Serdar Altinoz

Evaluation of chronic cough in children.

Chronic cough in children is among the problems that lead to frequent consultations with a doctor. In this study, we attempted to research the reasons for chronic cough by an evaluation method using the guidelines that were suggested for children by the American College of Chest Physicians (ACCP) in 2006. We studied 108 children between 6 and 14 years of age who had a cough that lasted for > 4 weeks. The patients were reevaluated during the second to fourth weeks, and until either the cough terminated or resolved. Twenty-five percent of the patients received diagnoses of asthma and asthma-like symptoms, 23.4% received diagnoses of protracted bronchitis, 20.3% received diagnoses of upper airway cough syndrome (UACS), and 4.6% received diagnoses of gastroesophageal reflux disease. Asthma and asthma-like symptoms, protracted bronchitis, and UACS were detected in order of frequency as the reason for chronic cough in children. We concluded that the 2006 ACCP guidelines for the management of chronic cough in children are effective and can be successfully utilized in a nonaffluent study setting.

Nephrocalcinosis in glucose-galactose malabsorption: nephrocalcinosis and proximal tubular dysfunction in a young infant with a novel mutation of SGLT1.

We report an association of proximal renal tubular dysfunction in a 50-day-old girl with glucose-galactose malabsorption who was found to have nephrocalcinosis, but no sign of nephrolithiasis. A novel homozygous nonsense mutation at 267Arg →stop (CGA→TGA) in the Na+-dependent glucose transporter (SGLT1) was found in loop 5 connecting transmembrane segments 6 and 7, indicating the complete loss of glucose transport activity. This case indicates that hypercalcaemia, nephrocalcinosis and proximal tubular dysfunction may be seen in association with glucose-galactose malabsorption and that most of these abnormalities improve with a glucose-galactose-free diet.

Steroid-induced psychosis in a child: treatment with risperidone

Steroid-induced psychosis is one of the most serious adverse effects of steroid therapy but is a little-known complication in children. There is no clear mechanism model for steroid-induced behavioral disturbance, but it may be related with dose or level of free fraction of steroids. Our case is a 12-year-old boy diagnosed with steroid-induced psychosis and treated with risperidone, an atypical antipsychotic, due to distinct psychotic symptoms. Pediatricians should be aware of this rare complication when administering corticosteroids for various medical illnesses.

FcγRIIIa‐V/F 158 polymorphism in Turkish children with asthma bronchiale and allergic rhinitis

Fc receptors (FcR) play an important role in immune regulation. This might be linked to the variability in immune response, therefore relating to the pathogenesis of atopic diseases. The aim of the present study was to evaluate the FcγRIIIa gene polymorphism in Turkish children with asthma and allergic rhinitis. The study included 364 atopic children (184 bronchial asthma, 180 allergic rhinitis) and 234 healthy subjects as the control group, aged between 5 to 16 years. Patients were recruited from outpatient clinics of allergy and general pediatric care. Plasma IgE concentrations were measured by immunoassays and skin prick test was done in children with atopic diseases. The FcγRIIIa gene polymorphism was determined using the polymerase chain reaction method. Distribution of V158V genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 5.33, 95% CI: 2.80–10.23, p < 0.001; for allergic rhinitis OR: 3.25, 95% CI: 1.75–6.07, p = 0.001). Distribution of 158 V allele was significantly different among asthmatic children (OR: 2.20, 95% CI: 1.65–2.92, p < 0.001) and allergic rhinitis patients (OR: 1.77, 95% CI: 1.32–2.35, p < 0.001) compared to healthy controls. Our study shows that the V158V genotype in FcγRIIIa gene polymorphism may be a genetic risk factor for the development of atopic diseases.

FcgammaRIIIa-V/F 158 polymorphism in Turkish children with asthma bronchiale and allergic rhinitis.

Fc receptors (FcR) play an important role in immune regulation. This might be linked to the variability in immune response, therefore relating to the pathogenesis of atopic diseases. The aim of the present study was to evaluate the FcγRIIIa gene polymorphism in Turkish children with asthma and allergic rhinitis. The study included 364 atopic children (184 bronchial asthma, 180 allergic rhinitis) and 234 healthy subjects as the control group, aged between 5 to 16 years. Patients were recruited from outpatient clinics of allergy and general pediatric care. Plasma IgE concentrations were measured by immunoassays and skin prick test was done in children with atopic diseases. The FcγRIIIa gene polymorphism was determined using the polymerase chain reaction method. Distribution of V158V genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 5.33, 95% CI: 2.80–10.23, p < 0.001; for allergic rhinitis OR: 3.25, 95% CI: 1.75–6.07, p = 0.001). Distribution of 158 V allele was significantly different among asthmatic children (OR: 2.20, 95% CI: 1.65–2.92, p < 0.001) and allergic rhinitis patients (OR: 1.77, 95% CI: 1.32–2.35, p < 0.001) compared to healthy controls. Our study shows that the V158V genotype in FcγRIIIa gene polymorphism may be a genetic risk factor for the development of atopic diseases.

Risk of systemic allergic reactions to allergen immunotherapy in a pediatric allergy clinic in Turkey

OBJECTIVES Even though allergen immunotherapy is an effective treatment method that has been used on rhinitis, asthma and venom anaphylaxis for over 100 years, systemic reactions (SRs) limit the use of this treatment method. We classified SRs associated with subcutaneous immunotherapy (SCIT) according to the World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. Risk factors for the SRs were assessed. METHODS In this study 67,758 injections to 1350 children with allergic rhinitis and/or asthma were analyzed throughout January 1999-December 2014. RESULTS A total of 51 systemic reactions were observed in 39 patients (0.075% per injection, %3 per patient). Mean age of SRs observed patients was 13±2.6 years (range 9.5-16 years) and 64.1% were male, 35.9% were female. 51.3% of SRs were grade 1, 38.5% grade 2, 7.7% grade 3 and 2.6% grade 4. SRs were early onset in 41% of the patients and delayed onset in 59%. 76.9% of SRs were seen during maintenance therapy and 56.4% during peak pollen season. In 28.2% of cases previous local reactions and in 30.8% previous grade 1 reactions were determined. There was no fatal outcome from any of the SRs. CONCLUSION SCIT related SRs are generally of mild severity. Although only 10% of the SRs were grade 3 or 4, there is a still a small risk of severe reactions. 76.9% of SRs were observed during maintenance therapy. Delayed-onset SRs rate in our study is 59%. So both clinicians and parents should be alert about the delayed reactions after SCIT.

FcγRIIIa-V/F 158 polymorphism in Turkish children with asthma bronchiale and allergic rhinitis: FcγRIIIa polymorphism in atopic diseases

Fc receptors (FcR) play an important role in immune regulation. This might be linked to the variability in immune response, therefore relating to the pathogenesis of atopic diseases. The aim of the present study was to evaluate the FcγRIIIa gene polymorphism in Turkish children with asthma and allergic rhinitis. The study included 364 atopic children (184 bronchial asthma, 180 allergic rhinitis) and 234 healthy subjects as the control group, aged between 5 to 16 years. Patients were recruited from outpatient clinics of allergy and general pediatric care. Plasma IgE concentrations were measured by immunoassays and skin prick test was done in children with atopic diseases. The FcγRIIIa gene polymorphism was determined using the polymerase chain reaction method. Distribution of V158V genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 5.33, 95% CI: 2.80–10.23, p < 0.001; for allergic rhinitis OR: 3.25, 95% CI: 1.75–6.07, p = 0.001). Distribution of 158 V allele was significantly different among asthmatic children (OR: 2.20, 95% CI: 1.65–2.92, p < 0.001) and allergic rhinitis patients (OR: 1.77, 95% CI: 1.32–2.35, p < 0.001) compared to healthy controls. Our study shows that the V158V genotype in FcγRIIIa gene polymorphism may be a genetic risk factor for the development of atopic diseases.