Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey.

BACKGROUND: Anaphylaxis proportions of incidence are increasing globally. However, limited data are available regarding anaphylaxis in the pediatric population of Greece. PURPOSE: The aim of the study was to evaluate management of anaphylaxis in Greek pediatric departments. METHODS: We performed a questionnaire-based study of children aged less than 16 years presenting with anaphylaxis in 10 national pediatric hospitals over a period of 2 years. Management of anaphylaxis was assessed prior to and after an informative intervention. RESULTS: In all, 127 cases of anaphylaxis were identified. Epinephrine was administered in almost half of all cases (51.2%), predominantly through intramuscular route (88.5%), while the majority of anaphylaxis patients were treated with antihistamines (92.9%) and corticosteroids (70.1%). Epinephrine was more likely administered by physicians if the elicitor was a drug (P < 0.003). Regarding long-term management, an epinephrine auto-injector was prescribed in 66.9% of patients. Follow-up information was available for most of the patients (92.9%), the majority of whom (76.3%) were referred to an allergist. More than half of these patients (63.6%) had a documented allergy follow-up, which identified a causative allergen in 53.3% of cases. No statistically significant differences were recorded prior to and after the intervention regarding management of anaphylaxis. CONCLUSIONS: This nationwide study highlighted the necessity of further improvement in terms of anaphylaxis treatment and secondary prevention measures. This presupposes appropriate education and training of healthcare professionals, thus contributing to proper and comprehensive care of the pediatric population.

Retrospective study identified fish and milk as the main culprits in cases of food protein-induced enterocolitis syndrome.

AIM: Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated food allergy, which is confined to the gastrointestinal tract and occurs most frequently in the first year of life. Our aim was to examine the clinical features, causative agents and outcomes of Greek children with FPIES. METHODS: This was a five-year (2013-2017) retrospective study, based on chart reviews of 78 children with FPIES from six Greek paediatric allergy centres. RESULTS: Only five children needed an oral food challenge (OFC) for diagnosis, but 54 children (69%) had OFCs to monitor tolerance development. The most common problems were fish and milk, which affected affecting 42 (54%) and 25 (35%) of children, respectively. The median age of tolerance based on the results of the negative OFCs occurred by 34.0 (26.6-58.4) months. Fish and milk were tolerated by 24 (57%) and 13 (52%) of children by 43.8 and 24.3 months, respectively. Coexisting IgE sensitisation to the offending food was related to delayed tolerance. CONCLUSION: Fish and milk were the most common food allergies in our series of Greek children with FPIES. Cases with IgE sensitisation to the food trigger took longer to resolve their allergies.

Helical multi-detector CT scan as a tool for diagnosing tracheomalacia in children.

BACKGROUND/AIMS: Tracheomalacia (TM) is not an unusual diagnosis in pediatric respiratory clinics. The aim of this study was to assess the accuracy of paired static end-inspiratory/end-expiratory helical multi-detector CT scan (MDCT) in detecting TM. METHODS: FB was performed in 28 children suspected of TM on the grounds of presence of recurrent episodes of vibrating cough and a need for more specific diagnostic information. Children diagnosed with flexible bronchoscopy (FB) as having TM were further investigated with MDCT. The cross-sectional area ratio of the trachea during end-expiration and end-inspiration, at the level of maximum end-expiration collapse (CSR), determined the basis for the MDCT diagnosis of TM. FB and MDCT were also performed in five children who suffered from mainly dry-but not honking, barking, or vibrating-cough for more than 3 months, and served as controls. RESULTS: The diagnosis of TM was established bronchoscopically in 26 out of 28 children. CRS was significantly smaller in patients (0.59 ± 0.14) compared with controls (0.85 ± 0.11) (P = 0.001). The optimal CSR cut-off point for TM diagnosis, as it was estimated by the ROC curve, was ≤0.705 (95%CI: ≤0.635-≤0.850) with a sensitivity 84.6% (95%CI: 65.1-95.6), and specificity 100.0% (95%CI: 47.8-100.0). CONCLUSIONS: MDCT can effectively diagnose TM in the majority of children and can be used as an alternative to FB. In children, the established criterion of CSR ≤0.5 should be replaced by CSR ≤0.7 that seems to be a more appropriate threshold.

Soy- and rice-based formula and infant allergic to cow's milk.

Soy milk formula has limited medical indications for infants feeding, although in several parts of the world it has been used as a source of nutrition in a large number of children. It used to be the main alternative feeding for infants allergic to cow's milk who did not breastfeed before the introduction of extensively hydrolyzed formulas. Although there is a debate, the fact that some children are allergic to soy or some children with cow's milk allergy can present with concomitant soy allergy, restricted the use of soy formulas for treatment of infants allergic to cow's milk. Other grain-based formulas like the rice-based ones are promising in infants with cow's milk allergy. Grain-based formulas could be an alternative and cheaper way of nutrition for infants allergic to cow's milk than extensively hydrolyzed formulas. Further large scale longitudinal clinical studies are required to clarify the safety of soy and other grain-based formulas for treatment of cow's milk allergy.