ve PC 15 PtcO 2 AMP arasinda iliski bulunmamistir. Epizodik ve persistan vizingli cocuklarin ayrimi icin PC 15 PtcO 2 sinir deger, ROC egrisi kullanilarak, metakolin icin %87.2 duyarlilik, %55 secicilik ile 0.24 mg/ml bulunmustur. Pozitif olabilirlik orani (positive LR) 1.94; negatif olabilirlik orani (negative LR) ise 0.23 bulunmustur. Adenozin 5’-monofosfat icin hesaplanan egri altinda kalan alan anlamli bulunmamistir. Sonuc: Direkt (metakolin) ve indirekt (AMP) brons provokasyon testleri; klinik pratikte okul oncesi yas grubunda, astim fenotipine uyan ve uymayan cocuklari belirlemede yeterli degildir.