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İlgün Gürel D, Parlak Z, Şahiner ÜM, Soyer Ö, Şekerel BE. Recognition of nuts and seeds in children with/without food allergies and their mothers: A reflection of culinary culture. Nutr Health 2024:2601060231209371. [PMID: 38504662 DOI: 10.1177/02601060231209371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Nuts and seeds are among the leading causes of food allergy. Effective food allergy management hinges on the ability to identify and avoid relevant foods. AIM To evaluate the nut/seed recognition ability in both children and mothers. METHODS Primary caregivers (mothers) and their children (6-18 years old) with/without food allergies were shown photographs of nuts/seeds, and their products with visible/hidden allergens to assess their ability to recognize accurately. RESULTS A total of 196 children and 184 mothers participated. The median ages of the children and mothers were 7.6 (6.8-10) and 37.8 (33.1-41.5) years, respectively. Over 75% of the children/adolescents and over 90% of the mothers accurately identified the kernel forms of nuts/seeds, except pine nuts. Walnuts, hazelnuts, almonds, and cashews were the most accurately recognized kernel forms by both populations. Generally, the kernel forms were recognized 5-20% more accurately than their in-shell forms, followed by products with visible and hidden forms, respectively. Some Turkish culinary-specific products with visible/hidden allergens were recognized as frequently as the kernel/in-shell forms by both study groups. Although there was a similar recognition pattern between study groups and subgroups (nut/seed allergy, other food allergy, controls), higher rates of recognition were found in mothers than in their children and adolescents than in schoolchildren. CONCLUSION In Eastern Mediterranean region, nuts and sesame seeds are highly recognized by both mothers and their children. Accurate identification of these foods is likely a culinary feature, but not the result of increased awareness. More information is needed on whether this ability reduces the risk of exposure.
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Affiliation(s)
- Deniz İlgün Gürel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeynep Parlak
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
- Nutrition and Dietetics Unit, Hacettepe İhsan Doğramacı Children's Hospital, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Özge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
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Birben E, Şahiner ÜM, Kalaycı CÖ. Determination of the effects of advanced glycation end products receptor polymorphisms and its activation on structural cell responses and inflammation in asthma. Turk J Med Sci 2023; 53:160-170. [PMID: 36945930 PMCID: PMC10387853 DOI: 10.55730/1300-0144.5569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/30/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Advanced glycation end products receptor (RAGE) is a pattern recognition receptor which attracted attention in chronic airway diseases recently. This study aimed to determine the association of RAGE with asthma and the cellular responses resulting from RAGE signaling pathway activation. METHODS Asthmatic (n = 362) and healthy (n = 134) children were genotyped by PCR-RFLP. Plasma sRAGE levels were determined by ELISA. Lung structural cells were stimulated with AGEs (advanced glycation end products) and control BSA. Expressions of cytokines and protein levels were determined by real-time PCR and ELISA. RESULTS : Gly82Ser and -374 T/A polymorphisms in RAGE gene were associated with lower plasma sRAGE levels (p < 0.001 and p < 0.025, respectively). AGE stimulation increased the expression of RAGE (p = 0.002), ICAM-1 (p = 0.010) and VCAM-1 (p = 0.002) in endothelial cells; TIMP-1 (p = 0.003) and MCP-1 (p = 0.005) in fibroblasts. AGE stimulation increased protein levels of IL-6 (p < 0.001) in endothelial cells; VEGF (p = 0.025) and IL-8 (p < 0.001) in fibroblasts; IL-1b (p < 0.001) and VEGF (p = 0.007) in epithelial cells. DISCUSSION Activation of RAGE pathway may contribute to asthma pathogenesis by increasing the expression of several asthmarelated genes. These findings suggest that suppression of RAGE signaling may be an alternative candidate for treating asthma.
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Affiliation(s)
- Esra Birben
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Can Ömer Kalaycı
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Türk M, Ertaş R, Şahiner ÜM, Kolkhir P, Şekerel BE, Soyer Ö, Avcı A, Atasoy M, Özyurt K, Türk Y, Zeydan E, Maurer M. In Chronic Spontaneous Urticaria, Complete Response to Antihistamine Treatment Is Linked to Low Disease Activity. Int Arch Allergy Immunol 2023; 184:421-432. [PMID: 36652936 DOI: 10.1159/000528395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/22/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The use of predictors of response to a specific treatment in patients with chronic spontaneous urticaria (CSU) can improve disease management, help prevent unnecessary healthcare costs, and save time. In this study, we aimed to identify predictors of complete response to standard-dosed and higher than standard-dosed antihistamine treatments in patients with CSU. METHODS Medical records of 475 CSU patients, 120 of them <18 years old, from 3 different centers were analyzed. We used 15 machine learning (ML) models as well as traditional statistical methods to predict complete response to standard-dosed and higher than standard-dosed antihistamine treatment based on 17 clinical parameters. RESULTS CSU disease activity, which was assessed by urticaria activity score (UAS), was the only clinical parameter that predicted complete response to standard-dosed and higher than standard-dosed antihistamine treatment, with ML models and traditional statistics, for all age groups. Based on ROC analyses, optimal cut-off values of disease activity to predict complete response were UAS <3 and UAS <4 for standard-dosed (area under the ROC curve [AUC] = 0.69; p = 0.001) and higher than standard-dosed (AUC = 0.79; p = 0.001) antihistamine treatments, respectively. Also, ML models identified lower total IgE (<150 IU/mL) as a predictor of complete response to a standard-dosed antihistamine and lower CRP (<3.4 mg/mL) as a predictor of complete response to higher than standard-dose antihistamine treatment. DISCUSSION In this study, we showed that patients with UAS <3 are highly likely to have complete response to standard-dosed AH and those with a UAS <4 are highly likely to have complete response to higher than standard-dosed AH treatment. Low CSU disease activity is the only universal predictor of complete response to AH treatment with both ML models and traditional statistics for all age groups.
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Affiliation(s)
- Murat Türk
- Kayseri City Education and Research Hospital, Clinic of Immunologic and Allergic Diseases, Kayseri, Turkey
| | - Ragıp Ertaş
- Health Science University, Kayseri Faculty of Medicine, Kayseri City Education and Research Hospital, Department of Dermatology, Kayseri, Turkey
| | - Ümit Murat Şahiner
- Hacettepe University, Division of Pediatric Allergy and Immunology, Ankara, Turkey
| | - Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Division of Immune-mediated Skin Diseases, Moscow, Russian Federation
| | - Bülent Enis Şekerel
- Hacettepe University, Division of Pediatric Allergy and Immunology, Ankara, Turkey
| | - Özge Soyer
- Hacettepe University, Division of Pediatric Allergy and Immunology, Ankara, Turkey
| | - Atıl Avcı
- Health Science University, Kayseri Faculty of Medicine, Kayseri City Education and Research Hospital, Department of Dermatology, Kayseri, Turkey
| | - Mustafa Atasoy
- Biruni University, Medical Faculty, Department of Dermatology, İstanbul, Turkey
| | - Kemal Özyurt
- Kırşehir Ahi Evran University, Department of Dermatology, Kırşehir, Turkey
| | | | - Engin Zeydan
- Services as Networks (SAS) Research Unit, Centre Tecnològic de Telecomunicacions de Catalunya (CTTC), Barcelona, Spain
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
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Gürel Dİ, Soyer Ö, Şahiner ÜM. Systemic treatments in atopic dermatitis in children. Turk J Pediatr 2023; 65:887-905. [PMID: 38204304 DOI: 10.24953/turkjped.2023.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Atopic dermatitis (AD) is a very common skin disease caused by inflammatory reactions, in which the main symptoms of severe itching and recurrent eczema diminish quality of life. As epidermal barrier function and the immune system play a critical role in atopic dermatitis, promoting IgE-mediated sensitization can be the main targets of AD treatment. The goal of AD treatment should be to eliminate the symptoms and obtain longterm eczema control with a multi-step approach adapted to the severity of the disease. Basic management for all patients comprises the use of moisturisers and avoiding triggers. While topical therapy is effective for most children diagnosed with AD, there may also be children who require systemic therapy. The aim of this paper was to present an extensive review of the systemic agents commonly used in childhood atopic dermatitis which mainly target cutaneous inflammation.
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Affiliation(s)
- Deniz İlgün Gürel
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Özge Soyer
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Abstract
BACKGROUND Optimum management of food allergy (FA) includes consideration of co-allergies and multimorbidities and tolerance assessment. Documentation of FA practices may pave the way for better practice. METHODS Patients aged 3-18 years, with persistent IgE-mediated hen`s egg allergy were reviewed. RESULTS A total of 102 children with a median age of 59 months (IQR= 40-84) (72.2% males) were included. All were diagnosed during infancy and the initial symptoms were atopic dermatitis (65.6%), urticaria (18.6%), and anaphylaxis (5.9%). Of the total population, 21 (20.6%) experienced anaphylaxis with hen`s eggs, and 79.4%, 89.2%, and 30.4% had multiple FAs (≥2 food categories), ever atopic dermatitis, and asthma, respectively. The most common co-allergies were tree nuts, cow`s milk, and seeds, respectively. From 52 heated egg yolk and 47 baked egg oral food challenges, 48 (92.3%) and 41 (87.2%) were found as tolerant, respectively. The baked egg nontolerant group had a greater egg white skin prick test diameter [9 mm (IQR: 6-11.5) vs. 6 mm (IQR: 4.5-9); (p=0.009)] and specific IgE [12.6 kU/L (IQR: 4.11-45.4) vs. 6.2 kU/L (IQR: 1.9-12.4) (p=0.009)], respectively. In the multivariate analysis, baked egg tolerance was more likely in those with egg yolk-tolerant subgroup (OR: 6.480, 95% CI: 2.524-16.638; p < 0.001) and heated egg tolerance in those with baked egg tolerance (OR: 6.943, 95% CI: 1.554-31.017; p=0.011). CONCLUSIONS Persistent hen`s egg allergy is characterized by multiple food allergies and age-related multimorbidities. Baked egg and heated egg yolk tolerance were more likely to be considered in a subgroup with a high expectation for finding a way to eliminate their allergy.
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Affiliation(s)
- Hilal Ünsal
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Sevda Tüten Dal
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ayşegül Akarsu
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Özge Soyer
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Bülent Enis Şekerel
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Türk M, Yılmaz İ, Şahiner ÜM, Kocatürk E, Şekerel BE, Zuberbier T, Maurer M. Experience-based advice on stepping up and stepping down the therapeutic management of chronic spontaneous urticaria: Where is the guidance? Allergy 2022; 77:1626-1630. [PMID: 35048385 DOI: 10.1111/all.15227] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Türk
- Clinic of Immunologic and Allergic Diseases Kayseri City Education and Research Hospital Kayseri Turkey
| | - İnsu Yılmaz
- Division of Allergy and Clinical Immunology Erciyes University School of Medicine Kayseri Turkey
| | - Ümit Murat Şahiner
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine İstanbul Turkey
| | - Bülent Enis Şekerel
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | - Torsten Zuberbier
- Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
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Tunçer F, Şahiner ÜM, Ocak M, Ünsal H, Soyer Ö, Şekerel BE, Birben E. Comparison of mirna expression in patients with seasonal and perennial allergic rhinitis and non-atopic asthma. Turk J Pediatr 2022; 64:859-868. [DOI: 10.24953/turkjped.2022.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Coronavirus Disease 2019 (COVID-19) affected the whole world in a short time. One of the most influential public health initiatives modern medicine has to offer, the vaccine has become even more important as the COVID-19 pandemic continues to worsen worldwide. Many vaccine trials were launched during the COVID-19 pandemic, and these vaccines were widely used around the world, offering realistic hope for ending the pandemic. Allergic reactions to vaccines were reported shortly after their approval. These reactions, in general, are rare, but, in some circumstances, they can be serious. Allergy to vaccines can occur because of either the active vaccine component or vaccine ingredients. The spectrum of the reactions may be just a local hypersensitiviy reaction or may be as severe as an anaphylaxis, which is an acute severe, life-threatening systemic hypersensitive reaction, and it requires quick intervention. If an allergy is suspected, a correct examination followed by algorithms is important for true diagnosis, treatment, and decision regarding revaccination. Patients who experience an allergic reaction with the first dose of covid 19 vaccine should be directed to the allergy-immunologist, and the evaluation of at-risk patients should be individualized. Finally, we should point out that the benefits of current COVID-19 vaccines go far beyond the side effects, and that the vaccine is the most important way to recover from the pandemic.
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Affiliation(s)
- Hilal Ünsal
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Akarsu A, Ocak M, Köken G, Şahiner ÜM, Soyer Ö, Şekerel BE. IgE mediated food allergy in Turkey: different spectrum, similar outcome. Turk J Pediatr 2021; 63:554-563. [PMID: 34449137 DOI: 10.24953/turkjped.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Food allergies (FAs) potentially differ across cultures. METHODS All medical records of 534 children and adolescents with IgE-mediated FA over a 5-year period were reviewed to document the regional characteristics with regard to spectrum and outcome. RESULTS According to their last visit, the most common FAs were tree nuts (TNs) (52.4%), cow`s milk (27.3%), seeds (24.7%), egg white (23.2%) and peanuts (14.9%). Hazelnut and Anacardia nuts were the most common etiologies for TN allergies, whereas lentils and chickpeas for legumes and sesame and pumpkin seed for seeds were most common, respectively. TN allergy was in first place in school-age children (55.3%) and adolescents (57.1%) while in the second place in preschoolers (57.7%) after egg white (60%). Of these 534 children, 59.2% had at least one resolved FA (mainly egg white, cow`s milk) and 21% had no residual FA during the study period. Emerging FAs (fish, shellfish, fruit, TN and seed) after the age of 3 years was reported in 94 children. The prevalence of current asthma (22.3%, 38.2%, 40%) and allergic rhinitis (11.6%, 45.2%, 60%) increased, while current atopic dermatitis (17.5%, 8.6%, 8,6%) decreased in preschoolers, school age children and adolescents, respectively. CONCLUSIONS The FA spectrum of Turkish children and adolescents differs from many regions of the world with high rates of TN (hazelnut, Anacardia nuts), seed (sesame, pumpkin seed) and lentils, and low rates of soy, peanut and seafood allergies. However, resolution, emergence and persistence of allergies and comorbidities are similar, which points to the limited role of the environment in the outcome.
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Affiliation(s)
- Ayşegül Akarsu
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Melike Ocak
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gizem Köken
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Soyer
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Division of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abstract
Food allergy (FA) has become an increasing problem throughout the world. Over the last 2 decades, the frequency of FA has increased in both children and adults. The prevalence differs according to the research methodology, age, and geographic regions, ranging between 2.0% and 10.0%. The most common form of FA is immunoglobulin E (IgE)-mediated FA. In this form, patients may present with life-threatening conditions, such as anaphylaxis, or milder conditions, such as urticaria, angioedema, sneezing, and nausea alone. The gold standard in the diagnosis of FA is oral provocation tests. Epidermal skin prick tests and specific IgE measurements, as well as component-resolved diagnostic techniques are helpful in the diagnosis and follow-up of patients. In this review, the epidemiology, diagnosis, follow-up, and prognosis of IgE-mediated FA in children and adults were discussed and some specific forms of FA, such as pollen FA syndrome, alpha-gal allergy, and food-dependent exercise-induced anaphylaxis were explained.
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Affiliation(s)
- Ebru Çelebioğlu
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayşegül Akarsu
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Doğan M, Şahiner ÜM, Ataç AS, Ballıkaya E, Soyer ÖU, Şekerel BE. Oral health status of asthmatic children using inhaled corticosteroids. Turk J Pediatr 2021; 63:77-85. [PMID: 33686829 DOI: 10.24953/turkjped.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Due to the increase in the prevalence of asthma, especially in childhood, oral health problems arising from the use of asthma medications have become a major health concern. Inhaled corticosteroids are widely used since they are the cornerstone of asthma management. This study aimed to investigate the effects of inhaled corticosteroids on oral health and various factors regarding active ingredients in inhalers, inhaler-spacer device use, rinsing the mouth after administration of inhaler, oral hygiene practices and parents` education on dental caries susceptibility in young children with asthma. METHODS Children with asthma who were treated with inhaled corticosteroids for at least 6 months were included in the study. A questionnaire related to demographic characteristics and oral health practices of children was conducted with parents and the children were examined using a dental mirror and probe under dental unit lighting after air-drying the teeth. RESULTS Oral health status was evaluated in 115 children, 54 (42-66) months old, 61% male and 39% female with determination of dmft-dmfs, DMFT-DMFS, ICDAS II, plaque index and gingival index. No statistically significant difference was found between sugar-containing and sugar-free inhalers, duration of inhaled corticosteroid use, inhaler-spacer device use, rinsing the mouth after administration of inhaler and dmft-dmfs, DMFT-DMFS, plaque and gingival index (p > 0.05). Long-term inhaled corticosteroid use was significantly associated with oral candidiasis (p=0.029). Also, the results showed that mothers` educational level had a significant effect on children`s oral health (p < sub > dmft/dmfs < /sub > < 0.001; p < sub > gingival index < /sub > =0.049; p < sub > plaque index < /sub > =0.005). CONCLUSION Due to the effect of immunosuppression, long-term use of inhaled corticosteroids enhances the risk of development of the opportunistic pathogen candida. Regular dental visits and preventive dental treatments are needed in these patients for healthy oral status.
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Affiliation(s)
- Münevver Doğan
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, , Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Atilla Stephan Ataç
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, , Ankara, Turkey
| | - Elif Ballıkaya
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, , Ankara, Turkey
| | - Özge Uysal Soyer
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ocak M, Nain E, Şahiner ÜM, Akin MŞ, Karabiber E, Şekerel BE, Soyer Ö. Recurrent angioedema in childhood: hereditary angioedema or histaminergic angioedema? Pediatr Dermatol 2021; 38:143-148. [PMID: 33275322 DOI: 10.1111/pde.14467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/06/2020] [Accepted: 10/31/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recurrent angioedema is a rare entity during childhood. This study aimed to clarify differences between hereditary angioedema (HAE) and histaminergic angioedema (HA) in children. METHODS Fifty-seven children with HAE (male 36.8%, 8.9 years [5.4-12.5]) and 42 children with recurrent HA (male 42.9%, 11.5 years [8.1-16.8]) were analyzed. RESULTS The median age at symptom onset (6 [3-10]; 7.8 [4.5-13] years), frequency of angioedema episodes within last year (3 [2-5]; 5 [2-10]), and duration of symptoms (48 [24-48]; 24 [12-48] hours) were similar in the HAE and HA group, respectively. Recurrent urticaria was observed in 7.3% (n = 3) of patients in the HAE group and in 45.2% (n = 19) of the HA group (P < .001). While angioedema episodes involving the lips (n = 30; 71.4%; P = .035) and eyelids (n = 28; 66.7%; P = .012) were observed more frequently in the HA group, gastrointestinal involvement/abdominal pain (n = 15; 36.6%) was more common in HAE (P < .001). Itching as a prodromal symptom was detected in 47.6% (n = 20) of HA patients versus 14.6% (n = 6) of those with HAE (P = .002). In the logistic regression analysis for the diagnosis of HAE, a family history of angioedema (OR = 58.289 [95% CI 10.656-318.853], P < 001) and trauma (OR = 35.208 [95% CI [4.368-283.794]], P = .001) as a triggering factor were determined to be independent variables. CONCLUSION A family history of angioedema, trauma as a triggering factor, and abdominal pain should suggest the diagnosis of HAE and the need for further investigation.
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Affiliation(s)
- Melike Ocak
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ercan Nain
- Department of Pediatric Allergy, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Şenol Akin
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esra Karabiber
- Department of Pediatric Allergy, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Soyer
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Vardar Acar N, Cavkaytar Ö, Arik Yilmaz E, Büyüktiryaki AB, Uysal Soyer Ö, Şahiner ÜM, Şekerel BE, Karaaslan IÇ, Saçkesen C. Rare occurrence of common filaggrin mutations in Turkish children with food allergy and atopic dermatitis. Turk J Med Sci 2020; 50:1865-1871. [PMID: 32536107 PMCID: PMC7775701 DOI: 10.3906/sag-1910-162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background/aim Filaggrin is a protein complex involved in epidermal differentiation and skin barrier formation. Mutations of the filaggrin gene (FLG) are associated with allergen sensitization and allergic diseases like atopic dermatitis (AD), allergic rhinitis, food allergy (FA), and asthma. The aim of the study is to reveal the frequency of change in the FLG gene and determine the association between FLG loss-of-function (LOF) mutations and FA and/or AD in Turkish children. Materials and methods Four
FLG
loss-of-function (LOF) mutations known to be common in European populations were analyzed in 128 healthy children, 405 food-allergic children with or without atopic dermatitis, and 61 children with atopic dermatitis. PCR-RFLP was performed for genotyping R501X, 2282del4, and R2447X mutations; S3247X was genotyped using a TaqMan-based allelic discrimination assay. Results were confirmed by DNA sequence analysis in 50 randomly chosen patients for all mutations.
Results A total of 466 patients [(67% male, 1 (0.7–2.8) years] and 128 healthy controls [59% male, 2.4 (1.4–3.5) years)] were included in this study. Two patients were heterozygous carriers of wild-type R501X, but none of the controls carried this mutation. Three patients and one healthy control were heterozygous carriers of wild-type 2282del4. Neither patients nor controls carried R2447X or S3247X
FLG
mutations. There were no combined mutations determined in heterozygous mutation carriers.
Conclusions Although R501X, 2282del4, R2447X, and S3247X mutations are very common in European populations, we found that FLG mutations were infrequent and there is no significant association with food allergy and/or atopic dermatitis in Turkish individuals.
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Affiliation(s)
- Neşe Vardar Acar
- Department of Biology, Faculty of Science, Hacettepe University Ankara, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey,Department of Pediatric Allergy and Immunology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Ebru Arik Yilmaz
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey,Department of Pediatric Allergy, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | | | - Özge Uysal Soyer
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Cansin Saçkesen
- Department of Pediatric Allergy, Faculty of Medicine, Koç University, İstanbul, Turkey
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14
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Çelik B, Nalçacıoğlu H, Karakükçü Ç, Aslaner H, Şahiner ÜM. Assessment of Hair Zinc in the School Children in Kayseri, Turkey. Biol Trace Elem Res 2020; 196:343-348. [PMID: 32221800 DOI: 10.1007/s12011-020-02115-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/09/2020] [Indexed: 11/25/2022]
Abstract
Zinc is an essential micronutrient for the organism and is critical for the functional and structural integrity of cells. Determination of the amount of trace element concentrations in tissues such as hair samples have been used for the evaluation of the metabolic status especially in children. Unlike serum zinc, concentrations of zinc in hair are more stable and indicative of variations over time. The purpose of this study is to assess the zinc status of healthy school-age children in Kayseri (Turkey) by measuring the zinc level in hair samples and its association with BMI and the frequency of intake of zinc-rich foods. A total of 527 healthy children, including preadolescent (n = 360) aged 6-10 years and adolescent (n = 167) aged 11-15 years were included in this study. Hair samples were analyzed for zinc content by the inductively coupled plasma-mass spectrophotometry. Analysis of 527 healthy children showed that the mean hair zinc level was 186 ± 77 μg/g. Mean hair zinc level was lower in preadolescent age group than adolescents. There was no significant relationship between the monthly income of the family and the zinc-rich food intake and the zinc level of the hair. Our study shows that samples for analysis of zinc can be obtained with a noninvasive method for determining cases of deficiency during periods of rapid growth. However, further studies are needed to determine the normal tissue zinc level in healthy children, especially in our country and including different geographical regions.
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Affiliation(s)
- Binnaz Çelik
- Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey.
| | - Hülya Nalçacıoğlu
- Department of Pediatric Nephrology, Kayseri City Hospital, Kayseri, Turkey
| | - Çiğdem Karakükçü
- Department of Biochemistry, Kayseri City Hospital, Kayseri, Turkey
| | | | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Hacettepe University Medicine faculty, Ankara, Turkey
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15
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Kahveci M, Koken G, Şahiner ÜM, Soyer Ö, Şekerel BE. Immunoglobulin E-Mediated Food Allergies Differ in East Mediterranean Children Aged 0-2 Years. Int Arch Allergy Immunol 2020; 181:365-374. [PMID: 32097952 DOI: 10.1159/000505996] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/17/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Precise diagnosis of allergy requires knowledge of the population's food allergy (FA) spectrum and predictors. METHODS Medical charts of Turkish children aged 0-2 years with FA and/or atopic dermatitis (AD) were reviewed. RESULTS A total of 1,389 patients, 912 with FA and 1,140 with AD, were included. In the FA group, the most frequently diagnosed FAs were egg white (75.9%), cow's milk (55.7%), tree nuts (31.5%) and sesame (20.6%). The detection of FA in 99% of children with any kind of FA necessitate testing with egg white, cow's milk, hazelnut, sesame, walnut, cashew, and pistachio. In the FA group, 72.7 and 56.8% had AD and multiple FA respectively. Multiple FA (56.8 vs. 49.8%) and hen's egg allergy (85.5 vs. 50.2%, p < 0.005) were more common and cow's milk allergy (51.4 vs. 67.1%, p < 0.005) less common in the AD subgroup of the FA group than in the non-AD subgroup. Multiple FA likelihood increases parallel to the severity of AD (p < 0.05). In the AD group, 58.2% had an immunoglobulin E-mediated FA. The risk of concomitant FA increased as the age at symptom onset of AD decreased (OR 0.800 [95% CI 0.731-0.875]; p < 0.001) and the severity of AD increased (OR 2.350 [95% CI 1.898-2.911]; p < 0.001). CONCLUSION Although severe and early-onset AD is a predictor of the presence and magnitude of FA in infancy, the spectrum of FA is a reflection of cultural characteristics. The clinical presentations of both AD and FA may in fact be an expression of the extent of the immune dysregulation underlying atopy and allergy.
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Affiliation(s)
- Melike Kahveci
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gizem Koken
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Soyer
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey,
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16
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Özyılmaz-Bozat G, Şahiner ÜM, Buyuktiryaki B, Uysal-Soyer Ö, Şekerel BE. Children with chronic spontaneous urticaria: Recurrence after remission and its predictors. The Journal of Allergy and Clinical Immunology: In Practice 2020; 8:796-798.e1. [DOI: 10.1016/j.jaip.2019.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/30/2019] [Accepted: 08/03/2019] [Indexed: 11/28/2022]
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17
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Soyer O, Demir S, Bilginer Y, Batu ED, Sonmez HE, Arıcı ZS, Şahiner ÜM, Sekerel BE, Ozen S. Severe hypersensitivity reactions to biological drugs in children with rheumatic diseases. Pediatr Allergy Immunol 2019; 30:833-840. [PMID: 31419311 DOI: 10.1111/pai.13114] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypersensitivity reactions (HSR) to biologic drugs (BD) may limit their use in children with rheumatic diseases. We aimed to analyze the incidence and clinical characteristics of immediate type I (IgE/non-IgE) hypersensitivity reactions to BD and the risk factors for these reactions. METHODS Children with rheumatic diseases using BD who were evaluated in the pediatric allergy department for possible drug hypersensitivity reaction (DHR) due to BD or any other drug were included in the study. RESULTS One hundred and twenty-eight children (49.2% boys; 14.6 years [9.9-16.9 years] with juvenile idiopathic arthritis [58%], familial Mediterranean fever [14%], vasculitis [14%], and other diseases [14%]) had used eight different BD with 32 494 infusions/injections. Fifteen patients were evaluated for DHR [injection-site reactions [n = 4], adverse events [n = 2], drug hypersensitivity other than BD [n = 3], and immediate BD hypersensitivity [n = 6]). The incidence of immediate BD HSR was 4.7%, with a clinical presentation of anaphylaxis in 3.9% (tocilizumab [n = 3], rituximab [n = 2], positive skin test with culprit BD [n = 3]). Among patients with BD HSR, the median follow-up was longer (84.5 vs 54 months, P = .048), and renal (33.3% vs 4.1%, P = .002), hematologic involvement (16.7% vs 0, P < .001), and active disease (83.3% vs 13.9%, P < .001) were more common. Logistic regression analysis revealed that renal involvement, more than 14 hospitalizations per lifetime, and more than two different BD used were associated with BD hypersensitivity. CONCLUSION The frequency of severe immediate HSR due to BD was shown to be 3.9% in children with rheumatic diseases. Children with active rheumatic disease and who have exposure to multiple BD should be monitored for BD HSR, particularly during intravenous BD infusions.
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Affiliation(s)
- Ozge Soyer
- Department of Pediatrics, Division of Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hafize Emine Sonmez
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zehra Serap Arıcı
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatrics, Division of Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent Enis Sekerel
- Department of Pediatrics, Division of Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
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18
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Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder of childhood. Underlying factors that contribute to AD are impaired epithelial barrier, alterations in the lipid composition of the skin, immunological imbalance including increased Th2/Th1 ratio, proinflammatory cytokines, decreased T regulatory cells, genetic mutations, and epigenetic alterations. Atopic dermatitis is a multifactorial disease with a particularly complicated pathophysiology. Discoveries to date may be considered the tip of the iceberg, and the increasing number of studies in this field indicate that there are many points to be elucidated in AD pathophysiology. In this review, we aimed to illustrate the current understanding of the underlying pathogenic mechanisms in AD, to evaluate available treatment options with a focus on recently discovered therapeutic agents, and to determine the personal, familial, and economic burdens of the disease, which are frequently neglected issues in AD. Currently available therapies only provide transient solutions and cannot fully cure the disease. However, advances in the understanding of the pathogenic mechanisms of the disease have led to the production of new treatment options, while ongoing drug trials also have had promising results.
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Affiliation(s)
- Pınar Gür Çetinkaya
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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19
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Gür Çetinkaya P, Esenboğa S, Uysal Soyer Ö, Tuncer A, Şekerel BE, Şahiner ÜM. Subcutaneous venom immunotherapy in children: Efficacy and safety. Ann Allergy Asthma Immunol 2018; 120:424-428. [PMID: 29625665 DOI: 10.1016/j.anai.2018.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/01/2018] [Accepted: 01/12/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Venom immunotherapy (VIT) is safe in children, although adverse effects can occur. OBJECTIVE To document adverse effects and to determine re-sting reactions and the efficacy of VIT in childhood. METHODS We retrospectively analyzed data from children who had taken VIT from 2002 through 2015. These patients were queried by telephone to determine reactions after re-stings during or after VIT. RESULTS In total 107 children with a systemic reaction after Hymenoptera sting and with proved immunoglobulin E-mediated sensitization were enrolled. Participants had a median age of 10.0 years (7.2-12.4 years) at the beginning of immunotherapy. Fifty-two participants had allergic reactions during VIT; 40 of these reactions were local (37.4%), 5 were large local (4.7%), and 7 were systemic (6.5%). Of the 52 patients with adverse reactions, most reactions were local (n = 40, 89%) and were observed mainly in dose-increase periods (n = 25, 60%; P < .001). Although local reactions were more frequently seen with Vespula treatment (P = .047), systemic reactions were common with Apis treatment (P = .031). Sixty-eight patients (63.5%) were queried for re-sting, 33 (48.5%) had a re-sting and 24 (72.7%) of these 33 patients developed allergic reactions. The reactions were local (n = 19), large local (n = 1), and systemic (n = 4). Risk analysis for local and systemic reactions during VIT showed pre-existing asthma as an independent risk factor (odds ratio 4.1, 95% confidence interval 1.3-12.7, P = .016). CONCLUSION In children, VIT appears to be safe and protective against severe reactions after re-sting. However, pre-existing asthma was identified as a risk factor for systemic and large local reactions during VIT in children.
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Affiliation(s)
- Pınar Gür Çetinkaya
- Division of Pediatrics, Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Saliha Esenboğa
- Division of Pediatrics, Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Özge Uysal Soyer
- Division of Pediatrics, Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ayfer Tuncer
- Division of Pediatrics, Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Division of Pediatrics, Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatrics, Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
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20
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Gür Çetinkaya P, Şekerel BE, Soyer ÖU, Şahiner ÜM. A Rare Case of Pediatric Bullous Spontaneous Acute Urticaria. Med Princ Pract 2018; 27:493-495. [PMID: 29953982 PMCID: PMC6243909 DOI: 10.1159/000491586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Acute spontaneous bullous urticaria is an extremely rare entity, and there are few reports with blister formation in acute urticaria patients. CLINICAL PRESENTATION AND INTERVENTION We present a 2-year-old girl who was admitted for bullous spontaneous acute urticaria; the underlying reason for this was not detected. Nikolsky's sign and Darier's sign were negative. Lesions were not compatible with erythema multiforme. However, biopsy was not allowed to be performed. Because of this, the underlying pathogenesis could not be clarified. The patient recovered by a short course of antihistamine and systemic steroid treatment, and the lesions did not recur during a 2-year follow-up. CONCLUSION Short-term systemic steroid in addition to oral antihistamines resulted in prompt recovery in a patient with acute urticaria complicated by bullae.
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Affiliation(s)
| | | | | | - Ümit Murat Şahiner
- *Umit Murat Sahiner, Pediatric Allergy and Asthma Unit, Faculty of Medicine, Hacettepe University, TR-06600 Ankara (Turkey), E-Mail
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