Acquired IgE-mediated food allergy after liver transplantation in children

BACKGROUND: In recent years, the number of studies regarding newly-diagnosed food allergies after liver transplantation has been increasing. In this study, we aimed to investigate the frequency, aetiology, risk factors, and severity of IgE-mediated food allergies after liver transplantation in children. METHODS: Paediatric patients who underwent liver transplantation at Inonu University Faculty of Medicine, Organ Transplantation Institute were included in the study. RESULTS: Forty-nine paediatric patients were enrolled in the study; 26 (53.1%) were female, the median age at transplantation was five years, and median follow-up time after transplantation was 16 months. Six patients (12.2%) developed IgE-mediated food allergies after transplantation; four had urticaria and/or angio-oedema and two developed anaphylaxis after food intake. Patients with and without IgE-mediated food allergies were similar in terms of sex, age at transplantation, comorbid atopic disease, immunosuppressant therapy with tacrolimus, and blood tacrolimus level (p > 0.05 for each). Serum total IgE levels ≥100 IU/mL (p = 0.02) and peripheral eosinophilia (p = 0.026) were more common in the patients who developed IgE-mediated food allergies. In five of the six patients who developed IgE-mediated food allergies, reaction occurred within the first year after transplantation; the risk of developing a reaction was 2.7 times higher within the first year after transplantation than in subsequent years (95% CI, 1.546-4.914; p = 0.026). No Epstein-Barr virus or cytomegalovirus infections were detected in any of the patients who developed IgE-mediated food allergies after liver transplantation. CONCLUSION: The risk of developing IgE-mediated food allergies is approximately three times higher within the first year after transplantation than in subsequent years

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Acquired IgE-mediated food allergy after liver transplantation in children.

BACKGROUND: In recent years, the number of studies regarding newly-diagnosed food allergies after liver transplantation has been increasing. In this study, we aimed to investigate the frequency, aetiology, risk factors, and severity of IgE-mediated food allergies after liver transplantation in children. METHODS: Paediatric patients who underwent liver transplantation at Inonu University Faculty of Medicine, Organ Transplantation Institute were included in the study. RESULTS: Forty-nine paediatric patients were enrolled in the study; 26 (53.1%) were female, the median age at transplantation was five years, and median follow-up time after transplantation was 16 months. Six patients (12.2%) developed IgE-mediated food allergies after transplantation; four had urticaria and/or angio-oedema and two developed anaphylaxis after food intake. Patients with and without IgE-mediated food allergies were similar in terms of sex, age at transplantation, comorbid atopic disease, immunosuppressant therapy with tacrolimus, and blood tacrolimus level (p>0.05 for each). Serum total IgE levels ≥100 IU/mL (p=0.02) and peripheral eosinophilia (p=0.026) were more common in the patients who developed IgE-mediated food allergies. In five of the six patients who developed IgE-mediated food allergies, reaction occurred within the first year after transplantation; the risk of developing a reaction was 2.7 times higher within the first year after transplantation than in subsequent years (95% CI, 1.546-4.914; p=0.026). No Epstein-Barr virus or cytomegalovirus infections were detected in any of the patients who developed IgE-mediated food allergies after liver transplantation. CONCLUSION: The risk of developing IgE-mediated food allergies is approximately three times higher within the first year after transplantation than in subsequent years.

Hallermann-Streiff syndrome with hemihypertrophy.

We report on a five year old girl with Hallermann-Streiff syndrome and hemihypertrophy. Hemihypertrophy does not appear to have ever been associated with Hallermann-Streiff syndrome.

A collodion baby with hypothyroidism.

Collodion baby is a rare keratinizing congenital disorder. Although it is milder in degree than harlequin fetus, the infant is at risk for increased water loss, thermal instability, percutaneous toxicity, and infection as a result of an impaired skin barrier function. Here we report on an 11 days-old collodion baby with hypernatremic dehydratation, septicemia and congenital hypothyroidism. To our knowledge congenital hypothyroidism associated with collodion baby is reported in only one case up to date.

Bilateral split feet: a new finding in Cornelia de Lange syndrome.

We report on a male infant with Cornelia de Lange syndrome and bilateral split feet. Bilateral split feet do not appear to have ever been a reported feature in any of the published cases of Cornelia de Lange syndrome.

Encephalitis in a child during atypical course of rubella.

Rubella is usually encountered as a mild viral illness in children and complications are not common. We reported rubella encephalitis in the atypical course of rubella without rash in a 9-year-old boy. He was admitted with a headache, fever, loss of consciousness and bilateral retroauricular lymphadenopathy. The cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis, increased protein levels and a normal glucose value. Immunoglobulin (Ig) M antibodies against rubella virus were positive in CSF and serum. IgG antibody also became positive in his serum 3 weeks after his admittance. We emphasized that rubella may appear without any rash and cause encephalitis. In unvaccinated children, rubella should be considered in the differential diagnosis of encephalitis.

Hepatitis A seroprevalence and its relationship with environmental factors in children of different age groups in Kahramanmaras, Eastern Mediterranean region of Turkey.

Hepatitis A infections are influenced by environmental and socioeconomic factors. Epidemiologic studies regarding hepatitis A virus (HAV) infection in Turkey have not previously examined these factors. We investigated HAV seroprevalence and its association with sociodemographic factors among children of various ages in the Eastern Mediterranean region of Turkey. The study included 1142 children (603 male and 539 female) between ages of 6 months and 18 years. Seropositivity in the whole group was 57.2%. HAV prevalence rates according to age groups were as follows: 35.5% in 6-23 months group, 19.2% in 2-5 years group, 74.3% in 6-10 years group, 83.0% in 11-14 years group, 92.8% in 15-18 years group. Risk factors that influenced seropositivity were; dense population, over-crowded families, excessive number of siblings, low socioeconomic status and low education of the mother. As HAV seroprevalence in children older than 6 years of age is high, we recommend hepatitis A vaccination in this region after the first year of life.

Enuresis prevalence and accompanying factors in schoolchildren: a questionnaire study from southeast Anatolia.

INTRODUCTION: The aims of this study were to establish the prevalence of enuresis, to determine accompanying factors, and to identify common methods in the management of enuresis in Turkish children aged between 6 and 11 years living in eastern Anatolia. METHODS: The parents of 3,527 schoolchildren aged between 6 and 11 years completed a self-administered questionnaire. The questionnaire asked about sociodemographic data, enuresis data, physical or psychological disorders, and family stressors. Descriptive statistics and chi2 test were used for data analysis. RESULTS: The response rate was 88%. The overall prevalence of reported enuresis was 12.96%, and the prevalence of marked enuresis (at least weekly) was 9.8%. Enuresis was notably more common in boys (male:female ratio 1.6), and the prevalence rates decreased by age without gender bias. Of all enuretic children, 21% had also daytime bed-wetting. The rate of a positive family history was 42% for siblings only and 66% for the other family members. Significantly more of the dry children woke up spontaneously at night to void as compared with the enuretic children (p < 0.001). The parental concern level was not high, and only 15% of the children visited a physician for the management of enuresis. Low socioeconomic status, unfavorable perinatal or postnatal history, and unsatisfactory familial characteristics were significantly more frequent in the enuretic group (p < 0.05). The enuretic children had also higher rates of poor school performance and poor social adaptation as compared with nonenuretic children (p < 0.001). CONCLUSIONS: These results suggest that the prevalence of enuresis in eastern Anatolia is similar to that reported from western Anatolia and from most other countries. Turkish families did not report a high-level concern about enuresis, and the problem was managed primarily within the family.

Head circumference measurement of urban children aged between 6 and 12 in Malatya, Turkey.

Head circumference (HC) is one of the most significant findings in physical examination, especially in the evaluation of the development and early diagnosis of neurological disorders in children. In the standard charts for developmental evaluation of Turkish children, there is no HC reference values for children over 6 years of age. Since the HC standards show differences among races and generations, many researchers have obtained normal values for their own populations, and recommend periodic reevaluation of these standards. In this study, the HC of 1826 healthy children (945 male, 881 female) aged between 6 and 12 years was measured in order to establish the Turkish standards. The sample represented various socioeconomic levels in the city of Malatya, Turkey. The study was conducted in ten schools and measurements were done twice by a pediatrician and the mean was recorded. Charts and graphs for boys and girls were prepared separately. Results were compared to the values of other populations. HC values of Turkish children were similar to that of Irish children. The data obtained in this study may replace the Nelhaus criteria to be used in clinics. However, a more widespread study should be carried out by including children from different regions of Turkey.

Autonomic nervous system functions in obese children.

Childhood obesity is a complex syndrome, probably due to the multiplicity of contributing factors, contradictory literature information about etiology, prognosis, prevention and treatment. In the recent reports, autonomic nervous system (ANS) dysfunction has been documented in adult obesity. Autonomic nervous system functions in obese children are not clear. This study was planned to investigate autonomic nervous system function in childhood (7-13 years of age) obesity. Study and control groups consisted of 33 simple obese (23 boys and ten girls, mean age 9.5+/-1.4 years) and 30 healthy children (18 boys and 12 girls, mean age 10.1+/-1.8 years), respectively. Four non-invasive autonomic nervous system function tests (Orthostatic test, Valsalva ratio, 30/15 ratio, Heart rate responses to deep breathing) and general ophthalmic examination were performed on both groups. The difference between the obese and control groups was found statistically significant in Valsalva ratio, 30/15 ratio and Heart rate responses to deep breathing (P<0.025), and insignificant in Orthostatic test (P>0.05). Ophthalmic examinations were normal. The result of these tests suggested normal activity of sympathetic, and hypoactivity of parasympathetic nervous system, implying parasympathetic nervous system dysfunction as a risk factor or associated finding in childhood obesity.

Autonomic nervous system function in childhood migraine.

BACKGROUND: Although the pathogenesis of migraine is controversial, autonomic nervous system (ANS) dysfunction has been reported in patients with adult migraine in recent years. The present study was planned to investigate ANS function in childhood migraine. METHODS: The migraine and control groups consisted of 25 migraineur and 30 healthy children, respectively. Orthostatic test, sustained handgrip, Valsalva ratio, 30/15 ratio and heart rate responses to deep breathing were used as non-invasive ANS function tests in both groups. RESULTS: In the orthostatic test, systolic (SBP) and diastolic blood pressures (DBP) were higher in the upright than the supine position in the migraine group, but were higher in the supine than upright position in the control group. In the sustained handgrip test, the mean difference in SBP was higher in the migraine than the control group (P = 0.0278), but there was no significant difference in DBP between migraine and control groups (P = 0.107). The Valsalva ratio was higher in the migraine than the control group (P = 0.0002), as was the 30/15 ratio (P = 0.0108). Heart rate responses to deep breathing were not different between the migraine and control groups (P = 0.749). CONCLUSIONS: Our results demonstrate ANS dysfunction, with hyperactivity of both the sympathetic and parasympathetic nervous system, in children with migraine.

Autonomic nervous system functions in children with nocturnal enuresis.

Nocturnal enuresis is involuntary urination during night sleep. The pathogenesis of nocturnal enuresis is controversial. Developmental delay, genetic factors, stress and psychological factors, and sleep abnormalities are considered to be the etiologic factors. Various urodynamic studies showed bladder hyperactivity in enuretic children. Since the cause of vesical hyperactivity is not clear, we investigated the possible role of autonomic nervous system dysfunction in these children. The study groups consisted of 41 enuretic (25 boys and 16 girls) and 30 healthy children (18 boys and 12 girls). Four non-invasive autonomic nervous system function tests (orthostatic test, Valsalva ratio, 30:15 ratio, heart rate responses to deep breathing) were carried out in both groups. The differences between the enuretic and control groups were statistically significant in the Valsalva and 30:15 ratios (P < 0.0005 and P < 0.005, respectively). The results of these two tests demonstrated parasympathetic nervous system hyperactivity. No abnormality of the sympathetic nervous system was found. We suggest that the parasympathetic nervous system hyperactivity shown in our study may be a cause of vesical hyperactivity in enuretic children.

Midazolam in treatment of various types of seizures in children.

Midazolam is a recently developed water-soluble benzodiazepine that shares anxiolytic, muscle relaxant, hypnotic and anticonvulsant actions with other members of this class. There are limited studies that midazolam can be used successfully to treat seizures in adults and children. In this study, 0.2 mg/kg intramuscular (i.m.) midazolam was administered to 11 children (eight boys and three girls), aged 3 days to 4 years (mean age 1.8 +/- 1.4 years), with seizures of various types. In all but one child, seizures stopped in 15 s-5 min after injection. No side effects were observed. These results suggest that i.m. administration of midazolam may be useful in a variety of seizures during childhood, especially in case of intravenous (i.v.) line problem.

Autonomic nervous system functions in childhood essential hypertension.

The etiopathology of essential hypertension (EH) is still controversial, different pathologic mechanisms have been estimated as a cause of EH. One of these mechanisms is autonomic nervous system dysfunction (ANSD). Although there are different studies showing ANSD in adult EH, limited studies on ANSD in childhood EH are present. The present study was planned to investigate the role of ANSD in childhood EH. The study group (SG) consisted of 24 children with EH and the control group (CG) was 24 healthy children. Non-invasive autonomic nervous system function tests: the orthostatic test, Valsalva ratio, 30/15 ratio and heart rate responses to deep breathing were performed on members of both groups. The mean differences in systolic blood pressure between supine resting and standing positions in the study and control groups were significant (z = -2.577, P = 0.0051). The mean differences in diastolic blood pressure between supine resting and standing positions in SG and CG were found to be statistically meaningful (z = -2.722, P = 0.0033). The mean differences in heart rate variation during hyperventilation in SG and CG were significant (z = -2.54, P = 0.0055). The mean differences in the Valsalva ratio between SG and CG were not statistically meaningful (z = 1.52, P = 0.0643). The mean differences in the 30/15 ratio in SG and CG were not found to be significant (z = -1.455, P = 0.0735). In the light of these results, both sympathetic and parasympathetic autonomic nervous system dysfunction in childhood essential hypertension were found.