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.

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.

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.

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 FcgammaRIIIa 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 FcgammaRIIIa 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 FcgammaRIIIa gene polymorphism may be a genetic risk factor for the development of atopic diseases.

Prognostic value of initial antithrombin levels in neonatal sepsis.

OBJECTIVES: We determined whether initial antithrombin (AT) levels help in diagnosis and prognosis of neonatal sepsis. METHODS: Sepsis was diagnosed according to clinical and laboratory findings and positive culture results in 34 of the 54 newborns who presented to the hospital with suspected sepsis. Between AT levels and hematological parameters (fibrinogen levels, prothrombin time (PT), activated partial thromboplastin time (aPTT) and liver function tests), these were correlated each other and with outcome of the babies. RESULTS: Initial AT and fibrinogen levels were significantly lower in newborns with sepsis compared to control (P < 0.05). Initial AT levels were lower in the ones who developed disseminated intravascular coagulation (DIC) compared to those without DIC (P < 0.05). Initial AT levels were significantly lower in newborns who died as compared to survivors (P < 0.05). Sensitivity of AT was highest at 15 mg/dL for prognosis in neonatal sepsis (sensitivity:92.3%, specificity:61.9%, positive predictive value : 61.9 %; negative predictive value: 61.9%;). CONCLUSION: Lower initial AT levels in neonatal sepsis are associated with a severe disease and increased mortality. It may be useful in predicting clinical outcome in neonatal sepsis.

Development of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy.

It has been hypothesized that specific immunotherapy (SIT) significantly decreases the development of new allergen sensitizations in mono-sensitized patients. In this study, we evaluated the effect of SIT on the development of new allergen sensitizations in 129 asthmatic children mono-sensitized to house dust mite. SIT was accepted by only 70 of them (SIT group). The remaining 59 children were treated only with medication (control group). At the end of the study we found that 33% of all patients developed new sensitizations. Surprisingly, the prevalence of new sensitizations was significantly higher in the SIT group (45.5%) than in the control group (18.1 %). Ash tree (Fraxinus excelsior), Olive and Meadow fescue (Festuca elatior) were the most common allergens responsible for the new sensitizations. We conclude that SIT did not prevent the onset of new sensitizations in asthmatic children mono-sensitized to house dust mite.

The Fc gammaRIIa polymorphism in Turkish children with asthma bronchial and allergic rhinitis.

OBJECTIVE: The aim of the present study was to evaluate the Fc gammaRIIa polymorphism in Turkish children with atopic asthma and allergic rhinitis. DESIGN AND METHODS: In this study, 372 atopic children (192 asthma bronchial, 180 allergic rhinitis) between ages of 5 and 16 years old (11.3+/-2.9) who were followed at Aegean University Paediatric Allergy and Pulmonology Outpatient Clinics and 234 healthy subjects as the control group were included. The evaluation of subjects included routine biochemical blood analysis and allergic workup based on the following laboratory determinants. The Fc gammaRIIa polymorphism was determined using the polymerase chain reaction method. RESULTS: Distribution of R131R genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 2.64 95%CI: 1.22-5.79, p=0.006; for allergic rhinitis OR: 2.58 95%CI: 1.18-5.71, p=0.009). Frequency of 131R allele was significantly different among patient groups compared to controls (for asthmatic children OR: 1.66 95%CI: 1.22-2.26, p=0.0007; for allergic rhinitis OR: 1.93 95%CI: 1.42-2.63, p=0.00001). CONCLUSION: This study shows that Fc gammaRIIa gene 131R allele represents an important genetic risk factor for bronchial asthma and allergic rhinitis susceptibility.

Effect of carbamazepine and valproate on bone mineral density.

The objective of this study was to examine the effect of carbamazepine and valproate monotherapy on bone mineral density in children. Femoral neck area bone mineral density was measured by dual-energy x-ray absorptiometry in 31 healthy children and 33 children with idiopathic epilepsy treated with either carbamazepine (n = 17) or valproate (n = 16) for more than 6 months. There were no significant differences between the control and study patients in age, height, weight, and physical activity. No patient had dietary restrictions or neurologic impairment. Serum levels (as mean +/- S.D.) of valproate and carbamazepine were 53.75 +/- 23.94 microg/mL and 6.26 +/- 2.00 microg/mL, respectively, and the duration of treatment for each drug was 24.38 +/- 10.58 months and 31.76 +/- 16.33 months, respectively. Calcium intake in the diet was similar in both the control and study groups. In the valproate-treated group, 25% of the patients were hypocalcemic, 6% had elevated alkaline phosphatase levels, and 50% were hypophosphatemic. In the carbamazepine-treated group, 17.6% of the patients were hypocalcemic and 35.3% were hypophosphatemic. Children treated with valproate had 31.9% reduction in bone mineral density at the femoral neck area (P < 0.05); the 20% reduction in bone mineral density in this anatomic location in carbamazepine-treated children was not significant. In conclusion, valproate monotherapy, but not carbamazepine therapy, significantly reduces femoral neck area bone mineral density in children with idiopathic epilepsy.