Asian Pacific journal of allergy and immunology, Jan 16, 2016
Despite the increasing frequency of anaphylaxis, there is inadequate information on the etiology ... more Despite the increasing frequency of anaphylaxis, there is inadequate information on the etiology and clinical features in various countries, regions and age groups, especially in developing countries. Our aim is to assess the etiology and clinical findings of anaphylaxis in Turkey. Gathering reliable data about the etiology and clinical findings of anaphylaxis in the general population will decrease the related morbidity and mortality. We obtained the names and phone numbers of individuals who had been prescribed an epinephrine auto-injector with a diagnosis of anaphylaxis from ministry of health. Demographic data, clinical history of the first episode of anaphylaxis including the triggering agent, clinical findings, course of hospitalization, and the management of anaphylaxis were obtained by phone survey. A total of 843 patients with a mean age of 21.4±17.3 years were evaluated. There was a significant male predominance among children younger than 10 years of age but a female pred...
Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2012
Reliable assessment of asthma control is essential for effective treatment. Although several meth... more Reliable assessment of asthma control is essential for effective treatment. Although several methods are used to assess asthma control, it is still suboptimal all over the world. Childhood asthma control test (C-ACT) is a widely used complementary test in determining the level of asthma control in conjunction with GINA guidelines. To evaluate the consistency between the childhood asthma control test (C-ACT) and the Global Initiative for Asthma (GINA) guideline-based asthma control measure in children with asthma and, if present, to investigate the reasons for any discrepancy. Patients and their caregivers filled a C-ACT and a socioeconomic status survey before the physician visit. Asthma control level was also assessed according to GINA criteria by a pediatric allergist who was blinded to C-ACT scores. The mean age of the total 314 patients was 9.0 ± 1.9 yr, ranging between 4.3 and 11.8 yr, of whom 56.1% (n = 176) were men. Regarding the study group, 54.8% of patients were controlle...
The aim of this study was to evaluate the risk factors of disease severity to facilitate better m... more The aim of this study was to evaluate the risk factors of disease severity to facilitate better management of children with severe atopic dermatitis (AD). All the patients were diagnosed using Hanifin-Rajka criteria. After medical and family histories were obtained and a detailed physical examination was performed, disease severity was determined with the objective SCORing Atopic Dermatitis (SCORAD) index. Skin prick tests were performed, and percent of peripheral blood eosinophils, total serum IgE and specific IgE were measured. The median age of the 501 patients was 15 months (interquartile range [IQR]: 6-40 months), and 62.9% (315) were male. Sensitization to at least one allergen and foods was observed in 40.3% (202) and 30.9% (155) of all patients, respectively. Of the study group, 17.6% (88) had severe disease. When logistic regression analyses were performed, with adjustments, the risk factors for severe AD were determined to be eosinophilia (odds ratio [OR] 1.137, 95% confid...
Background Because of the rise in the frequency, food allergies (FA) and consequently anaphylaxis... more Background Because of the rise in the frequency, food allergies (FA) and consequently anaphylaxis (A) are becoming public health problems. The conciousness about prevention, diagnosis and therapy has to be improved, especially among primary care physicians ( ...
Vitamin D is believed to affect the progression and severity of atopic dermatitis (AD). Allergic ... more Vitamin D is believed to affect the progression and severity of atopic dermatitis (AD). Allergic sensitization may cause this effect to vary. Individuals who fulfilled the Hanifin and Rajka criteria for AD underwent epidermal prick tests and blood tests for specific immunoglobulin E(IgE), serum total IgE, 25-hydroxy vitamin D, and peripheral blood eosinophil count and percentage. Disease severity was determined according to the Scoring Atopic Dermatitis (SCORAD) index. Patients were grouped according to allergic sensitization. Seventy-three children with AD (median age 33.0 mos, interquartile range 19.0-61.5 mos) were enrolled in the study; 33 (45.2%) were found to have allergic sensitization. In this group there was a negative correlation between SCORAD score and serum vitamin D level (p = 0.047, correlation coefficient [r] = -0.349), whereas there was no correlation in the group without sensitization (p = 0.30, r = -0.168). Vitamin D was not correlated with total IgE and eosinophil percentage in either AD group (p = 0.77, r = 0.054 and p = 0.73, r = -0.062, respectively). Vitamin D may affect the severity of AD, especially in children with allergic sensitization.
In this study, our goal is to evaluate the consistency between TRACK and the asthma control level... more In this study, our goal is to evaluate the consistency between TRACK and the asthma control levels assessed according to the GINA and NAEPP guidelines in children younger than 5 years of age. Patients under 5 years old, who were followed up for recurrent wheezing for at least 1 year have been included. Parents were given the TRACK questionnaire and the control level of asthma according to GINA and NAEPP guidelines were determined by a pediatric allergist blinded to TRACK scores. Patients were classified into two groups regarding the compatibility of the control level between TRACK and both GINA and NAEPP guidelines. A total of 365 questionnaires were evaluated. The TRACK cut-off point of 80 provided the most consistent balance between sensitivity and specificity for the compatibility with both GINA and NAEPP (for GINA 0.763 and 0.663, kappa = 0.487, p < 0.001 and for NAEPP 0.761 and 0.769, kappa = 0.524, p < 0.001, respectively). When 80 was taken as the cut-off value for TRACK, the compatibility rate of asthma control levels between TRACK and GINA and TRACK and NAEPP was 71.0 and 76.4%, respectively. About 70.1% of the patients who had TRACK scores over 80 and had mild asthma were grouped as controlled according to GINA and 50.0% of patients who had TRACK scores over 80 and had moderate to severe asthma was grouped as uncontrolled according to GINA (p = 0.019). TRACK is compatible with NAEPP and GINA in majority of asthmatic children under 5 years of age. Nevertheless, there is a discrepancy between guidelines and TRACK scores; therefore, it should be used in conjunction with a detailed clinical examination in order to make a better decision for assessing the control levels and management plan.
International Archives of Allergy and Immunology, 2013
Several studies have demonstrated a relationship between asthma and obesity. However, the results... more Several studies have demonstrated a relationship between asthma and obesity. However, the results have been conflicting with regard to the relationship between fractional exhaled nitric oxide (FeNO), used as a marker of airway inflammation in asthmatic patients, and obesity. We aimed to evaluate the association of FeNO with obesity and obesity-related metabolic complications in asthmatic and nonasthmatic children. The study population included children aged between 6 and 17 years and consisted of 4 groups: obese asthmatics (n = 52), normal-weight asthmatics (n = 49), obese nonasthmatics (n = 51) and normal-weight nonasthmatics (n = 42). FeNO measurement and spirometry were performed for all patients. To evaluate the metabolic complications, serum lipids, glucose and insulin levels were measured. Insulin resistance (IR) was estimated by the homeostasis model assessment, HOMA-IR. All participants were evaluated for the presence of metabolic syndrome (MS). The mean age for the 194 subjects participating in the study was 11.6 ± 2.5 years. The FeNO level of asthma patients with MS was not different from those without MS (14.5 ± 8.0 and 16.7 ± 8.7, respectively, p = 0.449). In the nonasthmatic group, subjects with MS had a higher FeNO level than subjects without MS (12.5 ± 5.1 and 17.3 ± 8.3, respectively, p = 0.014). Spearman's rank correlation coefficients revealed a positive correlation between FeNO and body mass index (BMI; p = 0.049, r(2): 0.204) in the nonasthmatic group and after multivariate regression analysis, BMI still persisted as an independent risk factor for FeNO. We found a positive correlation between BMI and FeNO level which suggests a link between obesity and increased airway inflammation in nonasthmatic children.
Drug provocation tests (DPTs) are gold standard to diagnose drug allergy. Our goal was to evaluat... more Drug provocation tests (DPTs) are gold standard to diagnose drug allergy. Our goal was to evaluate the results and safety of diagnostic methods including DPTs during childhood. Between January 2010 and February 2013 DPTs were performed and evaluated, prospectively, in children who attended our pediatric allergy clinic with a suspected drug hypersensitivity reaction. One hundred ninety-eight suspected drug reactions in 175 patients (88 boys and 87 girls) were evaluated. The median age of the subjects at the time of the suspected drug-induced hypersensitivity reaction and at the time of the study was 56 (interquartile range [IQR] = 24-120 months) months and 76 (IQR = 35-149 months) months, respectively. Suspected drugs were beta-lactam antibiotics in 108 cases (54.5%), non-beta-lactam antibiotics in 22 cases (11.1%), and nonsteroid anti-inflammatory drugs in 52 cases (26.3%). The history was compatible with immediate-type reactions in 69 cases (34.8%). Skin-prick tests were not positive in any of the cases. Intradermal tests were positive in three cases (4%). DPTs were positive in 13 (6.8%) of 191 provocation cases, which were performed with culprit drugs. Our results suggest that a positive clinical history is not enough to make a diagnosis of drug allergy, which highlights the significance of undertaking further diagnostic evaluation especially for DPTs.
Anaphylaxis is a potentially life-threatening condition. There are limited data about the etiolog... more Anaphylaxis is a potentially life-threatening condition. There are limited data about the etiology and the clinical characteristics in developing countries. This study aimed to investigate the clinical characteristics of anaphylaxis patients attending our pediatric allergy clinic. We conducted a prospective analysis of patients who were admitted to our allergy clinic for anaphylaxis from 2010 to 2012. Ninety-six patients were evaluated during the study period. The mean age was 7.4 ± 5.2 years. Venom, food, and drugs were the most common causative agents responsible for 31 (32.3%), 30 (31.3%), and 26 (27.1%) of the cases, respectively. Foods implicated most frequently were peanuts and nuts (n = 9; 30.0%), cow's milk (n = 7; 23.3%), and egg white (n = 6; 20.0%). The clinical manifestations during anaphylaxis in order of frequency were cutaneous (97.9%), respiratory (86.5%), gastrointestinal (42.7%), neurological (37.5%), and cardiovascular symptoms (30.2%). A biphasic course was noticed in five cases (5.2%). Of the 91 patients, 79 (86.8%) received H1-antihistamines, 73 (80.2%) received corticosteroids, 40 (44.4%) received adrenaline, 38 (41.8%) received fluid replacement therapy, 18 (19.8%) received β2-mimetics, and 8 (8.8%) received H2-antihistamines. According to severity, 7.3% of patients had mild, 59.4% had moderate, and 33.3% had severe anaphylaxis. Food and bee venom allergy were the most common etiologies. Adrenaline, the first-line treatment of anaphylaxis, was administered in only 44.4% of our cases.
Asian Pacific journal of allergy and immunology, Jan 16, 2016
Despite the increasing frequency of anaphylaxis, there is inadequate information on the etiology ... more Despite the increasing frequency of anaphylaxis, there is inadequate information on the etiology and clinical features in various countries, regions and age groups, especially in developing countries. Our aim is to assess the etiology and clinical findings of anaphylaxis in Turkey. Gathering reliable data about the etiology and clinical findings of anaphylaxis in the general population will decrease the related morbidity and mortality. We obtained the names and phone numbers of individuals who had been prescribed an epinephrine auto-injector with a diagnosis of anaphylaxis from ministry of health. Demographic data, clinical history of the first episode of anaphylaxis including the triggering agent, clinical findings, course of hospitalization, and the management of anaphylaxis were obtained by phone survey. A total of 843 patients with a mean age of 21.4±17.3 years were evaluated. There was a significant male predominance among children younger than 10 years of age but a female pred...
Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2012
Reliable assessment of asthma control is essential for effective treatment. Although several meth... more Reliable assessment of asthma control is essential for effective treatment. Although several methods are used to assess asthma control, it is still suboptimal all over the world. Childhood asthma control test (C-ACT) is a widely used complementary test in determining the level of asthma control in conjunction with GINA guidelines. To evaluate the consistency between the childhood asthma control test (C-ACT) and the Global Initiative for Asthma (GINA) guideline-based asthma control measure in children with asthma and, if present, to investigate the reasons for any discrepancy. Patients and their caregivers filled a C-ACT and a socioeconomic status survey before the physician visit. Asthma control level was also assessed according to GINA criteria by a pediatric allergist who was blinded to C-ACT scores. The mean age of the total 314 patients was 9.0 ± 1.9 yr, ranging between 4.3 and 11.8 yr, of whom 56.1% (n = 176) were men. Regarding the study group, 54.8% of patients were controlle...
The aim of this study was to evaluate the risk factors of disease severity to facilitate better m... more The aim of this study was to evaluate the risk factors of disease severity to facilitate better management of children with severe atopic dermatitis (AD). All the patients were diagnosed using Hanifin-Rajka criteria. After medical and family histories were obtained and a detailed physical examination was performed, disease severity was determined with the objective SCORing Atopic Dermatitis (SCORAD) index. Skin prick tests were performed, and percent of peripheral blood eosinophils, total serum IgE and specific IgE were measured. The median age of the 501 patients was 15 months (interquartile range [IQR]: 6-40 months), and 62.9% (315) were male. Sensitization to at least one allergen and foods was observed in 40.3% (202) and 30.9% (155) of all patients, respectively. Of the study group, 17.6% (88) had severe disease. When logistic regression analyses were performed, with adjustments, the risk factors for severe AD were determined to be eosinophilia (odds ratio [OR] 1.137, 95% confid...
Background Because of the rise in the frequency, food allergies (FA) and consequently anaphylaxis... more Background Because of the rise in the frequency, food allergies (FA) and consequently anaphylaxis (A) are becoming public health problems. The conciousness about prevention, diagnosis and therapy has to be improved, especially among primary care physicians ( ...
Vitamin D is believed to affect the progression and severity of atopic dermatitis (AD). Allergic ... more Vitamin D is believed to affect the progression and severity of atopic dermatitis (AD). Allergic sensitization may cause this effect to vary. Individuals who fulfilled the Hanifin and Rajka criteria for AD underwent epidermal prick tests and blood tests for specific immunoglobulin E(IgE), serum total IgE, 25-hydroxy vitamin D, and peripheral blood eosinophil count and percentage. Disease severity was determined according to the Scoring Atopic Dermatitis (SCORAD) index. Patients were grouped according to allergic sensitization. Seventy-three children with AD (median age 33.0 mos, interquartile range 19.0-61.5 mos) were enrolled in the study; 33 (45.2%) were found to have allergic sensitization. In this group there was a negative correlation between SCORAD score and serum vitamin D level (p = 0.047, correlation coefficient [r] = -0.349), whereas there was no correlation in the group without sensitization (p = 0.30, r = -0.168). Vitamin D was not correlated with total IgE and eosinophil percentage in either AD group (p = 0.77, r = 0.054 and p = 0.73, r = -0.062, respectively). Vitamin D may affect the severity of AD, especially in children with allergic sensitization.
In this study, our goal is to evaluate the consistency between TRACK and the asthma control level... more In this study, our goal is to evaluate the consistency between TRACK and the asthma control levels assessed according to the GINA and NAEPP guidelines in children younger than 5 years of age. Patients under 5 years old, who were followed up for recurrent wheezing for at least 1 year have been included. Parents were given the TRACK questionnaire and the control level of asthma according to GINA and NAEPP guidelines were determined by a pediatric allergist blinded to TRACK scores. Patients were classified into two groups regarding the compatibility of the control level between TRACK and both GINA and NAEPP guidelines. A total of 365 questionnaires were evaluated. The TRACK cut-off point of 80 provided the most consistent balance between sensitivity and specificity for the compatibility with both GINA and NAEPP (for GINA 0.763 and 0.663, kappa = 0.487, p < 0.001 and for NAEPP 0.761 and 0.769, kappa = 0.524, p < 0.001, respectively). When 80 was taken as the cut-off value for TRACK, the compatibility rate of asthma control levels between TRACK and GINA and TRACK and NAEPP was 71.0 and 76.4%, respectively. About 70.1% of the patients who had TRACK scores over 80 and had mild asthma were grouped as controlled according to GINA and 50.0% of patients who had TRACK scores over 80 and had moderate to severe asthma was grouped as uncontrolled according to GINA (p = 0.019). TRACK is compatible with NAEPP and GINA in majority of asthmatic children under 5 years of age. Nevertheless, there is a discrepancy between guidelines and TRACK scores; therefore, it should be used in conjunction with a detailed clinical examination in order to make a better decision for assessing the control levels and management plan.
International Archives of Allergy and Immunology, 2013
Several studies have demonstrated a relationship between asthma and obesity. However, the results... more Several studies have demonstrated a relationship between asthma and obesity. However, the results have been conflicting with regard to the relationship between fractional exhaled nitric oxide (FeNO), used as a marker of airway inflammation in asthmatic patients, and obesity. We aimed to evaluate the association of FeNO with obesity and obesity-related metabolic complications in asthmatic and nonasthmatic children. The study population included children aged between 6 and 17 years and consisted of 4 groups: obese asthmatics (n = 52), normal-weight asthmatics (n = 49), obese nonasthmatics (n = 51) and normal-weight nonasthmatics (n = 42). FeNO measurement and spirometry were performed for all patients. To evaluate the metabolic complications, serum lipids, glucose and insulin levels were measured. Insulin resistance (IR) was estimated by the homeostasis model assessment, HOMA-IR. All participants were evaluated for the presence of metabolic syndrome (MS). The mean age for the 194 subjects participating in the study was 11.6 ± 2.5 years. The FeNO level of asthma patients with MS was not different from those without MS (14.5 ± 8.0 and 16.7 ± 8.7, respectively, p = 0.449). In the nonasthmatic group, subjects with MS had a higher FeNO level than subjects without MS (12.5 ± 5.1 and 17.3 ± 8.3, respectively, p = 0.014). Spearman's rank correlation coefficients revealed a positive correlation between FeNO and body mass index (BMI; p = 0.049, r(2): 0.204) in the nonasthmatic group and after multivariate regression analysis, BMI still persisted as an independent risk factor for FeNO. We found a positive correlation between BMI and FeNO level which suggests a link between obesity and increased airway inflammation in nonasthmatic children.
Drug provocation tests (DPTs) are gold standard to diagnose drug allergy. Our goal was to evaluat... more Drug provocation tests (DPTs) are gold standard to diagnose drug allergy. Our goal was to evaluate the results and safety of diagnostic methods including DPTs during childhood. Between January 2010 and February 2013 DPTs were performed and evaluated, prospectively, in children who attended our pediatric allergy clinic with a suspected drug hypersensitivity reaction. One hundred ninety-eight suspected drug reactions in 175 patients (88 boys and 87 girls) were evaluated. The median age of the subjects at the time of the suspected drug-induced hypersensitivity reaction and at the time of the study was 56 (interquartile range [IQR] = 24-120 months) months and 76 (IQR = 35-149 months) months, respectively. Suspected drugs were beta-lactam antibiotics in 108 cases (54.5%), non-beta-lactam antibiotics in 22 cases (11.1%), and nonsteroid anti-inflammatory drugs in 52 cases (26.3%). The history was compatible with immediate-type reactions in 69 cases (34.8%). Skin-prick tests were not positive in any of the cases. Intradermal tests were positive in three cases (4%). DPTs were positive in 13 (6.8%) of 191 provocation cases, which were performed with culprit drugs. Our results suggest that a positive clinical history is not enough to make a diagnosis of drug allergy, which highlights the significance of undertaking further diagnostic evaluation especially for DPTs.
Anaphylaxis is a potentially life-threatening condition. There are limited data about the etiolog... more Anaphylaxis is a potentially life-threatening condition. There are limited data about the etiology and the clinical characteristics in developing countries. This study aimed to investigate the clinical characteristics of anaphylaxis patients attending our pediatric allergy clinic. We conducted a prospective analysis of patients who were admitted to our allergy clinic for anaphylaxis from 2010 to 2012. Ninety-six patients were evaluated during the study period. The mean age was 7.4 ± 5.2 years. Venom, food, and drugs were the most common causative agents responsible for 31 (32.3%), 30 (31.3%), and 26 (27.1%) of the cases, respectively. Foods implicated most frequently were peanuts and nuts (n = 9; 30.0%), cow's milk (n = 7; 23.3%), and egg white (n = 6; 20.0%). The clinical manifestations during anaphylaxis in order of frequency were cutaneous (97.9%), respiratory (86.5%), gastrointestinal (42.7%), neurological (37.5%), and cardiovascular symptoms (30.2%). A biphasic course was noticed in five cases (5.2%). Of the 91 patients, 79 (86.8%) received H1-antihistamines, 73 (80.2%) received corticosteroids, 40 (44.4%) received adrenaline, 38 (41.8%) received fluid replacement therapy, 18 (19.8%) received β2-mimetics, and 8 (8.8%) received H2-antihistamines. According to severity, 7.3% of patients had mild, 59.4% had moderate, and 33.3% had severe anaphylaxis. Food and bee venom allergy were the most common etiologies. Adrenaline, the first-line treatment of anaphylaxis, was administered in only 44.4% of our cases.
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