Çocukluk çağı alerjik astım prognozu: 6 yıllık bir klinik izlem çalışması

Objective: There have been few studies on prognosis and factors influencing the prognosis in children with atopic asthma. We intended to evaluate the prognosis, clinical remission rate, and influencing factors of childhood atopic asthma. Methods: In 72 pediatric patients with atopic asthma who were followed up between 2016 and 2022 with a mean follow-up period of 6.03±2.19 years, demographic characteristics, family history, clinical symptoms, pulmonary function test results, and asthma control test scores were evaluated. Totally controlled patients who had not received any asthma treatment for ≥1 year were considered to be in “clinical remission.” Results: The study group included 72 children with atopic asthma (female/male: 28/44), with a mean age of 13.36±1.98 (8-18) years. 12.5% (n=9) of the patients had uncontrolled asthma, 45.8% (n=33) were partially controlled asthma, 41.7% (n=30) were complete controlled asthma. Clinical remission was seen in 23.6% (n=17) patients with total control. Patients who were symptomatic before the age of three and had a persistent course had a lower clinical remission rate (p=0.05). Conclusion: In our study, the clinical remission rate in atopic asthma in early adulthood was 23.6%. Our results reveal that the clinical remission rate was lower in patients who developed symptoms and had persistent wheezing before the age of three.Amaç: Alerjik astımı olan çocuklarda prognoz ve prognozu etkileyen faktörler üzerine az sayıda çalışma yapılmıştır. Biz çalışmamızda çocukluk çağı alerjik astımının prognozunu, klinik remisyon oranını ve katkıda bulunan faktörleri değerlendirmeyi amaçladık. Gereç ve Yöntem: 2016-2022 yılları arasında ortalama takip süresi 6,03±2,19 yıl olan alerjik astım tanılı 72 pediatrik hastada demografik özellikler, aile öyküsü, klinik semptomlar, solunum fonksiyon testi sonuçları ve astım kontrol testi skorları değerlendirildi. Bir yıldan fazla herhangi bir astım tedavisi almayan kontrollü hastalar “klinik remisyonda” kabul edildi. Bulgular: Çalışma grubuna yaş ortalaması 13,36±1,98 olan 72 alerjik astımlı çocuk (kız/erkek: 28/44) dahil edildi. Astım kontrol durumuna göre hastaların %12,5’i (n=9) kontrolsüz, %45,8’i (n=33) kısmi kontrollü, %41,7’si (n=30) tam kontrollü idi. Tamamen kontrol altına alınan olguların %23,6’sında (n=17) klinik remisyon gözlendi. Üç yaşından önce semptomatik olan ve persistan seyirli hastalarda klinik remisyon oranı daha düşüktü (p=0,05). Sonuç: Çalışmamızda erken çocukluk döneminde alerjik astımda klinik remisyon oranı %23,6 idi. Üç yaşından önce semptomları başlayan ve persistan seyirli olgularda klinik remisyon oranının daha düşük olduğunu saptadık

Adverse drug reactions affecting treatment adherence in first-line treatment of asthma: An observational study

BACKGROUND: Asthma is the most common chronic lung disease among children. International guidelines recommend inhaled corticosteroids (ICS) as the first-line daily controller therapy for children with asthma and leukotriene receptor antagonists (LTRA) as the second alternative therapy. Adherence to treatment is the most significant component to optimize the benefits of therapy in asthma. OBJECTIVE: This study aims to investigate the frequency of drug discontinuation due to adverse drug reactions (ADRs) that affect adherence to treatment in children with asthma or asthma and allergic rhinitis using LTRA or ICS as monotherapy. METHODS: The subjects aged 4-18 years with asthma or asthma and allergic rhinitis and using montelukast or ICS as monotherapy were included in the study. They were evaluated in terms of ADRs affecting adherence to treatment in the first and third months of treatment. RESULTS: A total of 468 cases, 356 of whom received montelukast monotherapy and 112 of whom received ICS treatment, with a mean age of 9.10 ± 3.08 (4-17) years, were included in the study. Males constituted 65.6% of the total cases (n = 307). In the first month of follow-up of the cases, it was observed that 4.8% (n = 17) of the patients in the montelukast group could not continue the treatment due to ADR. It was determined that the drug discontinuation rate in the montelukast group in the first month was significantly higher than in the ICS group (P = 0.016), and the risk of drug discontinuation due to ADR in the montelukast group was 1.333 (95% CI, 1.26-1.40) times higher. CONCLUSIONS: As a result, it was observed that the drug was discontinued due to ADR at a higher rate in children with asthma who received montelukast monotherapy compared to those who received ICS monotherapy

CD4+CD25+CD127loFOXP3+ cell in food allergy: Does it predict anaphylaxis?

Background: Food allergy (FA), hence the incidence of food anaphylaxis, is a public health problem that has increased in recent years. There are still no biomarkers for patients with FA to predict severe allergic reactions such as anaphylaxis. Objective: There is limited information on whether regulatory T (Treg) cell levels are a biomarker that predicts clinical severity in cases presenting with FA, and which patients are at a greater risk for anaphylaxis. Methods: A total of 70 children were included in the study: 25 who had IgE-mediated cow’s milk protein allergy (CMPA) and presented with non-anaphylactic symptoms (FA/A−), 16 who had IgE-mediated CMPA and presented with anaphylaxis (FA/A+) (a total of 41 FA cases), and a control group consisting of 29 children without FA. The study was conducted by performing CD4+CD25+CD127loFOXP3+ cell flow cytometric analysis during resting at least 2 weeks after the elimination diet to FA subjects. Results: When the FA group was compared with healthy control subjects, CD4+CD25+CD127loFOXP3+ cell rates were found to be significantly lower in the FA group (p < 0.001). When the FA/A− and FA/A+ groups and the control group were compared in terms of CD4+CD25+CD127loFOXP3+ cell ratios, they were significantly lower in the FA/A− and FA/A+ groups compared to the control group (p < 0.001). Conclusions: Although there was no significant difference between the FA/A+ group and the FA/ A− group in terms of CD4+CD25+CD127loFOXP3+ cells, our study is important, as it is the first pediatric study we know to investigate whether CD4+CD25+CD127loFOXP3+cells in FA p redict anaphylaxis

Prevalence of allergic rhinitis and risk factors in school children

Objective: To evaluate the prevalence and the risk factors of allergic rhinitis in a particular area. Methods: The main study group consisted of all school children in Kemalpasa district aged 13-14 years. Children with current rhinitis based on responses given in ISAAC questionnaire survey were further evaluated for confirmation. Parents responded to a more detailed questionnaire about allergic diseases and risk factors. Then peak nasal inspiratory flow (PNIF) was evaluated to objectively assess nasal patency. Skin-prick test was performed for ten common allergens. Results: The questionnaire was answered by 90.8% (1373) of children. The prevalence of physician-diagnosed AR was 11.1%. Current rhinitis was found to be 31.3%. Of this group, 55.0% were admitted for the parent questionnaire and tests. Precisely, 90.3% of children accepted PNIF evaluation, and %10.1 of them had a nasal obstruction. Skin-prick tests revealed allergy for at least 1 allergen in 16.6% of children. The present study showed that the children with maternal allergic rhinitis history had 2,18 fold, and the children with seasonal allergic rhinitis had 2,11 fold higher possibility of sensitization to an allergen. The probability of perennial allergic rhinitis was 3,1 fold higher in the children who had siblings with allergic rhinitis. Conclusion: We included all children in a specific age group living in an area in our survey. As well as we found the prevalence of current rhinitis with the ISAAC questionnaire; we also evaluated peak nasal inspiratory flow and used skin-prick tests that yielded objective results

Characteristics of the patients followed with the diagnosis of common variable immunodeficiency and the complications

Introduction: In this study, we aimed to retrospectively evaluate the clinical and laboratory findings and complications of 28 common variable immunodeficiency (CVID) patients. Material and methods: The clinical features and laboratory data of 28 CVID patients were evaluated. Results: Nineteen patients were male. In 53.5% of the cases, complications included inflammatory bowel disease, cytopenia, bronchiectasis, granulomatous lymphocytic interstitial lung disease (ILD) and asthma. In their immunological evaluations, IgG, IgM, and IgA mean values were 474.8 ±214.1 mg/dl; 56.7 ±41.9 mg/dl; 35.3 ±58.2 mg/dl, respectively, and the vaccine response was positive in 64.2% of the cases. In all age groups, absolute lymphocyte counts, naive (CD19+IgD+27-), nonswitch (CD19+IgD-27+) memory B cells were numerically higher when compared to the data of healthy children; however, although switch memory (CD19+IgD+27+) B cells were proportionally low in the 4-8 and 12-18 age groups, they were low both numerically and proportionally in the 8-12 age group. No statistically significant difference was found between the cases with complications and without complications. But the cases with pulmonary complications were compared within the group, the CD8 ratio was high but the IgA level was low in patients with bronchiectasis and CD3 was numerically and proportionally low in the cases with ILD compared to others. According to the Paris classification, 11/27 (40.7%) of the cases, 3/27 (11.1%) of them and 13/27 (48.2%) of them were evaluated as MB0, MB1, and MB2, respectively. Conclusions: In genetic studies, TACI (trans-membrane activator and calcium-modulating cyclophilin ligand interactor – TNFRSF13B) mutation was found positive in 25% of the cases

The clinical spectrum of reactions developed based on paraphenylenediamine hypersensitivity two pediatric cases

WOS: 000365404500012PubMed ID: 26759549Paraphenylenediamine (PPD) is a blue-black aniline dye commonly used in hair dyes. It is also used in textile and fur dyes, wool dye, dark cosmetics, temporary tattoo hennas, photo baths, and photocopy and printing ink. Paraphenylenediamine, which accelerates the absorption of hair dye and henna tattoos by the skin and helps the formation of the black color, is an allergen. Paraphenylenediamine leads to hypersensitivity reactions, involving allergic and irritant contact dermatitis [1–3]. Since tattoo and hair dyes are now frequently used in younger children, complications of these applications (which are considered harmless and temporary) are appearing in children. In this study, two pediatric patients who presented to our department with clinical symptoms similar to angioedema and allergic contact dermatitis are discussed

Inherited classical and alternative pathway complement deficiencies in children: A single center experience

Background: Primary complement deficiencies are rare diseases. Objective: To retrospectively evaluate the clinical and laboratory findings and complications of patients to increase awareness of pediatricians about complement deficiencies, which are rarely encountered. Methods: In this study, the clinical and immunological characteristics of 21 patients who consulted the Immunology Department of our hospital between 2003 and 2017 and were diagnosed with classical or alternative pathway complement deficiency were obtained from the file records. Results: Ten patients with C1 inhibitor deficiency, four patients with factor I deficiency, three patients with properdin deficiency, two patients with C8 deficiency, one patient with C1q deficiency, and one patient with C4B deficiency were assessed. The mean age of the patients at diagnosis was 11.4±4.7 years, the age of onset of symptoms was 7.9±3.9 years, and the follow-up period was 6.7±3.9 years. Fourteen cases had a similar medical history in the family. All patients with C1q, factor I, properdin, C8, and C4B deficiencies presented with an infection, and vasculitic rash was present in two patients with factor I deficiency. In addition, immune complex glomerulonephritis was present in one patient with factor I deficiency. Meningococcal, Haemophilus influenzae type B, and pneumococcal vaccines were administered and prophylactic antibiotic treatment was initiated in all patients except patients with C1 inhibitor deficiency. Conclusions: Early diagnosis of complement deficiencies can facilitate prevention of life-threatening complications such as severe bacterial infections by considering prophylactic antibiotics and vaccines. In patients with C1 inhibitor deficiency, achieving an acurate early diagnosis will assist in the management and timely treatment of life-threatening attacks such as upper airway obstruction and improve outcomes

Markers of inflammation and tolerance development in allergic proctocolitis

WOS: 000428743500010PubMed ID: 29333812Background. Today, as a result of an increase in the frequency of food protein-induced allergic proctocolitis (FPIAP), there is a need for studies not only to enlighten the pathophysiology of the disease but also to determine simple, non-invasive markers in both diagnosis, and evaluation of the development of tolerance. No study has been found in the literature about the place of neutrophil/ lymphocyte ratio (NLR) and mean platelet volume (MPV), which are easy to calculate and non-invasive markers. Objectives. The purpose is to determine the relation between NLR and MPV with the diagnosis and development of tolerance in children with FPIAP. Methods. In this retrospective cross-sectional study, clinical, demographic symptoms and laboratory findings of patients, monitored with FPIAP diagnosis in allergy and gastroenterology clinics, were acquired from the patient record system. Hemogram values at the time of diagnosis were compared with the values of healthy children of the same age and gender. Results. Among 59 patients diagnosed with FPIAP, males constitute 47.4% and females constitute 52.6%. MPV and platelet crit (PCT) values were significantly high when compared to the control group (n:67) in FPIAP cases (p <0.001). Also, MPV and PCT values were significantly high in non-tolerance developing cases when compared to developing ones (p=0.01). Conclusions. Contrary to NLR, MPV and PCT values have been considered to be good markers in predicting prognosis in cases with FPIAP since they are quick, cost effective and easy to calculate