Serap Özmen

Tuberculin responses in children with allergic diseases.

Background: The prevalence of allergic disorders has been increasing over the last 30 years, especially in developed countries. One factor associated with this rise may be the decline of many childhood infections. We investigated tuberculin responses in allergic children in order to see the development of delayed‐type hypersensitivity reactions to tubercule bacillus infection.

Evaluation of allergic sensitization and gastroesophageal reflux disease in children with recurrent croup

Background:  Croup, which is seen commonly in childhood, is a disorder that can be recurrent and progress to bronchial asthma. In the present study the prevalence of gastroesophageal reflux (GER) and atopy and the response to therapy were investigated in children with recurrent croup.

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.

Is acute generalized exanthematous pustulosis an uncommon condition in childhood

teroids were less used in the mild group. The modified classification proposed by Van Hoecke et al. (2) applied to the French general population appeared to be less relevant than the one proposed by ARIA and does not seem to simplify the correlation between symptoms severity and treatment. Even if some statistical differences were observed, mainly because of the very large sample size, no clear clinically relevant trends were observed that could support the need for a distinction between mild, moderate and severe patients. Missing data have probably not affected the results as no differences have been found for the main parameters between this selected population and the original one. Another limitation might be the low proportion of patients with mild AR. However, as the objective of the study was the differentiation between moderate and severe AR, this should not have induced any important bias. In another article of the same group (4), 89% of 431 patients considered the severity of their symptoms on a visual analogue scale as moderate to severe. These scale scores were perfectly correlated with specific quality of life scores. Bousquet et al. (5) found similar results in a study on 3052 patients seen in primary care and suffering from AR for at least 3 years. Although the debate does not seem to be closed, we have shown here that the ARIA severity classification is still valid, supporting the decision of the ARIA update (6).

Perceptions of Parents and Physicians Concerning the Childhood Asthma Control Test

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.

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.

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.