Drug reexposure in children with severe mucocutaneous reactions

In pediatric patients, severe cutaneous adverse reactions (SCARs) frequently occur in the course of acute illnesses, mostly infections, which are usually treated with antibiotics or analgesics. The drug provocation test (DPT) is contraindicated in such situations, due to the risk of triggering a new severe reaction. As a consequence, lifelong avoidance is recommended. However, causation is uncertain in most cases. The dilemma arises when avoiding the drug is not harmless for the patient. We have attended three patients who were referred to our pediatric allergy unit with a history of SCAR related in time to simultaneous use of paracetamol and ibuprofen. Medical records and images of the patients were reviewed with the assistance of a dermatologist, and alternative diagnoses were considered in both cases. The ALDEN score for implicated drugs was calculated. After considering a high probability of ibuprofen tolerance and obtaining informed consent from the patients, we performed a sequential allergy workup including in vitro tests, skin tests, and finally DPT in two of the patients, confirming ibuprofen tolerance. In conclusion, although generally contraindicated, DPT may be considered for some useful drugs after careful evaluation of the risk–benefit balance, preceded by a sequential study including in vitro and skin tests.

Mosquito hypersensitivity may be associated with atopic background in children

Background: Many children encounter unusual or “exaggerated” reactions such as large local, atypical or systemic reactions after mosquito bites.Objective: The aim of this study was to document the clinical features of children with mos-quito allergy and investigate the possible associations between demographic features and type of reactions in this population.Methods: Children with large local or unusual reactions after mosquito bites who attended to our outpatient pediatric allergy department were enrolled in the study along with control subjects.Results: A total of 180 children (94 with mosquito allergy and 86 age and sex-matched control subjects) with a median age of 6.8 years (IQR 5.5–9.3) were enrolled. Atopy (35.1% vs. 11.6%, p < 0.001) and grass pollen sensitization (28.7% vs. 8.1%, p < 0.001) were significantly more frequent in children with mosquito allergy. Skin prick test with mosquito allergen was positive in only 6 children (6,4%). Grass pollen sensitization was most common in children (28.7%) followed by sensitization to house dust mite (9.6%). 30 children (31.9%) had an accompanying atopic disease such as allergic rhinitis, asthma or atopic dermatitis. Bullae were significantly more frequent in children with asthma (41.7% vs.15.9, p = 0.034). The median duration of symptoms after onset were significantly longer in patients with ecchymosis, with immediate wheals and in children whose symptoms start in 20 min to 4 hours after mosquito bites.Conclusion: There is an association between unusual, large local or exaggerated reactions after mosquito bites and allergic diseases in children. The severity of reactions increases with age and particularly in children with atopic background.

Outcome of Cyclophosphamide versus Mycophenolate Mofetil in Induction of remission in Pediatrics Lupus Nephritis

Background Systemic lupus Erythematous (SLE) is an autoimmune inflammatory disease characterized by antibodies directed against self-antigens, resulting in multi-organ damage. Up to 20% of cases are diagnosed during childhood with 55% of these patients are expected to develop lupus nephritis (LN). Objective At comparing the efficacy of mycophenolate mofetil versus pulse intravenous cyclophosphamide in induction of remission in pediatric patients with lupus nephritis. Subjects and Methods This is a retrospective study that was conducted in Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain-Shams University from the period of December 2007 to January 2017 on 65 pediatric patients with lupus nephritis taking either cyclophosphamide or Mycophenolate Mofetil as an induction therapy. Patients’ data was gathered from their medical records in the Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain-Shams University. Patients enrolled in the study after consideration of inclusion and exclusion criteria. Results Our studied patients were 65 patients divided into 58(89%) female and 7(11%) male with female: male ratio (8: 1) and their age ranged between (5- 18) years. There was no statistically significant difference between different laboratory parmaters used to compare between both groups (C3, 24 hour urinary protein, anti-DNA). However, the rate of change in SLEADI score was higher in patient receiving Cyclophosphamide and Mycophenolate mofetil, but with no significant difference. Conclusions No significant difference between group taking cyclophosphamide and mycophenolate mofetil.

Influence of physical limitation in children with juvenile idiopathic arthritis

Background Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Health-related quality of life (HRQOL) is an important outcome measure in understanding the impact of chronic illness. Aim of the Work We saught to measure the amplitude of physical disability in children with juvenile idiopathic arthritis in relation to HRQOL. Patients and Methods This analytical cross sectional study was conducted on children with JIA following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University in the period from May 2018 to May 2019 The sample included 119 patients who were enrolled consecutively by using The Pediatric Quality of Life Inventory TM Version 4.0 (PedsQLTM). Results Physical problem score showed negative correlation with age, age at onset (years) and disease duration (years). The older the child was and the longer the duration of the illness the more severe was his awareness of physicaical disability. Conclusion Juvenile idiopathic arthritis has a negative impact on physical abilities in child which influence their quality of life.

Does Drug Allergy Workup in Children Satisfy Their Parents?

<b><i>Introduction:</i></b> Although drug allergy workup for pediatric patients (skin and drug provocation tests [DPT]) is performed, the procedures are troublesome, painful, and time-consuming. The aim of this study was to assess parents’ perception of and satisfaction with their child’s drug allergy workup. Further, to evaluate parents’ tendency to use the tested drug following a negative DPT and the consequences of re-exposure. <b><i>Methods:</i></b> Parents of children that underwent drug allergy workup from January 2017 to August 2020 in the Pediatric Allergy Department of Trakya University Medical Faculty were included. Satisfaction levels were assessed via a telephone questionnaire (3 open-ended, 7 multiple-choice questions). Satisfaction was scored on a Likert scale (1: very unsatisfied and 5: very satisfied). <b><i>Results:</i></b> A total of 102 parents participated the study. Fifty-two (51%) of patients were male, and median age was 6.2 years and a median time interval between admission and test appointment of 1 month; 16.7% had a positive drug allergy workup, with 88.3% reporting being satisfied (56.9%) or very satisfied (31.4%) with the workup. Satisfaction levels were inversely related to the time between admission and test appointment (rho: −0.254, <i>p</i> = 0.01), with 8.2% reporting they did not use the tested drug when necessary despite a negative result. The tested drug was used by 35 individuals (41.1%), 33 (94.2%) tolerating without reaction. <b><i>Conclusion:</i></b> Most parents were satisfied with the workup, but levels were inversely related to the admission and procedure time interval. Drug allergy workup should be performed as soon as possible to relieve parents’ anxiety and achieve more patient satisfaction.

Pediatric health care professionals’ vaccine knowledge, awareness and attitude: a survey within the Italian Society of Pediatric Allergy and Immunology

Background Physicians play a key role in driving vaccine acceptance and their recommendations are crucial to address vaccine hesitancy. The aim of the study was to assess knowledge, awareness and attitude of Italian Pediatric Health Care Professionals (pHCPs) on vaccinations. Methods An anonymous on-line questionnaire was developed within the Vaccine Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP) and spontaneously completed by 231 Pediatricians and Pediatric Nurses (PN). Results An accurate vaccine education was reported by 70% of pediatricians and 13% of PN but 11% of pediatricians versus 26% of PN consult social media instead of scientific sources for their vaccine update. The investigation on the pHCPs attitudes to vaccination in a personal and family setting highlights poor adherence to vaccinations. Only 63% of pediatricians versus 16% of PN (p < 0.0001) annually received the Flu vaccine. In their family setting 93% of pediatricians versus 51% of PN recommended all vaccinations (p < 0.0001). Anti-flu, anti-rotavirus, anti-zoster and anti-pneumococcal vaccines were not regularly recommended by all pHCPs due to doubts of uselessness (55% of pediatricians versus 40% of PN) and preference for “natural immunity” (44% of pediatricians versus 40% of PN). Conclusions Our results indicate that pHCPs’ attitude and confidence in regards to vaccines remain suboptimal. Current COVID-19 pandemic and the rapid development of vaccines could increase vaccine hesitancy. Due to the documented pHCPs’ influence in the parental decision, educational interventions are needed to improve their level of knowledge and counselling skills in order to address parental vaccine hesitancy and to maintain continuity of immunization services.

Food-induced anaphylaxis in early childhood and factors associated with its severity

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.