Retrospective evaluation of adverse reactions after subcutaneous allergen-specific immunotherapy in children with house dust mite allergy.

OBJECTIVE: Although it is accepted as an effective and safe treatment way, side effects can be observed as a result of subcutaneous immunotherapy (SCIT). In our study, it was aimed to evaluate the local and systemic reactions in children after SCIT and the factors that may be associated with these reactions. METHODS: Our study included 138 house dust mite allergic patients with asthma and/or allergic rhinitis who underwent SCIT in the Pediatric Allergy and Immunology Outpatient Clinic between November 2013 and April 2022. Sociodemographic, clinical, laboratory features, and development of adverse reactions after SCIT were analyzed from patient files. RESULTS: The median age of 138 patients was 9.0 years. About 56.5% (n=78) were male, 43.5% (n=60) were female. Of the patients, 55.1% (n=76) had asthma and allergic rhinitis. A total of 7366 SCIT injections were administered to all patients in our clinic. The total number of observed adverse reaction was 118. 50.7% of the patients (n=70) experienced at least one adverse reaction after SCIT. The rate of development of adverse reactions per injection was 1.6% (local: 1.0%, large local: 0.1%, systemic: 0.5%). CONCLUSION: Although serious systemic reactions and death were not observed in our patients; care should be taken in terms of the development of adverse reactions during SCIT in children.

Impact of Allergic Rhinitis on Voice in Children.

INTRODUCTION: The purpose of the present study was to determine the possible effect of allergic rhinitis (AR) on voice change in children with acoustic analysis and Turkish children's voice handicap index-10 (TR-CVHI-10). METHODS: This is a case-control study. Forty-one children with AR, and a positive skin prick test, as well as 39 children of controls who had produced a negative skin prick test and lacked a history of allergic disease, were selected for the study. Each assessment included recordings for the purposes of acoustic voice analysis (fundamental frequency [f0], jitter %, shimmer %, and harmonics-to-noise ratio (HNR)), and aerodynamic analysis (maximum phonation time (MPT) and s/z ratio). All participants completed TR-CVHI-10. RESULTS: The mean TR-CVHI-10 score of the AR group was significantly higher than the control group (p = 0.013). No difference was observed between the AR and control groups in terms of jitter, shimmer, HNR, and MPT values and s/z ratio (p > 0.05). Conversely, the f0 value was more pronounced in controls (270.9 ± 60.3 Hz) than in the AR group (237.7 ± 54.3 Hz) (p = 0.012). CONCLUSION: The study's results revealed that AR can have an effect on fundamental frequency and voice quality in children. The diagnostic process should include AR as a potential cause of voice disorders in children.

Predictive fiberoptic endoscopic findings of upper airway in children with allergic rhinitis.

OBJECTIVE: To determine predictive fiberoptic findings of upper airway in children with allergic rhinitis. METHOD: 129 children had fiberoptic evaluation of nasal cavity, pharynx and larynx. They were divided into allergic rhinitis group and normal group based on skin prick test results. All video recordings were randomly reviewed by three independent national board-certified otolaryngologists who were blinded to the clinical details and outcomes of the participants' allergy testing. Each physician assessed and documented 10-item questionnaire. Intra-rater, inter-rater reliability and correlation between items and allergic status was calculated. RESULTS: Intra-rater reliability was moderate to perfect for all physicians on all items (kappa = 0.578-0.962). Inferior turbinate hypertrophy (κ = 0.714, p = 0.02), middle turbinate hypertrophy (κ = 0.728, p = 0.01), discoloration of inferior turbinate (κ = 0.685, p = 0.01), adenoid hypertrophy (κ = 0.662, p = 0.02) had good inter-rater reliability and these findings were predictive of allergic rhinitis. Adenoid hypertrophy was less encountered in allergic rhinitis. All other endoscopic findings beyond the nasal cavity were not predictive for allergic rhinitis in children. CONCLUSION: Nasal cavity findings including inferior turbinate hypertrophy, middle turbinate hypertrophy, discoloration of inferior turbinate and adenoid tissue assessment rather than pharyngolaryngeal findings are predictive of allergic rhinitis in children.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with cefotaxime and clindamycin use in a 6 year-old boy: a case report.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening idiosyncratic drug reaction. It presents with extensive rash, fever, lymphadenopathy, hematologic abnormalities (eosinophilia and/or atypical lymphocytosis) and internal organ involvement. It has been described in association with more than 50 drugs. To the best of our knowledge neither cefotaxime nor clindamycin has been previously reported to induce DRESS syndrome in children. Clindamycin was reported only in adults as a cause of DRESS syndrome in the literature. In this report, we aimed to present a child with DRESS syndrome that developed after cefotaxime and clindamycin treatment. A 6-year-old boy was diagnosed with the left lower lobe pneumonia and pleural effusion. Parenteral cefotaxime and clindamycin were then started, after which the patient improved clinically and was discharged 7 days later with oral amoxicillin clavulanate treatment. After four days he was readmitted to the hospital with fever and cough. Chest X-ray revealed left lower lobe pneumonia and pleural effusion. We considered that the pneumonia was unresponsive to oral antibiotic treatment, and therefore parenteral cefotaxime and clindamycin were re-administered. As a result, his clinical and radiological findings were improved within 10 days. On the 12th of day of hospitalization, the body temperature has risen to 39°C, which we considered to be caused by antibiotics and stopped antibiotic treatment. At the same day he developed generalized maculopapular erythematous rash, which was considered an allergic reaction secondary to antibiotics. Despite the antihistaminic drug administration, the clinical status quickly deteriorated with generalized edema, lymphadenopathies and hepatosplenomegaly. Laboratory tests revealed a white blood cell count of 4300/µl, a lymphocyte count of 1300/µl, a hemoglobin level of 11.2 gr/dl, a platelet count of 120.000/µl, an eosinophilia ratio of 10% on peripheral blood smear, a C-reactive protein level of 20 mg/dl, a procalcitonin level of 23.94 ng/ml and an erythrocyte sedimentation rate of 48 mm/h. Anti nuclear antibody, anti-double stranded DNA, the serologic tests for Epstein Bar virus, herpes simplex virus, parvovirus, mycoplasma, toxoplasmosis, rubella, cytomegalovirus were all found negative. Bone marrow aspiration was consistent with an autoimmune reaction. An echocardiographic examination was normal. Thoracic tomography revealed multiple enlarged axillary, supraclavicular and anterior mediastinal lymph nodes. As the patient met 8 out of 9 RegiSCAR criteria for the diagnosis of DRESS, we started pulse methyl prednisolone (30 mg/kg/day) for three days followed by 2 mg/kg/day. On the 2nd day fever resolved and cutaneous rash and edema improved. Ten days after developing eruptions the patient was discharged. To our knowledge, we report the first pediatric case of DRESS syndrome following treatment with cefotaxime and clindamycin. Pediatricians should be aware of this potential complication associated with these commonly prescribed antibiotics.