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BACKGROUND Tolerance of baked milk indicates a good prognosis in IgE-mediated cow's milk allergy. OBJECTIVE The present study aims to investigate the predictors of baked milk tolerance, particularly the amount of milk tolerated in the first oral food challenge (OFC) test, in children with IgE-mediated cow's milk allergy. METHODS The study included 35 cases who were diagnosed with IgE-mediated cow's milk allergy upon open OFC testing in the Pediatric Allergy Clinic. Four weeks after the diagnosis, skin prick test (SPT) and OFC were performed with baked milk. Cases who did and did not develop reactions during OFC with baked milk were compared regarding clinical and laboratory parameters. RESULTS Twelve cases (33.3%) did not develop a reaction during OFC with baked milk. Those who had low levels of casein sIgE, β-lactoglobulin sIgE, and β-lactoalbumin sIgE; small SPT wheal diameter for baked milk and β-lactoalbumin; and a large amount of unheated milk tolerated in the first OFC were found to be tolerant to baked milk (p < 0.05). For predicting baked milk tolerance, a cut-off level of the amount of unheated milk tolerated in OFC was calculated as 620 mg [with the area under the curve (AUC) 0.88 (95% confidence interval 0.77-0.99) in ROC curve analysis]. CONCLUSIONS If a child with cow's milk allergy is able to tolerate more than 620 mg of milk protein during challenge with unheated milk, this may show that this child will tolerate baked milk, meaning that the child will be able to tolerate cow's milk in the future.

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6‐18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.

Allergic reactions to bananas have rarely been reported. The clinic reports mostly moderate local allergic reactions (Oral Allergy syndrome) to bananas, though some reports state reactions reaching anaphylaxis. We report three cases of banana allergy. The first case, immediately after giving a teaspoon of banana to a 7-month-old baby by the mother, he was admitted to the emergency department with the complaints of vomiting, urticaria, swelling of the mouth and eyes. The second case, after some banana yogurt was eaten by a 6.5-month-old baby, she presented with a rash which developed at the 3rd hour. In the third case, a 16-year-old male patient applied with itchy rashes on his body after eating a banana in 1-2 hours. Our cases are presented to emphasize that urticaria and anaphylaxis may occur due to banana allergy. Muza karşı alerjik reaksiyon nadir olarak raporlanmıştır. Muz alerjisinde klinik genellikle orta derecede lokal semptomlar (Oral Alerji sendromu) şeklinde bildirilmekte, ancak bazı raporlarda anafilaksiye kadar gidebilen şiddetli semptomlar da bildirilmiştir. Bu bildiride muz alerjisi tanısı alan üç olgu sunulmuştur. İlk olgu 7 aylıkken annesinin 1 çay kaşığı muz yedirmesinden hemen sonra fışkırarak kusma, ürtiker, ağız ve gözlerde şişlik şikayetiyle acile başvurdu. İkinci olgu 6,5 aylıkken yediği muzlu yoğurt sonrası 3. saatte gelişen döküntü şikayetiyle bize başvurdu. Üçüncü olgu olan 16 yaşındaki erkek hasta, muz yedikten 1-2 saat sonra vücutta kaşıntılı döküntüler ile başvurdu. Muz alerjisine bağlı ürtiker ve anafilaksi görülebileceğini vurgulamak için olgularımız sunulmuştur.

Food allergy is seen in 5-10 % of the children in developed countries but garlic allergy is a rare condition. A case having anaphylaxis after consumption of garlic is presented in this report. After the history of consumption of yoghurt flavored with garlic, the 16-month-old male patient presented to the emergency room with diffuse erythema and itching on his body, swelling on the eye lids and lip, vomiting, cough and wheezing complaints, and was intervened with the diagnosis of anaphylaxis. Six weeks after the anaphylaxis episode with garlic, the result of the skin prick test with raw garlic was positive (11x8 mm induration). The garlic serum IgE level was determined as 11 kU/L. Patients with garlic allergy should be informed about cross-reactions in terms of other food such as onion, leek and asparagus which are in the same family (Liliaceae family). Although is a rare condition, this case is presented to emphasize the probability of anaphylaxis due to garlic consumption.

Introduction In this study, we aimed to retrospectively evaluate the clinical and laboratory findings and complications of 28 common variable immunodeficiency (CVID) patients. Material and methods The clinical features and laboratory data of 28 CVID patients were evaluated. Results Nineteen patients were male. In 53.5% of the cases, complications included inflammatory bowel disease, cytopenia, bronchiectasis, granulomatous lymphocytic interstitial lung disease (ILD) and asthma. In their immunological evaluations, IgG, IgM, and IgA mean values were 474.8 ±214.1 mg/dl; 56.7 ±41.9 mg/dl; 35.3 ±58.2 mg/dl, respectively, and the vaccine response was positive in 64.2% of the cases. In all age groups, absolute lymphocyte counts, naive (CD19+IgD+27-), nonswitch (CD19+IgD-27+) memory B cells were numerically higher when compared to the data of healthy children; however, although switch memory (CD19+IgD+27+) B cells were proportionally low in the 4-8 and 12-18 age groups, they were low both numerically and proportionally in the 8-12 age group. No statistically significant difference was found between the cases with complications and without complications. But the cases with pulmonary complications were compared within the group, the CD8 ratio was high but the IgA level was low in patients with bronchiectasis and CD3 was numerically and proportionally low in the cases with ILD compared to others. According to the Paris classification, 11/27 (40.7%) of the cases, 3/27 (11.1%) of them and 13/27 (48.2%) of them were evaluated as MB0, MB1, and MB2, respectively. Conclusions In genetic studies, TACI (trans-membrane activator and calcium-modulating cyclophilin ligand interactor - TNFRSF13B) mutation was found positive in 25% of the cases.

Background: previous studies demonstrated critical deficits in diagnosis and management of childhood food allergy (FA), and recent developments in FA research support adopting a proactive approach in FA management. Our objective was to describe FA knowledge and management patterns of pediatricians. Method: we applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatric gastroenterologists practicing in Turkey. Results: some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falsely recognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively. By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Most frequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test (1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%, respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foods were 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and >10 foods were 28%, 25% from the maternal and infant diet, respectively. Cow's milk, cheese, butter, yoghurt, baked milk products and hen's egg were the most commonly restricted items. Conclusion: overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approach when advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immune tolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus on emphasizing the deleterious effects of injudicious and extensive eliminations., NA

Objective: To evaluate the prevalence and the risk factors of allergic rhinitis in a particular area. Methods: The main study group consisted of all school children in Kemalpasa district aged 13-14 years. Children with current rhinitis based on responses given in ISAAC questionnaire survey were further evaluated for confirmation. Parents responded to a more detailed questionnaire about allergic diseases and risk factors. Then peak nasal inspiratory flow (PNIF) was evaluated to objectively assess nasal patency. Skin-prick test was performed for ten common allergens. Results: The questionnaire was answered by 90.8% (1373) of children. The prevalence of physician-diagnosed AR was 11.1%. Current rhinitis was found to be 31.3%. Of this group, 55.0% were admitted for the parent questionnaire and tests. Precisely, 90.3% of children accepted PNIF evaluation, and %10.1 of them had a nasal obstruction. Skin-prick tests revealed allergy for at least 1 allergen in 16.6% of children. The present study showed that the children with maternal allergic rhinitis history had 2,18 fold, and the children with seasonal allergic rhinitis had 2,11 fold higher possibility of sensitization to an allergen. The probability of perennial allergic rhinitis was 3,1 fold higher in the children who had siblings with allergic rhinitis. Conclusion: We included all children in a specific age group living in an area in our survey. As well as we found the prevalence of current rhinitis with the ISAAC questionnaire; we also evaluated peak nasal inspiratory flow and used skin-prick tests that yielded objective results.

Can, Demet (Balikesir Author), Objective: Asthma is one of the most common chronic diseases of childhood. Many studies have shown that education positively affects asthma control and patients’ quality of life. In this study, it was aimed to measure the awareness levels of children who have been under observation for a long time and who underwent Allergen Specific Immunotherapy (AIT). Methods: Patients with asthma, asthma & allergic rhinitis and/or rhinoconjunctivitis who received subcutaneous AIT between July 2019 and December 2019 were included in our prospective case-control study. A questionnaire was applied to each patient, in which both the levels of awareness related to their disease and AIT, as well as their knowledge of the allergens and prevention measures they were sensitive to were measured. The results were examined. Age, gender, type of allergic diseases, allergen type, AIT time were evaluated statistically. Results: 82 cases (48 boys and 34 girls) were included in the study. The number of patients who know the name of the disease correctly is 68 (82.9%); The number of patients who knew allergens to be sensitive was found to be 47 (57.3%). It was observed that 15%-72% of the cases had information about asthma disease. Age, gender and diseases of the patients were not statistically different. Conclusion: In our study, it was observed that our children were highly aware of especially about sports and environmental protection methods. It is essential to raise awareness of patients and parents for increase treatment success and control the asthma., Amaç: Astım çocukluk çağının en sık görülen kronik hastalıklarından biridir. Yapılan birçok çalışmada eğitimin, astım kontrolünü ve hastaların yaşam kalitesini olumlu yönde etkilediği gösterilmiştir. Bu çalışmada uzun süredir izlem altında olan ve Alerjen Spesifik İmmünoterapi (AIT) programı nedeniyle sık sık bir araya gelinen çocukların hem hastalıkları ve AIT ile ilişkili farkındalık düzeylerinin ölçülmesi hedeflenmiştir. Yöntem: Prospektif, olgu kontrol çalışmamıza, Çocuk Alerji Polikliniği’ne Temmuz 2019-Aralık 2019 tarihleri arasında subkutan AIT uygulanan astım, astım&alerjik rinit ve/veya rinokonjonktivitli hastalar dahil edildi. Her hastaya hem hastalıkları ve AIT ile ilişkili farkındalık düzeylerinin, hem de duyarlı oldukları alerjenler ve korunma önlemleri ile ilgili bilgilerinin ölçüldüğü bir anket uygulandı. Anket sonuçları üzerinde yaşın, cinsin, alerjik hastalık tipinin, uygulanan alerjen tipinin, AIT süresinin etkisi olup olmadığı araştırıldı. Bulgular: Çalışmaya toplam 82 olgu (48 erkek ve 34 kız) alındı. Hastalığının tam olarak adını bilen olgu sayısı 68 (%82.9), duyarlı olduğu alerjeni bilen olgu sayısı ise 47 (%57.3) olarak saptandı. Olguların %15-72’sinin astım hastalığı ile ilgili bilgi sahibi olduğu görüldü. Hastalara ait yaş cinsiyet ve sahip olduğu hastalıklar arasında istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Araştırmamızda özellikle spor ve çevresel korunma yöntemlerini içeren konular hakkında çocuklarımızın farkındalığının yüksek olduğu görülmüştür. Astım semptomlarının azaltılması ve kontrolünün sağlanması için tedavi uygulamaları ile beraber, tedaviye uyumu arttırmak için hasta ve ailelerin bilinçlendirilmesi ve bu eğitimin devamlılığının sağlanması esastır.

Yazıcı, Selçuk (Balikesir Author), Aim: Allergic sensitization in infancy generally develops against food allergens. We aimed to investigate the frequency of aero-allergens sensitization at older ages in infants with food allergy. Material and Methods: This retrospective cross-sectional study was conducted in Dr. Behcet Uz Children's Allergy Clinic. Infants with confirmed IgE-mediated food allergy between January 1st, 2004, and December 31st, 2016, were evaluated for aero-allergen sensitivities through skin prick tests (SPT) after at least two years after diagnosis, and the data were compared with a healthy control group. Results: A total of 187 cases, 87 of which were patients, were included in the study. The cause of food allergies was cow's milk only in 24 (27.6%) cases, egg only in 26 (29.9%) cases, both cow's milk and egg in 33 (37.9%) cases, fish only in two cases (2.3%), and both fish and egg in two (2.3%) cases. The mean age at which the aero-allergen SPT was performed was 65 (46-180) months in the patient group and 72 (48-132) months in the healthy control group. In the patient group, 39 (44.8%) had aero-allergen sensitization, whereas, in the healthy control group, five (5%) had aero-allergen sensitization. Aero-allergen sensitization was more frequent in the patient group (p0.05). Conclusion: In infants with food allergies, sensitization may develop with aero-allergens at an early age. Clinical follow-up of these patients may be important in terms of allergic respiratory diseases., Amaç: İnfant dönemde alerjik duyarlanma genellikle besin alerjenlerine karşı gelişir. Amacımız besin alerjisi olan infantlarda ileri yaşlarda aero-allerjenlere duyarlılık gelişimini araştırmaktır. Gereç ve Yöntemler: Geriye dönük kesitsel bu çalışmada Dr. Behçet Uz Çocuk Hastanesi Çocuk Alerji Kliniği’mizde 01.01.2004 ile 31.12.2016 tarihleri arasında başvuran IgE aracılı besin alerjisi tanısı doğrulanan infantlar en az 2 yıl sonra deri prick testi ile aero-alerjen duyarlanmaları değerlendirildi. Aero-alerjen duyarlılıkları sağlıklı kontrol grubu ile karşılaştırıldı. Bulgular: Çalışmaya 87’si hasta olmak üzere toplam 187 olgu alındı. Olguların 24’ü (%27,6) sadece süt, 26’sı (%29,9) sadece yumurta, 33’ü (%37,9) süt ve yumurta, 2’si (%2,3) balık, 2’si (%2,3) balık ve yumurta alerjisi saptanmıştı. Aero-alerjen deri prick testin yapıldığı ortalama yaş hasta grubunda 65 (46–180) ay, kontrol grubunda 72 (48–132) ay saptandı. Hasta grubunda 39 (%44,8) olguda aero-alerjen duyarlılığı saptanırken kontrol grubunda 5 (%5) olguda aero-alerjen duyarlılığı saptandı. Aero-alerjen duyarlılık hasta grubunda daha sık saptandı (p0,05). Çıkarımlar: Besin alerjisi olan infantlarda erken yaşlarda aero-alerjenlerle duyarlanma gelişebilmektedir. Gelişebilecek alerjik solunum yolu hastalıkları açısından bu hastaların klinik izlemi önemlidir.

WOS: 000439906200001 PubMed ID: 30035656 Aim: The aim of this study was to examine the serum and urine levels of kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), matrix metalloproteinase-9 (MMP-9), and serum Cystatin-C to determine the renal effect of obesity in obese children.Methods: Seventy-two obese and 35 non-obese healthy children were included in this study. Blood pressure (BP) was evaluated with office measurement. Creatinine, cystatin C, lipids, fasting glucose, and insulin levels were measured, and homeostasis model assessment -insulin resistance (HOMA-IR) was calculated. The urine albumin/creatinine ratio was calculated. The serum and urine KIM-1, NGAL, OPN, and MMP-9 levels were measured.Results: Serum cystatin-C, triglyceride, and homeostasis model assessment-insulin resistance (HOMA-IR) index were found to be significantly higher in the obese group (p=.0001), and high-density lipoprotein (HDL) cholesterol was found to be significantly lower (p=.019) in the obese group. No significant differences were found in serum KIM-1, NGAL, OPN or MMP-9 levels between groups (p>.05). No significant differences were found in urine KIM-1 and MMP-9 levels (p>.05), Urine NGAL, and OPN levels were found significantly higher in obese groups (p

Background The diagnostic values for the skin prick test (SPT) diameters and egg white-specific IgE (EW-sIgE) levels that will allow us to predict the result of the oral food challenge test (OFC) in the diagnosis of egg white allergy vary by the community where the study is carried out. Objective This study aimed to determine the diagnostic values of SPT and EW-sIgE levels in the diagnosis of egg white allergy. Methods 59 patients followed with the diagnosis of egg allergy September 2013 to September 2015 were included in our retrospective cross-sectional study. The patients were investigated in terms of egg and anaphylaxis history or the requirement of the OFC positivity. The demographic, clinical and laboratory findings of the cases were recorded, and they were compared with the patients with the suspected egg allergy but negative OFC (n = 47). Results In the study, for all age groups, the value of 5 mm in SPT was found to be significant at 96.4% positive predictive value (PPV) and 97.8% specificity and the value of 5.27 kU/L for EW-sIgE was found to be significant at 76% PPV and 86.6% specificity for egg white. The diagnostic power of the SPT for egg white (AUC: 72.2%) was determined to be significantly higher compared to the diagnostic power of the EW-sIgE (AUC: 52.3%) (p Conclusion Along with the determination of the diagnostic values of communities, the rapid and accurate diagnosis of the children with a food allergy will be ensured, and the patient follow-up will be made easier.

Background Food protein-induced allergic proctocolitis (FPIAP) is characterised by inflammation of the distal colon in response to one or more food proteins. It is a benign condition of bloody stools in a well-appearing infant, with usual onset between one and four weeks of age. Objective Our objective was to examine the clinical properties of patients with FPIAP, tolerance development time as well as the risk factors that affect tolerance development. Methods The clinical symptoms, offending factors, laboratory findings, methods used in the diagnosis and tolerance development for 77 patients followed in the Paediatric Allergy and Gastroenterology Clinics with the diagnosis of FPIAP during January 2010–January 2015 were examined in our retrospective cross-sectional study. Results The starting age of the symptoms was 3.3 ± 4.7 months (0–36). Milk was found as the offending substance for 78% of the patients, milk and egg for 13% and egg for 5%. Mean tolerance development time of the patients was 14.7 ± 11.9 months (3–66 months). Tolerance developed before the age of one year in 40% of the patients. Tolerance developed between the age of 1–2 years in 27%, between the age of 2–3 years in 9% and after the age of 3 years in 5% of the patients. Conclusions Smaller onset age and onset of symptoms during breastfeeding were found associated with early tolerance development. In the majority of the patients, FPIAP resolves before the age of one year, however in some of the patients this duration may be much longer.

Background The severe cutaneous adverse drug reactions (SCARs) are rare but could be life-threatening. These include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis. Objective The purpose of this study was the evaluation of the clinical characteristics of patients with the diagnosis of SCARs. Methods Patients who were diagnosed with SCARs between January 2011 and May 2016 by pediatric allergy clinics in the provinces of Ankara, Trabzon, Izmir, Adana, and Bolu were included in this multicenter study. Clinical and laboratory findings, the time between suspected drug intake and development of clinical findings, treatments they have received, and length of recovery time were recorded. Results Fifty-eight patients with SCARs were included in this study. The median age of the patients was 8.2 years (interquartile range, 5.25-13 years) and 50% (n = 29) were males. Diagnosis was Stevens-Johnson syndrome/TEN in 60.4% (n = 35), DRESS in 27.6% (n = 16), and acute generalized exanthematous pustulosis in 12% (n = 7) of the patients. In 93.1% of the patients, drugs were the cause of the reactions. Antibiotics ranked first among the drugs (51.7%) and antiepileptic drugs were the second (31%) most common. A patient who was diagnosed with TEN developed lagophthalmos and a patient who was diagnosed with DRESS developed secondary diabetes mellitus. Only 1 patient with the diagnosis of TEN died. Conclusions SCARs in children are not common but potentially serious. Early diagnosis and appropriate treatment of SCARs will reduce the incidence of morbidity and mortality.

Yazıcı, Selçuk (Balikesir Author), "Introduction: Bronchiectasis (BE) is a parenchymal lung disease evolving as a result of recurrent lung infections and chronic inflammation. Although it has been shown in adult studies that mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) can be used as biomarkers of airway inflammation, knowledge is limited in the paediatric age group. The aim of our study is to investigate the potential of MPV and NLR as biomarkers that may indicate acute exacerbations of non-cystic fibrosis BE in children. Material and methods: Children with non-cystic fibrosis BE (n = 50), who were followed in the division of Paediatric Pulmonology of our hospital between June 2010 and July 2015, were involved in the present retrospective cross-sectional study. Haemogram values during acute exacerbations and non-exacerbation periods, and a control group were compared. Results: I n children with bronchiectasis, the average leukocyte count (p < 0.001), platelet count (p = 0.018), absolute neutrophil count (p < 0.001), and NLR (p < 0.001) were higher, as expected, when compared with the control group. NLR values, in the period of acute exacerbation were significantly higher than the values of both the non-exacerbation periods (p = 0.02) and the control group (p < 0.001). In contrast, MPV values in the period of acute exacerbation did not exhibit a significant difference from those of non-exacerbation periods (p = 0.530) and the control group (p = 0.103). Conclusions: It was concluded that leukocyte count, platelet count, absolute neutrophil count, and NLR can be used to show chronic inflammation in BE, but only NLR and absolute neutrophil count can be used as biomarkers to show acute exacerbations."

Introduction: Environmental tobacco smoke (ETS) is thought to increase the severity and number of attacks in wheezy children. Objective assessments are needed to change the behavior of families to reduce the exposure of wheezy children to ETS. Aim: To determine whether informing families about their children’s urinary cotinine levels curtailed the exposure of children to ETS. Material and methods: A survey was used to determine the ETS exposure level, and the urinary cotinine level of each patient was tested. Children with positive urinary cotinine levels were included in the second part of the study. The families were randomly divided into two groups: an intervention group that was advised about urinary cotinine levels by telephone and a non-intervention group that was not so advised. The groups were followed-up 2 months later, and urinary cotinine levels were measured once again. Results: The intervention group contained 65 children of average age of 24.4 ±8.9 months, of whom 46 (70.8%) were male. The non-intervention group contained 69 children of average age of 25.3 ±9.8 months (p > 0.05), of whom 52 (75.4%) were male. The urinary cotinine levels at the time of the second interview were lower in both groups. The number of cigarettes that fathers smoked at home decreased in the intervention group (p = 0.037). Conclusions: Presenting objective evidence on ETS exposure to families draws attention to their smoking habits. Measurement of cotinine levels is cheap, practical, and noninvasive. Combined with education, creating awareness by measuring cotinine levels may be beneficial.

Background Various inflammatory biomarkers have been used in asthma cases for evaluating inflammation, however it has been determined that the majority of these biomarkers are insufficient for putting forth the course and severity of the disease. Osteoprotegerin is a glycoprotein mediator in the lung and macrophages. As far as we know, there are no studies about the role played by osteoprotegerin in child patients with asthma. Objective It was planned to examine the relationship between osteoprotegerin levels in childhood asthma and respiratory functions and airway inflammation and to assess its use as a biomarker. Methods The study included patients aged 6–16 years who were diagnosed with asthma at the pediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. The correlation analyses for the osteoprotegerin levels of asthma patients and their respiratory functions were examined. Results The age average of asthma cases was 10.61 ± 3.04 years and 51.2 % were female. No statistically significant difference was observed between the osteoprotegerin levels of the groups (p > 0.05). A negative and statistically significant correlation was observed between the FEV1 and FVC values and osteoprotegerin levels (p = 0.015, p = 0.003). Conclusions This was the first study to examine the relationship between osteoprotegerin levels and airway inflammation in children with asthma. We believe that there is a need for wider scale studies in which clinical symptoms and more parameters are evaluated for defining the role played by osteoprotegerin level in children with asthma and for determining its usability as a biomarker.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a specific immune and inflammatory mechanism. This study investigates inflammatory biomarkers and their correlation with disease severity. Objectives: The aim of this study is to determine the relationship between platelet parameters [(mean platelet volume (MPV), platelet distribution width (PDW)], the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and AD severity in children. Methods: In this retrospective study, we reviewed patients diagnosed with AD and a healthy control group at the department of pediatrics at Health Sciences in a university-affiliated hospital in Istanbul, Turkey, between January 2015 and December 2016. The study included 79 children with AD and 75 healthy controls. AD severity was graded using the Scoring Atopic Dermatitis (SCORAD) index. Complete blood count was measured, and NLR and PLR were calculated. NLR, PLR, MPV, PDW were compared between AD patients and healthy controls, and the correlations between these indexes and clinical characteristics were analyzed. Results: No significant difference was observed between patients and controls for MPV, NLR, and PLR (P = 0.708, P = 0.340, P = 0.179, respectively). In the AD group, PDW was lower than controls (17.39 +/- 1.45, 18.04 +/- 1.65, P = 0.006). In the severe AD group, MPV was higher (7.62 +/- 1.81, 6.64 +/- 1.16, P = 0.035) and PDW was lower than in the mild AD group (16.52 +/- 1.49, 17.93 +/- 1.44, P = 0.0001). Conclusions: Mean MPV and PDW levels are correlated with atopic dermatitis severity in children.

Introduction : Platelets play important roles in airway inflammation and are activated in inflammatory lung diseases, including asthma. Aim :We evaluated the mean platelet volume (MPV), used as a marker of platelet activation, in asthmatic patients during asymptomatic periods and exacerbations compared to healthy controls to determine whether MPV can be used as an indicator of inflammation. Material and methods :Our patient group consisted of95 children with exacerbation of asthma who were admitted to our allergy clinic. The control group consisted of 100 healthy children matched for age, gender, and ethnicity. Mean platelet volume values of the patient group obtained during exacerbation of asthma were compared to those of the same group during the asymptomatic period and with the control group. We investigated factors that can affect the MPV values of asthma patients, including infection, atopy, immunotherapy treatment, and severity of asthma exacerbation. Results :The patient group consisted of 50 (52.6%) boys and 45 (47.4%) girls with a mean age of 125 ±38 months old. Mean MPV values in the exacerbation period, the healthy period, and in the control group were 8.1 ±0.8 fl, 8.1 ±1.06 fl, and 8.2 ±0.9 fl, respectively; there were no significant differences between groups (p > 0.05). The severity of asthma, severity of asthma exacerbation, immunotherapy, coinfection, eosinophil count, and IgE level also had no effect on MPV (p > 0.05). Conclusions : Although platelets play a rolein the pathophysiology of asthma, MPV measurement is insufficient to detect inflammation through platelets

Objectives Even though allergen immunotherapy is an effective treatment method that has been used on rhinitis, asthma and venom anaphylaxis for over 100 years, systemic reactions (SRs) limit the use of this treatment method. We classified SRs associated with subcutaneous immunotherapy (SCIT) according to the World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. Risk factors for the SRs were assessed. Methods In this study 67,758 injections to 1350 children with allergic rhinitis and/or asthma were analyzed throughout January 1999–December 2014. Results A total of 51 systemic reactions were observed in 39 patients (0.075% per injection, %3 per patient). Mean age of SRs observed patients was 13 ± 2.6 years (range 9.5–16 years) and 64.1% were male, 35.9% were female. 51.3% of SRs were grade 1, 38.5% grade 2, 7.7% grade 3 and 2.6% grade 4. SRs were early onset in 41% of the patients and delayed onset in 59%. 76.9% of SRs were seen during maintenance therapy and 56.4% during peak pollen season. In 28.2% of cases previous local reactions and in 30.8% previous grade 1 reactions were determined. There was no fatal outcome from any of the SRs. Conclusion SCIT related SRs are generally of mild severity. Although only 10% of the SRs were grade 3 or 4, there is a still a small risk of severe reactions. 76.9% of SRs were observed during maintenance therapy. Delayed-onset SRs rate in our study is 59%. So both clinicians and parents should be alert about the delayed reactions after SCIT.

Background Local and especially systemic reactions are important problems in subcutaneous immunotherapy (SCIT). Local and systemic reactions develop in 0.7% to 4% and 0.2% of all injections, respectively. Objective To evaluate the frequency of and risk factors for reactions developing in pediatric patients undergoing SCIT. Methods Local and systemic reactions developing after 14,308 injections between 2003 and 2013 were retrospectively evaluated in the current study using the Subcutaneous Immunotherapy Systemic Reaction Grading System, as recommended by the World Allergy Organization. The type of allergic disease, allergens producing a sensitivity, allergen immunotherapy content, adjuvant content, and the effects of treatment phase on the frequency of adverse effects were investigated. Results Of 319 patients, local reactions occurred in 11.9%, wide local reactions occurred in 5%, and systemic reactions occurred in 4.7%. A local reaction was observed in 0.38% of all injections, whereas a systemic reaction was observed in 0.1% of all injections. Local reactions were most frequent in the build-up phase, and systemic reactions were most frequent in the maintenance phase ( P = .01). Side reactions were more common in patients undergoing SCIT with multiple allergens ( P = .002) and house dust mite ( P = .001). No statistically significant difference was found between adjuvant content and adverse effect frequency ( P = .32). Conclusions The frequencies of local and wide local reactions during SCIT were lower than expected. Although systemic reactions were frequently seen, no fatal reaction was observed in the current study. House dust mite SCIT and multiple allergen use increased the risk of reaction.

Today, as a result of an increase in the frequency of food protein-induced allergic proctocolitis (FPIAP), there is a need for studies not only to enlighten the pathophysiology of the disease but also to determine simple, non-invasive markers in both diagnosis, and evaluation of the development of tolerance. No study has been found in the literature about the place of neutrophil/lymphocyte ratio (NLR) and mean platelet volume (MPV), which are easy to calculate and non-invasive markers.The purpose is to determine the relation between NLR and MPV with the diagnosis and development of tolerance in children with FPIAP.In this retrospective cross-sectional study, clinical, demographic symptoms and laboratory findings of patients, monitored with FPIAP diagnosis in allergy and gastroenterology clinics, were acquired from the patient record system. Hemogram values at the time of diagnosis were compared with the values of healthy children of the same age and gender.Among 59 patients diagnosed with FPIAP, males constitute 47.4% and females constitute 52.6%. MPV and platelet crit (PCT) values were significantly high when compared to the control group (n: 67) in FPIAP cases (p0.001). Also, MPV and PCT values were significantly high in non-tolerance developing cases when compared to developing ones (p= 0.01).Contrary to NLR, MPV and PCT values have been considered to be good markers in predicting prognosis in cases with FPIAP since they are quick, cost effective and easy to calculate.Con el incremento de la proctocolitis alérgica inducida por proteínas de la dieta (PAIPD), son necesarios estudios que aclaren su fisiopatología y determinar marcadores no invasivos y sencillos para el diagnóstico y la evaluación del desarrollo de tolerancia. No hallamos estudios publicados sobre la función del índice de neutrófilos/linfocitos (INL) y el volumen plaquetario medio (VPM), que son marcadores no invasivos fácilmente medibles, en pacientes con PAIPD.Determinar la relación entre el INL y el VPM con el diagnóstico y desarrollo de tolerancia en niños con PAIPD.Estudio transversal retrospectivo, los datos se obtuvieron del sistema de registros médicos, los síntomas y los resultados de laboratorio de los pacientes con diagnóstico de PAIPD fueron controlados en los consultorios de alergia y gastroenterología. Se compararon valores del hemograma al momento del diagnóstico con el grupo de niños sanos de edad y sexo similares.Entre los 59 pacientes con diagnóstico de PAIPD, los varones representaron el 47,4% y las niñas, el 52,6%. El VPM y el volumen plaquetario relativo (VPR) eran significativamente más altos entre los pacientes con PAIPD en comparación con el grupo de referencia (n: 67) (p0,001). Asimismo, VPM y el VPR fueron significativamente elevados en pacientes que no desarrollaron tolerancia comparados con los que la desarrollaron (p= 0,01). Con el INL no hubo diferencias entre los grupos.El VPM y el VPR se consideraron marcadores adecuados para predecir el pronóstico de los pacientes con PAIPD dado que son rápidos, costo-efectivos y fáciles de medir.

Sipahi S, Nacaroglu HT, Can D, Gunay I, Unsal-Karkiner CS, Kamali H, Ozdemir A, Gunay T. Effect of socioeconomic status on allergic diseases and atopy in school children. Turk J Pediatr 2017; 59: 670-677. Higher family socioeconomic status (SES) has been suggested as a risk factor for allergic diseases. We investigated the effect of SES on the prevalence of allergic diseases and atopy. The study included 13-14-year-old primary school students in Kemalpasa, Turkey. The International Study of Asthma and Allergies in Childhood phase 1 questionnaire was administered to all students to identify allergic diseases. Those identified as having allergic diseases underwent a skin prick test (SPT). Group I included students with allergic diseases and a positive SPT. Group II comprised students with allergic disease who were SPT negative. The control group was randomly selected from the students with no allergic diseases. Three weighted SES scores were calculated for each student (equally weighted, education-weighted, and social class-weighted). SES was classified as lower, middle, or upper according to the weighted SES scores. Allergic diseases were detected in 657 of the 1,373 children who participated in the study. A higher percentage of children with allergic diseases and atopy were in the lower SES group in all weighted SES analyses compared with controls (Group I: 59%, 83.1%, 67.5%; Group II: 62.9%, 80%, 63.5%; control group: 12.4%, 12.9%, 21.2%). Significantly more children with allergic and atopic diseases (Groups I and II) were in the lower SES group compared with the control group (p < 0.001). In contrast to the hygiene hypothesis, we found the incidence of atopic disease was higher in families with lower SES.

Carinal trifurcation is described as an opening of the right upper lobe or accessory lobe close to the tracheal bronchus and carina. The etiology of these malformations has not been clearly understood since they commonly occur with cardiac anomalies resulting from their common embryonic development. Isolated partial anomalous pulmonary venous return with an intact atrial septum is a congenital anomaly where one or more of the pulmonary veins are connected to the venous circulation. To the best of our knowledge, the coexistence of a carinal trifurcation, tracheomalacia, and an isolated partial anomalous pulmonary venous return with an intact atrial septum has not yet been reported in the literature. In this article, we report the diagnostic approach and management of a seven-year-old girl with a delayed diagnosis and management of a coexisting carinal trifurcation, tracheomalacia, and an isolated partial anomalous pulmonary venous return with an intact atrial septum.

Ozet Akut infantil hemorajik odem (AIHO), genellikle 2 yas alti cocuklarda gorulen kutanoz lokositoklastik vaskulitin selim seyirli bir formudur. Etiyolojisi bilinmemekle birlikte genellikle enfeksiyon, ilac tedavisi ya da asilamayi takiben gelisir. Baslangici genellikle gurultulu olup ozellikle ekstremite, yuz ve kulaklarda petesi, ekimoz ve annuler ya da hedef tarzindaki purpurik lezyonlar seklinde gorulur. Burada asiya bagli gelistigini dusundugumuz bir AIHO olgusu sunulmaktadir. (J Pediatr Inf 2013; 7: 000-000) Anahtar kelimeler: Akut infantil hemorajik odem, lokositoklastik vaskulit, asilama Abstract Acute infantile hemorrhagic edema (AIHE) is a benign form of cutaneous leukocytoclastic vasculitis that usually occurs in children younger than 2 years of age. Although the etiology is unknown, AIHE often follows infections, drug treatment, or vaccination. The onset of AIHE is often dramatic with petechiae, ecchymoses, and annular, nummular or targetoid purpuric lesions usually appearing on the extremities, face, or ears. In this report we aimed to present a case with AIHE in whomvaccination was considered the etiologic cause. (J Pediatr Inf 2013; 7: 000-000)

Chronic granulomatous disease (CGD) is a genetically heterogeneous primary immunodeficiency that is characterized by recurrent and life-threatening infections resulting from defects in phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system and granuloma formation due to increased inflammatory response. The most commonly involved organs are the lungs, skin, lymph nodes, and liver due to infection. It may present with recurrent pneumonia, hilar lymphadenopathy, empyema, abscess, reticulonodular patterns, and granulomas due to lung involvement. In recent years, mycobacterial disease susceptibility has been reported in CGD cases. This article presents two male cases, one of whom is aged 18 months and the other is aged 5 years, who were diagnosed with CGD and tuberculosis during examination due to extended pneumonia. This report is presented because CGD should be considered not only in the presence of skin abscesses and Aspergillus infections, but also in the differential diagnosis for cases with BCG-itis and/or tuberculosis. It should be kept in mind that mycobacterial infections can occur during the course of the disease.

Background: Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily. Reduced OPG levels are related to obesity, insulin resistance, and non-alcoholic fatty liver disease (NAFLD). Objectives: The aim of this study was to evaluate the relationship between OPG levels, obesity, insulin resistance, and NAFLD in pediatric patients. Methods: This was a prospective, cross-sectional, controlled study that was conducted in the department of pediatrics at Bagcilar training and research hospital in Istanbul, Turkey, between April and August 2015. The study was performed on 107 children with obesity and 37 controls aged 5 - 17 years. In the obese subset, 62 patients had NAFLD. Homeostatic model assessment-insulin resistance (HOMA-IR) was used to calculate insulin resistance. Insulin resistance was defined as a HOMA-IR value greater than 2.5. Plasma OPG levels were measured using enzyme-linked immunosorbent assays. NAFLD was diagnosed by hepatic ultrasound. Results: The mean age was 11.25 ± 3.38 years in the patient group and 10.41 ± 3.15 years in the control group. The OPG level in the obese group with the mean of 55.20 ± 24.55 pg/mL (median = 48.81 pg/mL) was significantly lower than that in the control group with the mean of 70.78 ± 33.41 pg/mL (median = 64.57 pg/mL) (P = 0.0001). The optimal cut-off point (sensitivity, specificity) of the OPG level for the diagnosis of obesity was ≤ 46, 19 pg/mL. According to logistic regression analysis, fasting insulin (P = 0.036) and OPG (P = 0.01) levels were most affected by obesity. In the obese patients, who had HOMA-IR < 2.5, the mean level of OPG was 58.91 ± 6.88729 pg/mL (median = 49.55). In the obese patients, who had HOMA-IR ≥ 2.5, the mean level of OPG was 54.19 ± 22.21 pg/mL (median = 48.47). No significant correlations were found between OPG and HOMA-IR (P = 0.791). No statistically significant difference was observed in the mean OPG between patients with hepatosteatosis (mean = 54.55 ± 25.01 pg/mL) (median = 49.46) and those without the disease (56.30 ± 24.02 pg/mL) (mean = 48.34) (P = 0.089). Conclusions: We confirmed that serum OPG concentrations reduce in obese children. However, no correlation was identified between OPG and insulin resistance. OPG levels are not meaningful in the diagnosis of NAFLD in children with obesity.

Background Prospective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors. Objective The aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey. Methods Fifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients’ records. The factors influencing remission at the end of 10 years follow-up were evaluated. Results A total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p > 0.05). Conclusion Childhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma.

Akut generalize ekzantematoz pustulozis AGEP , klinik olarak ani baslayan, atesle birlikte tum vucutta yaygin pustuler dokuntu ile seyreden nadir bir dermatozdur. Vakalarin %90’ninda ilac kullanim oykusu mevcut olmakla birlikte etyopatogenezde nadiren viral ve bakteriyel enfeksiyonlar ile civaya karsi asiri duyarlilik reaksiyonlari da suclanmaktadir. Klinik olarak eritemli zemin uzerinde, folikuler yerlesimli olmayan, cok sayida steril pustulle karekterizedir. Hastaligin spesifik bir tedavisi yoktur, altta yatan nedenin ortadan kaldirilmasi ile spontan iyilesme gozlenir. Bu makalede AGEP’in etiyolojik, klinik ve histopatolojik ozellikleri gozden gecirilmistir

Pulmoner arteriyovenoz malformasyonlar PAVM anormal kapiller gelisimden kaynaklanan, genellikle konjenital lezyonlardir. Lezyonlar izole tek bir anomali seklinde gorulebilecegi gibi otozomal dominant gecisli herediter hemorajik telenjiektazi Rendu-Osler-Weber sendromu; ROWS ile birlikte cok sayida da olabilir. Bu vakalar asemptomatik olabilecekleri gibi efor dispnesi, carpinti ve cabuk yorulma da gorulebilir. Klasik radyolojik gorunumu yuvarlak, duzgun sinirli lezyonlardir. Bilgisayarli toraks tomografisi ve anjiyografi de teshis icin faydalidir.Burada comaklasma ve siyanoz ile PAVM tanisi alan 2 ve 13 yaslarinda iki kiz olgu sunulmustur

Identifying the risk factors is important in prevention of urinary tract infections (UTIs) in children. The aim of this study is to evaluate the association of UTI and idiopathic hypercalciuria (IHC).Two hundred and twenty-four children aged between 1 month and 16 years and diagnosed to have UTI were evaluated for urinary calcium excretion. The children were diagnosed to have IHC if their urinary calcium/creatinine ratios in at least two different spot urine samples were0.6 between 0-1 year old and ≥0.21 over 1 year or daily calcium excretion4 mg/kg.The frequency of IHC was found to be 16.7%. Family history of urolithiasis, parental consanguinity, presentation with abdominal pain, loss of appetite, and discomfort were found to be significantly higher in the IHC group. No association was found between IHC and the recurrence of UTI, presence of vesicoureteral reflux, renal scar formation, and the prognosis.IHC should be considered among the risk factors for UTI and should be investigated particularly in patients with family history of urinary stones and suggestive complaints of IHC.

Background It is thought that airway inflammation is more common in obese asthmatic patients because inflammation is harder to control and does not respond well to glucocorticoid treatment. Objective This study's aim was to investigate the effect of obesity on airway and systemic inflammation in children with asthma and to identify the biomarkers that play a role in this inflammation. Methods The study included patients aged 6–16 years who were diagnosed with asthma in the paediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. Complete blood count parameters were compared between three groups: obese asthmatic (n = 43), obese non-asthmatic (n = 45), and non-obese non-asthmatic (control group, n = 30). Levels of high-sensitive CRP (hs-CRP), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and matrix metalloproteinase-9 (MMP-9), and 25(OH)-vitamin D were compared between the groups. Results No statistically significant differences were observed in 25(OH)-vitamin D, NGAL, OPN, hs-CRP, and MMP-9 levels between groups. There was a statistically significant negative correlation between FEV1/FVC and NGAL and MMP-9. Conclusion This is the first study to investigate levels of hs-CRP, NGAL, OPN, MMP-9, and 25(OH)-vitamin D in obese asthmatic children. Larger studies with sputum and BAL examinations are required to determine the potential of biomarkers for identifying inflammation in obese asthmatic children.

Objectives Henoch-Schonlein Purpura (HSP) is the most widespread systemic vasculitis during childhood. Gastrointestinal tract retention and gastrointestinal bleeding are among its major complications. Neutrophil-Lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are indicators related to inflammatory diseases. This study evaluated the relationship between NLR or PLR and gastrointestinal bleeding in HSP. Methods The study consisted of 119 patients and 40 healthy children in the same age group. White Blood Cell (WBC) count, hemoglobin level, platelet count, mean platelet volume (MPV), neutrophil count and lymphocyte count were recorded. The NLR and PLR were calculated based on the results of complete blood count tests performed during the first visit to the hospital. Results The average neutrophil count and NLR of the patients with HSP were found to be significantly increased compared to the control group (P = 0.0001). No significant difference was observed between the PLR average of HSP and control groups (P = 0.053). Platelet count average (P = 0.0001) and PLR (P = 0.001) of the patients with gastrointestinal system (GIS) bleeding were found to be statistically significantly increased compared to those who did not have gastrointestinal bleeding. No significant difference was found in the NLR of the patients with and without gastrointestinal bleeding (P = 0.060). Conclusions While the NLR was significantly increased in patients with HSP in this study, the PLR was found to be more significant in patients with gastrointestinal bleeding. Similar to NLR, PLR may also be used as an inflammatory indicator among children with HSP, who have gastrointestinal bleeding.