Yakup Canitez

Anaphylaxis in Turkish children: a multi-centre, retrospective, case study

Anaphylaxis is a serious and potentially lethal systemic reaction affecting more than one organ or system.

Risk factors for wheezing in primary school children in Bursa, Turkey

Background Wheezing is the most common symptom of childhood respiratory tract illnesses. It is important not only for its associated acute morbidity, but also for the fact that early childhood wheezing confers a high risk for asthma. Epidemiological studies from various countries show that 10–15% of children <1 year of age and 25% of children <5 years of age have wheezing-associated respiratory tract illness, and one-third of these children develop asthma later in life. Methods In this retrospective study, we evaluated the association between a history of wheezing and prenatal, postnatal, familial, and environmental risk factors in 858 7-year-old children, randomly selected from seven primary schools in Bursa, Turkey, by means of an easy-to-understand questionnaire form. Among these children, 12.4% had a history of early transient wheezing, 7.1% had persistent wheezing, and 7.7% had late onset wheezing; 72.8% had no wheezing symptoms and 33.3% of children who experienced wheezing during the first 3 years of life had physician-diagnosed asthma. Results Notable risk factors associated with wheezing were as follows: male gender, lower socioeconomic status, premature birth, maternal smoking during pregnancy, bottle-feeding before 2 months of age, dampness and mold at home, hospitalization due to any respiratory illness in infancy, history of croup between 6 months and 5 years of age, frequent upper respiratory infections during the first 3 years of life, allergic eczema in the child, and any allergic disease in the mother or siblings. Conclusion This study shows that the high rates of reported wheezing in the 858 primary school children in Bursa are clearly attributable to important risk factors that have long been recognized and discussed by researchers worldwide, and this suggests that all efforts at primary prevention may be insufficient.

A multicenter survey of childhood asthma in Turkey. II: Utilization of asthma drugs, control levels and their determinants.

Many surveys worldwide have consistently demonstrated a low level of asthma control and under‐utilization of preventive asthma drugs. However, these studies have been frequently criticized for using population‐based samples, which include many patients with no or irregular follow‐ups. Our aim, in this study, was to define the extent of asthma drug utilization, control levels, and their determinants among children with asthma attending to pediatric asthma centers in Turkey. Asthmatic children (age range: 6–18 yr) with at least 1‐yr follow‐up seen at 12 asthma outpatient clinics during a 1‐month period with scheduled or unscheduled visits were included and were surveyed with a questionnaire‐guided interview. Files from the previous year were evaluated retrospectively to document control levels and their determinants. From 618 children allocated, most were mild asthmatics (85.6%). Almost 30% and 15% of children reported current use of emergency service and hospitalization, respectively; and 51.4% and 53.1% of children with persistent and intermittent disease, respectively, were on daily preventive therapy, including inhaled corticosteroids. Disease severity [odds ratio: 12.6 (95% confidence intervals: 5.3–29.8)], hospitalization within the last year [3.4 (1.4–8.2)], no use of inhaled steroids [2.9 (1.1– 7.3)], and female gender [2.3 (1.1–5.4)] were major predictors of poor asthma control as defined by their physicians. In this national pediatric asthma study, we found a low level of disease control and discrepancies between preventive drug usage and disease severity, which shows that the expectations of guidelines have not been met even in facilitated centers, thus indicating the need to revise the severity‐based approach of asthma guidelines. Efforts to implement the control‐based approach of new guidelines (Global Initiative for Asthma 2006) would be worthwhile.

Airborne pollen grains in Yalova, Turkey, 2004

In this study, airborne pollen grains of Yalova province were investigated using VPSS 2000 from January to December 2004. During studying period, a total of 22409 pollen grains/m3 which belonged to 46 taxa and 74 unidentified pollen grains were recorded. From the identified taxa, 26 belong to arboreal and 20 to non-arboreal plants. Total pollen grains consist of 80.50% arboreal, 19.17% non-arboreal plants and 0.33% unidentified pollen grains. In the investigated region, from arboreal plant taxa Platanus spp. (29.08%), Cupressaceae/Taxaceae (21.22%), Pinus spp. (7.34%), Alnus spp. (4.75%), Castanea spp. (3.03%), Quercus spp. (3.07%), Olea spp. (2.50%), Acer spp. (2.21%), Corylus spp. (1.41%) and Fagus spp. (1.15%), and from non-arboreal plant taxa Poaceae (10.01%), Asteraceae (2.86%), Plantago spp. (1.47%) and Artemisia spp. (1.11%) were responsible for the greatest amounts of pollen.

Evaluation of the need for routine preoperative latex allergy tests in children.

Background : Recently, there was a great increase in allergic reactions to latex and this brought relatively more concern to the latex allergy. In this prospective study we aimed to identify the frequency of latex allergy in preoperative patients, and tried to clarify whether it is necessary to perform latex allergy tests routinely in the preoperative period or not.

Health-care conditions in elementary schools and teachers’ knowledge of childhood asthma

Background: For the adequate control of asthma in school-age children, it is recommended that teachers, school health personnel and administrators should have sufficient knowledge of how to manage asthma during school hours. Aim: To investigate asthma health care in elementary schools, and teachers’ knowledge of childhood asthma and its management. Methods: The extent of knowledge of childhood asthma in 2779 teachers in 141 elementary schools (children aged 6–14, grades 1–8) in Bursa, the fourth largest city in Turkey, was evaluated. Section I comprised questions about asthma health-care in schools, Section II teachers’ knowledge of the main characteristics of asthma and Section III (Likert Scale) teachers’ detailed knowledge of the signs, triggering factors, treatment and general knowledge of asthma. Results: The findings of Section I demonstrated that the organisation of health-care for asthma in schools was insufficient. Of the teachers questioned, 14·7% were not even aware and only 1% and 9·6% of the teachers had been made aware by school health personnel and school records, respectively, of asthmatic children. Only 27·3% of the teachers stated that they were responsible for the health of an asthmatic child. The majority of teachers (70%) said that asthmatic children could use the medication (e.g. inhalers) themselves. In Section II, there were between 44·1% and 75·5% correct answers, while in Section III this figure ranged from 3·3% to 78·4%. The correct answer rate was 60·4% for Sections II and III combined. The results of Sections II and III showed that the teachers’ knowledge of asthma was poor in many respects. Teachers who stated that they had asthma or had first-degree relatives with asthma, or those with 10 or more years’ experience provided significantly more correct answers in Sections II and III combined than did those without these characteristics (P<0·001). Conclusions: There is a need to improve and standardise health care for asthma (asthma management policies) in schools. The implementation of asthma education programmes for teachers and other staff responsible for pupils’ health should result in better control of this common disease.

Characteristics and Prognosis of Childhood Atopic Dermatitis: A Multicenter Study in Turkey

Background:Childhood atopic dermatitis (AD) is classically accepted as initial finding of atopic march; however, nonatopic cases do not follow this course. The aim of this study was to determine the characteristics and prognosis of AD in childhood in Turkey. Methods:The study included 531 children with AD that presented to pediatric allergy departments in 11 different regions of Turkey. Age at diagnosis, total serum and inhalant-specific immunoglobulin E (IgE) levels and allergen skin prick test results were recorded retrospectively. Clinical characteristics like additional allergic diseases at presentation or during follow-up were recorded as well as duration of follow-up. Results:Mean age at diagnosis was 37.8 ± 36.2 months. Mean IgE level was 318.3 ± 677.8 IU/ml (median 100 IU/ml). Skin prick tests yielded positive results in 47% of children. At presentation, 31.6% of children reported additional allergic disease, while 11.7% developed allergic disease during follow-up. Among all, 46.6% had additional allergic disease at any point. IgE levels were significantly higher in children with additional allergic diseases (p = 0.001). Allergen skin prick test positivity and family history of allergic diseases increased the risk of additional allergic diseases significantly (OR = 3.90, 95% CI = 2.3–6.6 and OR = 1.89, 95% CI = 1.3–2.8, respectively). Conclusions: Allergic sensitization is not present in all cases of AD. Coexistence of additional allergic diseases is not as high as expected but more common in children who have been demonstrated to have atopic sensitization with high IgE levels and allergen skin prick test positivity.

Bir İl Merkezinde 6-14 Yaş Grubu Çocuklarda ve Ailelerinde Görülen Besin Alerjisi ve Alerjik Hastalıkların Sıklığı

Bu calismada bir il merkezinde secilen 4 okulda okuyan 6-14 yas grubu cocuklarda ve ailelerinde besin alerjisi ve alerjik hastaliklarin sikliginin arastirilmasi amaclanmistir. Tanimlayici tipteki bu calisma Bursa il merkezinde yer alan secilmis 4 okulda gerceklestirilmistir. Bu okullarda 6-14 yas grubunda bulunan toplam 4195 cocuktan 3944 cocugun ebeveyni calismaya katilmayi kabul etmistir (katilim hizi %94’tur). Calismaya katilmayi kabul eden ogrencilerin ebeveynlerine cocuklarinda ve aile bireylerinde gorulen besin alerjisi ve alerjik hastaliklarin sikligini sorgulayan sorulardan olusan bir anket formu uygulanmistir. Calisma icin universite etik kurulundan ve milli egitim mudurlugunden yazili izin alinmistir. Ogrencilerin (n=3944) yasam boyu en az bir kez besin alerjisi bulgulari varligi (yasam boyu veya kumulatif prevalans) %13.4 (529), doktor tarafindan yasam boyu en az bir kez besin alerjisi tanisi konmasi %6.4 (253) olarak saptanmistir. Doktor tarafindan en az bir kez besin alerjisi tanisi konulan cocuklarin %29,6’sinin birinci derece aile yakinlarindan en az birinde (anne, baba, kardesler) besin alerjisi oykusu mevcuttur. Doktor tarafindan yasam boyu en az bir kez besin alerjisi tanisi konulan cocuklarin anne veya babasinda gorulen alerjik hastaliklar sirasiyla besin alerjisi %12,2, astim %10,7, alerjik rinit %9,1, alerjik konjonktivit %5,9, atopik dermatit %5,1; kardeslerindeki alerjik hastalik sikligi astim %10,7, alerjik rinit %9,5, besin alerjisi %9,1, alerjik konjonktivit %4,3 olarak saptanmistir. Bursa’da ailelerin doldurdugu anketlerle tespit edilen doktor tarafindan yasam boyu en az bir kez besin alerjisi tanisi konulan 6-14 yas grubu cocuklarda ve aile bireylerinde gorulen alerjik hastaligi tespit etmeye yonelik yapilan bu calisma alerjik hastalik seyrinde aile oykusunun son derece onemli oldugunu gostermektedir.

Atopik dermatit tanı yaşının ek alerjik hastalık gelişimi üzerine etkisi

Amac: Bu calismada atopik dermatit tanisi almis cocuk hastalarda tani yasinin ek alerjik hastalik ve aeroalerjen duyarliligi gelisimi uzerine etkisinin arastirilmasi amaclanmistir Gerec ve Yontem: Hanifin ve Rajka olcutlerine gore atopik dermatit tanisi konulan 114 cocuk hasta calismaya alindi Tum hastalar tani yasi bakimindan 24 ay alti ve ustu olarak gruplandirildiktan sonra; total serum IgE inhalan spesifik IgE eozinofil katyonik protein ECP duzeyleri deri prik testleri yapildi Izlem suresinde gelisen ek alerjik hastaliklari kaydedildi Bu calisma icin Uludag Universitesi Yerel Etik Kurul izni alindi 2 9 2010 2010 8 12 Bulgular: Tani yasi bakimindan hastalar 24 ay alti ve ustu olarak gruplandirildiginda; 90 hasta 78 9 24 ay altinda 24 hasta 21 1 ise 24 ay uzerinde tani almisti Calisma grubumuzdaki olgularin ortalama tani yasi 14 0 plusmn;21 4 ay olup ek alerjik hastalik gelisimi icin gecen sure 23 8 plusmn;22 3 ay ortalama izlem suresi 58 7 plusmn;41 2 ay en az 8 en fazla 180 ay; ortanca 50 5 ay olarak tespit edildi Yirmi dort ay altinda tani alanlarda ileride astim gelisimi icin anlamli bir fark saptandi p=0 042 Cikarimlar: Erken donemde atopik dermatit bulgulari baslayan olgularda alerjik surecin onlenebilmesi icin ailelerin solunum sistemi ile ilgili alerjik hastaliklar konusunda uyarilmasi ve inhalen alerjenlerden korunmasi bu ilerleyiste bir cozum saglayabilir Turk Ped Arfl 2011; 46: 308 12