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

The relationship between ABO and rh blood types and cow’s milk protein allergy

Objective: Cow’s milk protein allergy (CMPA) is the most common type of food allergy among infants. Several studies have found an association between ABO blood types and allergies such as allergic rhinitis, asthma, and atopic dermatitis, but the role of blood type differences in cases of IgE-mediated CMPA and food protein-induced-allergic proctocolitis (FPIAP) is not known yet. Methods: A total of 100 patients born in our hospital approximately 2017-2021 and followed up in our Paediatric Allergy Clinic with the diagnosis of IgE-mediated CMPA and FPIAP, and as the control group, 259 children born in our hospital who had no family history of atopy and no signs of allergic disease in the follow-up were included in the study. Blood types of healthy children, and those with IgE-mediated CMPA and FPIAP diagnosis were compared. Results: One hundred patients with CMPA were included in the study. The mean age of these patients was 10.8 months, and 49% (n=176) were male. 57% of the patients were followed up with a diagnosis of IgE-mediated CMPA and 43% with FPIAP. Familial atopy accompanied 23% (n=23) of the cases with CMPA. There was no statistically significant difference between the distribution of ABO and Rh blood types between the cases with CMPA and the control group (p>0.05). Additionally, there was no significant difference in blood type comparisons of the cases followed up with the diagnosis of IgE-mediated CMPA and FPIAP (p>0.05). Conclusion: As far as we know, this is the first study of investigating the relationship between the blood type distribution of patients with CMPA and healthy subjects. To comprehend the role of blood type in the pathogenesis of CMPA and investigate the effect of blood types on tolerance development in CMPA cases, we think prospective studies with wider groups are necessary

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

Yenidoğan döneminde akut ürtiker ile prezente olan inek sütü proteini alerjisi

Urticaria is a common disease in children. But there are few case reportsin neonatal period. Urticaria has many causes, unfortunately it cannotbe figured out in some of the cases. Drug and food allergies, infectionsare common reasons that have been commonly shown. IgE-mediatedfood allergy should be considered in patients with acute urticaria and/orangioedema after food intake. Here we present a case of acute urticariadue to cow’s milk protein allergy in the newborn period. A 21-day-old malepatient was admitted to our emergency department with the complaintof widespread rash on the body which started one day earlier. Medicalhistory has revealed that he did not have a different drug intake beforethe onset of complaints, had no previous rashes, upper respiratory tractinfection or other infective-inflammatory disease since birth. His parentsdid not admit to another hospital. We obtained blood tests for food allergy.Total IgE: 38 IU/L and cow’s milk protein-specific IgE (f2): 2.26 kU/Lwere found to be suspicious for food allergy. According to these results,the formula which the baby was treated before has been stopped andextensively hydrolyzed formula has been started. After 12 hours, urticariahad started to fade. While going on our treatment, on 5th day the urticarialesions totally disappeared. Although urticaria is a common disease, it israrely reported in patients under six months. We want to emphasize thatfood allergies may be considered in cases presenting with urticaria inneonatal period.Ürtiker, küçük çocuklarda çok sık görülen medikal bir problemdir. Yenidoğan döneminde ise az sayıda olgu bildirimi vardır. Ürtikerin birçok olguda nedeni bulunamasa da oldukça fazla nedeni vardır. Daha çok gıda alerjisi, ilaç etkisi veya enfeksiyonlara bağlı meydana geldiği gösterilmiştir. Besin alımı sonrası akut ürtiker ve/veya anjioödem görülen hastalarda IgE aracılı besin alerjisinin olabileceği mutlaka akla getirilmelidir. Bu yazıda ise yenidoğan döneminde inek sütü proteini alerjisine bağlı gelişen akut ürtiker olgusı sunulmuştur. Yirmi bir günlük erkek hasta acil servisimize 1 gün önce başlayan vücuttaki yaygın döküntü şikayeti ile başvurdu. Hastanın öyküsünde şikayetleri başlamadan önce farklı bir ilaç alımı olmadığı, daha önce döküntülerinin olmadığı, doğumundan bu yana üst solunum yolu enfeksiyonu veya başka bir enfektif-enflamatuvar hastalık geçirmediği ve başka bir tıbbi kuruma başvurmadıkları öğrenildi. Hastanın besin alerjisi şüphesi açısından alınan tetkiklerinde Total IgE: 38 IU/L, süt spesifik IgE (f2): 2,26 kU/L olarak saptandı. Bu sonuçlara göre olgunun almış olduğu formüla mama kesilerek ileri derece hidrolize formüla başlanıldı. İzlemde olgunun 12 saat sonra vücuttaki döküntülü lezyonlar solmaya başladı ve tedavisinin 5. gününde tüm lezyonları düzeldi. Ürtiker, sık görülen bir hastalık olsa da 6 aydan küçük olgularda nadir olarak bildirilmektedir. Yenidoğan döneminde ürtiker tablosu ile başvuran olgularda besin alerjisi olabileceğinin akılda tutulması gerektiğini vurgulamak için olgumuz sunulmuştur

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

Over restrictive elimination of foods in children with foodallergy

Background. Previous studies demonstrated critical deficits in diagnosis and management of childhood foodallergy (FA), and recent developments in FA research support adopting a proactive approach in FA management.Our objective was to describe FA knowledge and management patterns of pediatricians.Method. We applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatricgastroenterologists practicing in Turkey.Results. Some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falselyrecognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively.By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Mostfrequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test(1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%,respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foodswere 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and >10 foods were 28%, 25% from thematernal and infant diet, respectively. Cow’s milk, cheese, butter, yoghurt, baked milk products and hen’s eggwere the most commonly restricted items.Conclusion. Overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approachwhen advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immunetolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus onemphasizing the deleterious effects of injudicious and extensive eliminations

Garlic allergy: A rare cause of anaphylaxis in infants

Food allergy is seen in 5-10 % of the children in developed countries but garlic allergy is a rare condition. A case having anaphylaxis after consumption of garlic is presented in this report. After the history of consumption of yoghurt flavored with garlic, the 16-month-old male patient presented to the emergency room with diffuse erythema and itching on his body, swelling on the eye lids and lip, vomiting, cough and wheezing complaints, and was intervened with the diagnosis of anaphylaxis. Six weeks after the anaphylaxis episode with garlic, the result of the skin prick test with raw garlic was positive (11x8 mm induration). The garlic serum IgE level was determined as 11 kU/L. Patients with garlic allergy should be informed about cross-reactions in terms of other food such as onion, leek and asparagus which are in the same family (Liliaceae family). Although is a rare condition, this case is presented to emphasize the probability of anaphylaxis due to garlic consumption

Ever increasing allergies to the edible seeds in recent years: Sesame allergy

Amaç: Susam, önemli alerjenitesi ve hipersensitivitesi ile diğer tohum allerjilerinden daha sık görülmekteolup; prevalansı %0,1-0,2 olarak tahmin edilmektedir. Tohum alerjileri konusunda çocuklarda yapılmışçalışmalar oldukça sınırlı olup daha çok vaka takdimi şeklindedir. Çalışmamızda susam alerjisi olan olguların klinik ve laboratuvar özelliklerinin değerlendirilmesi amaçlandı.Yöntem: Kesitsel tanımlayıcı çalışmamızda Şubat 2017-Haziran 2019 tarihleri arasında çocuk alerji polikliniğine başvuran 3863 hasta içerisinde, besin alerijsi ve/veya atopik dermatit tanısı ile değerlendirilen 804(%20,8) hastanın dosyaları retrospektif olarak incelendi. Susam alerjisi olduğu saptanan 7 (%0,87) olgunundemografik özellikleri, başvuru yakınmaları ve laboratuvar incelemeleri kaydedildi.Bulgular: Çalışmaya dahil edilen 7 hastanın yaş ortancası 11 ay olup, tamamı erkek idi. Hastalarımızınhepsinde atopik dermatit bulguları olup, 1 hastamızda eşlik eden inek sütü proteini ilişkili anafilaksi tablosu mevcut idi. Hastaların eozinofil sayısı ortancası; 780 mm3, total IgE düzeyi ortancası; 264 IU/L, susamspesifik IgE düzeyi ortancası 2,7 kU/L idi.Sonuç: Son yıllarda susam gibi tohumların günlük beslenme programımızda kullanımının artmasıyla birlikte tohumlarla ilgili hipersensitivite reaksiyonları giderek artan oranlarda bildirilmektedir. Ülkemizde sıktüketilmeleri nedeniyle önem taşımaktadır. Dikkatli öykü alımı, besin alerjileri test panellerine yenilebilirtohum-çekirdeklerin eklenmesi ve şüpheli olgularda tanıların besin yükleme testleri konfirmasyonları ilesusam alerjilerinde tanı konma oranlarının artabileceğini düşünmekteyiz.Objective: While being seen more often than the other seeds, prevalence of sesame allergy has been estimated to be 0.1-0.2 %. There have been limited studies about sesame allergy in children, and it is frequently in the form of case reports. In our study, evaluating clinical and laboratory features in cases with sesame allergy was aimed.Method: In our cross sectional-descriptive study, a retrospective review of 804 (%20.8) children who received evaluation by the diagnosis of food allergy and/or atopic dermatitis in a population of 3863 patients applied to the pediatric allergy outpatient clinic from February 2017 to June 2019 has been conducted. Information including the demographic characteristics, presenting symptoms and laboratory examinations of 7 patients (0.87%) with sesame allergy were recorded.Results: The median age of 7 patients who were included in the study was 11 months and all were males. All the patients had symptoms of atopic dermatitis, there was accompanying anaphylaxis related to Cow's Milk Protein Allergy in one patient. Among the patients; median eosinophil count was:780/mm(3), median total IgE level was: 264 IU/L, median sesame specific IgE level was: 2.7 IU/L.Conclusion: With the growing trend of using seeds such as sesame in our daily diet, hypersensitivity reactions are being reported with ever increasing rates Because of its frequent consumption, it carries importance in our country. A careful history taking, together with inclusion of edible seeds in food allergy testing panels and confirmation of diagnosis by challenge testing in the suspected cases may be contributing to the rise in the frequency of diagnosing sesame allergy