Comparison of diagnostic tests for suspected cow's milk allergy in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease. A third of pediatric AD patients have also food allergy. Although food challenge test is gold standard test for the diagnosis of food allergies, they should be administered by experienced physicians, considering that the test is time-consuming and carries some risks. Documentation of the efficacies of specific IgE (sIgE), skin prick test (SPT), and atopy patch test (APT) are important for determining the necessity of oral food challenge tests(OFC). METHODS: Fifty-three AD patients with suspected cow's milk allergy (CMA) were included in our study. Diet-related questions were asked to the patients. Blood samples were taken for measurement of total blood count, total IgE, and milk sIgE. OFC, SPT, and APT were performed using pasteurized cow milk. RESULTS: The mean age of the study population was 1.4±0.8 years, and the male:female ratio was 1.12. Cow milk allergy was detected in 45.3% of the patients after OFC. A comparison between CMA(+) and CMA(-) patients revealed no significant difference in sIgE positivity (P=0.940), but there was a significant difference in SPT (P=0.000) and APT (P=0.001) positivity. When our study group was divided into immediate reaction, delayed onset reaction, and not reactive subgroups after OFC, efficacy of SPT was more prominent in immediate reaction subgroup while APT was more efficient in delayed reaction subgroup. CONCLUSIONS: Our study showed that using SPT test with APT test in allergic reactions with IgE and other mechanisms such as AD will increase the diagnostic yield, thereby reducing the need for OFC.

Mothers' emotional states and attitudes regarding their children with asthma.

OBJECTIVES: The aim of this study was to investigate the associations of asthma with the psychological profile (depression and anxiety) of children with asthma and their mothers as well as the attitudes of these mothers toward their children and their family relationships. METHODS: Sixty-four children with asthma, 60 healthy children and their mothers were included in the study. The Children's Depression Inventory (CDI) and Childhood Anxiety Sensitivity Index (CASI) were applied to the children. All mothers completed the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Parental Attitude Research Instrument and the Family Assessment Device. RESULTS: CASI scores were significantly higher in children with asthma (p < 0.001) than in healthy children. The increasing duration and severity of asthma were associated with increasing anxiety levels in children with asthma. Depression and anxiety scores were significantly higher in the mothers of children with asthma than in the comparison group. The mothers of children with asthma did not have supportive and friendly relationships with their children. In addition, these mothers had significantly higher Attitude of Hostility and Rejection, Attitude of Over-parenting and Authoritarian Attitude scores than those of the comparison group. Increasing duration and severity of asthma influenced family functions and the attitude of the mothers of children with asthma. There was a correlation between an increasing number of emergency department visits and increasing depression in the mothers of children with asthma. CONCLUSIONS: This cross-sectional study revealed that the disease may negatively affect the lives of children with asthma and their mothers and their family relationships.

[Genotypes of rhinoviruses in children and adults patients with acute respiratory tract infections]. / Akut solunum yolu enfeksiyonlu çocuk ve eriskin hastalarda rinovirüs genotiplerinin belirlenmesi.

Rhinovirus (RV) is one of the most frequent causative agent of acute respiratory tract infections in the world. The virus may cause a mild cold, as well as more serious clinical symptoms in patients with immune system deficiency or comorbidities. Rhinoviruses have been identified by molecular methods under three types: RV-A, RV-B and RV-C. In most of the cases, it was reported that RV-A and RV-C were related with lower respiratory tract infections and asthma exacerbations, while RV-B was rarely reported in lower respiratory tract infections. The main objective of this study was to investigate RV species by sequence analysis in nasopharyngeal samples in pediatric and adult patients who were admitted to hospital with acute respiratory tract infections and to establish the relationship between species and age, gender and clinical diagnosis of the patients. Secondly, it was planned to emphasize the efficiency of the sequence analysis method in the determination of RV species. One hundred twenty seven patients (children and adults) who were followed up with acute respiratory tract infections in our university hospital were evaluated between January 2014 and January 2016. Viral loads were determined by quantitative real-time PCR in RV positive patients detected by a commercial kit in nasopharyngeal swab specimens. Thirty-one samples whose viral loads could not be determined were excluded from the study. The remaining 96 samples (50 children and 46 adults) were retested by conventional PCR using the target of VP4/VP2 gene region. A total of 65 samples (32 adults and 33 children) with the bands (549 bp) corresponding to the VP4/VP2 gene regions after the conventional PCR were analyzed by DNA sequencing. A phylogenetic tree was constructed using the neighbour-joining method. After sequence analysis it was determined that 28 (43.07%) were RV-A, 7 (10.76%) were RV-B and 28 (43.07%) were RV-C; and moreover one of each enterovirus (EV) species EV-D68 (1.53%) and EV-C (1.53%) were detected. The distribution of the species in adults was: 15 (48.3%) RV-A, 5 (16.1%) RV-B and 11 (35.4%) RV-C. The distribution of the species in children was 13 (40.6%) RV-A, 2 (6.3%) RV-B and 17 (53.1%) RV-C. RV-A is more frequent in adults, while RV-C is more frequent among children. It has been observed that RV-C infection is detected in children with bronchiolitis, while RV-A infection is detected in adults with pneumonia. There was no statistically significant difference between RV species and clinical diagnosis, age and gender in both of the age groups (p> 0.05). In conclusion, this is the first study that reports the frequency of RV species in children and adult patients with acute respiratory tract infections; the frequency of RV-A and RV-C species were found to be similar but higher than RV-B species in all age groups. RV-C and RV-A was the highest species seen in children and adult patients, respectively. There is a need for further research to identify the types of RV circulating in the community and the prevalence of infections caused by the species.

Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies.

BACKGROUND: The etiology of minimal-change disease is not fully known, it is believed to be mediated by the immune system. Minimal-change disease also reported as having association with atopy. In this study, atopy history, the levels of serum IgE, and skin prick test in children with steroid-sensitive nephrotic syndrome were investigated. METHODS: A group of 30 children (mean age 7.7 ± 2.2 years, 56.6% male) diagnosed with steroid-sensitive nephrotic syndrome were included in the study. Serum immunoglobulin E levels and eosinophil counts were evaluated in children with steroid-sensitive nephrotic syndrome both in relapse and remission. Skin prick test was performed in remission. RESULTS: Of the 30 children investigated, 11 (36.7%) had a history of atopy. The median serum total IgE levels in nephrotic children in relapse, with (445 IU/mL) and without atopy (310 IU/mL) were significantly higher than those in remission (respectively, 200 IU/mL, p = 0.021, and 42 IU/mL, p = 0.001). The skin prick tests for all the allergens were evaluated as negative in all the patients. CONCLUSION: It was thought that increased IgE may reflect the activation of immune mechanism following various stimuli rather than a direct association with atopy in children with steroid-sensitive nephrotic syndrome.

A case of mitral papillary muscle rupture due to blunt chest trauma.

Mitral regurgitation due to papillary muscle rupture after blunt chest trauma is uncommon. Sudden onset severe mitral regurgitation may lead to death due to heart failure if surgical repair is delayed. A previously healthy 12-year-old girl underwent splenectomy and chest tube insertion for pneumothorax after a traffic accident in a vehicle 15 days before. She was discharged from the hospital after a nine-day follow-up. She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized. Transthoracic echocardiogram showed severe mitral regurgitation with freely moving posterior mitral chordae and prolapse of the posterior mitral valve leaflet. She received reimplantation of the complete ruptured posteromedial papillary muscle of the mitral valve. Her medical condition improved after the operation. On the postoperative echocardiogram, the left ventricular systolic function was normal with no mitral regurgitation.

Is there an increase in the prevalence of allergic diseases among schoolchildren from the Aegean region of Turkey?

The prevalence of asthma, allergic rhinitis, allergic conjunctivitis, and allergic skin disorders (urticaria and atopic dermatitis) was investigated between the years 1993 and 1994 in the Aegean region of Turkey and was found to be 3.8, 4.6, 12.6, and 19.4%, respectively (Tanaç R, Kurugöl Z, Demir E, et al., Cocuk Sagligi ve Hast Derg 39:77-85, 1996). The aim of the present study was to determine whether there is a change in the prevalence of allergic diseases in the Aegean region in the last 8 years, based on the comparison of the results using the same method applied in the study mentioned above. Three thousand three hundred seventy children (48.6% male participants and 51.4% female participants) between the ages of 5 and 18 years (mean age, 11.55 +/- 3.34 years) were enrolled in the study. The participants were randomly chosen among children attending primary schools in the cities of the Aegean region. The children completed a questionnaire; and physical examinations, serum-specific immunoglobulin E antibody levels, and peak expiratory flow measurements were done for each of them. Of the children, 21.2% were found to have at least one attack of wheezing whereas the prevalence of asthma was 6.4%. The prevalence of allergic rhinitis, allergic conjunctivitis, and allergic skin disorders (urticaria and atopic dermatitis) were found to be 13.6, 13.2, and 23.7%, respectively. The increase of prevalence for asthma was 2.6%, for allergic rhinitis was 9%, and for allergic conjunctivitis was 0.6%. These data show that the prevalence of allergic diseases, especially respiratory allergy, has increased among schoolchildren from the Aegean region of Turkey.

Hair zinc level in Down syndrome.

Immunological, endocrinological, and haematological abnormalities are relatively common in people with Down syndrome (Cuadrado & Barrena, 1996; Decoq & Vincker, 1995; Hestnes et al., 1991; Sustrova & Strbak, 1994; Nespoli, Burgio, Ugazio & Maccario, 1993; Kempski, Chessells & Reeves, 1997; Kivivuori, Rajantie, & Siimes, 1996; David et al., 1996; Gjertson, Sturm & Berger, 1999). Zinc is one of the elements that act in the maintenance of normal function of these systems. This study was designed to investigate zinc levels in children with Down syndrome. Zinc levels were measured in hair using atomic absorption spectrophotometry. The hair zinc level of 19 children with Down syndrome was compared with the zinc level of 11 typically developing children. Hair zinc levels were found to be significantly lower (p < .05) in those with Down syndrome (average 95.18 +/- 56.10 ppm) than in the typically developing children (average 208.88 +/- 152.37 ppm). Some of the problems experienced by children with Down syndrome may be due to these low zinc levels, but further research is required to confirm these results, and to establish any correlation with these problems.