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Background: Tranexamic acid (TXA) is a medication used to treat or prevent excessive blood loss due to certain medical conditions. It has a low side effect profile and is safe to administer in most instances. Anaphylaxis cases due to intravenous TXA have been reported in the literature. We report the first pediatric case of anaphylaxis due to the use of nebulized TXA. Case Presentation: A 2-year-old boy with cerebral palsy, epilepsy, and tracheostomy was hospitalized with pneumonia. On the fourth day of hospitalization, the patient started bleeding from the trachea. Nebulized TXA was started to reduce tracheal bleeding. Anaphylaxis developed 5 min after administration of nebulized TXA. Subsequently, the patient was successfully treated with adrenaline, intravenous fluids, antihistamines, and steroids. Conclusion: Nebulized TXA is increasingly used off-label. Although it has a safe profile, side effects such as anaphylaxis may occur rarely. It is essential to recognize the symptoms of anaphylaxis when using nebulized TXA.

Background: IgG subclass deficiency is a laboratory diagnosis and becomes important with recurrent infections. This study aimed to examine the demographic, clinical, and laboratory results of pediatric cases with IgG subclass deficiency and to improve the understanding of the clinical significance of IgG subclass deficiency., Methods: In this study, the clinical and laboratory features of 111 pediatric patients, with at least one whose serum IgG subclasses was measured as lower than 2 standard deviation of healthy aged-matched control values, were evaluated. The clinical and laboratory features of the cases with isolated IgG subclass deficiency (Group 1) and those with low serum levels of any of IgG, IgA, and IgM in addition to the IgG subclass deficiency (Group 2) were compared., Results: A total of 55 (49.54%) and 56 (50.45%) patients were included in Groups 1 and 2, respectively. Among our studied cases, 20 (18.1%) had a history of hospitalization in the neonatal period, 61 (54.95%) had at least one hospitalization due to infection, and 55 (49.54%) had a history of recurrent infection. The frequencies of these three conditions were statistically significantly higher in Group 2 (p < 0.05). The frequencies of infections in the last year in Groups 1 and 2 were 4.4 ± 1.2 and 5.4 ± 1.9, respectively (p < 0.05). As a result of recurrent infections, 43.24% (n = 48) of our patients received antibiotic prophylaxis, and 21.62% (n = 24) had immunoglobulin replacement therapy. Furthermore, the numbers of patients who needed these treatments were higher in Group 2 (p < 0.05)., Conclusion: In cases with IgG subclass deficiencies, concomitant main-group immunoglobulin deficiencies may increase the number and severity of infections, leading to hospitalizations, antibiotic prophylaxis, and immunoglobulin therapy. More attention should be paid to cases of immunoglobulin main-group deficiencies in the follow-up of these cases., Competing Interests: Declaration of competing interest The authors have declared that they have no conflicts of interest relevant to this article., (Copyright © 2022 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)