Ozkan Karaman

Background: Early complementary feeding practices and timely allergen introduction are important components of current infant feeding recommendations. However, evidence remains limited regarding how complementary feeding routines and socioeconomic factors influence parental allergy-related healthcare-seeking behavior during early childhood. Objective: To examine the association between complementary feeding routines, early allergen introduction, socioeconomic characteristics, and parental allergy-related healthcare-seeking behavior in young children. Methods: In this cross-sectional study, parents of young children completed a structured questionnaire assessing complementary feeding routines, the timing and type of allergen introduction, allergy-related symptoms, and socioeconomic characteristics. All data were based on parental self-report and were not independently verified through clinical assessment or medical records. The primary outcome, allergy-related healthcare-seeking behavior, was operationally defined as any parent-reported healthcare contact, including at least one visit to a pediatrician or pediatric allergy clinic, due to suspected allergy-related symptoms or parental concern. Multivariable logistic regression analysis was performed to identify factors associated with allergy-related healthcare-seeking behavior. Results: Early introduction of specific allergens, particularly egg white, was significantly associated with increased parental allergy-related healthcare-seeking behavior. The presence of allergy-related symptoms was also a strong determinant of healthcare utilization. In addition, socioeconomic factors, including household income and parental employment status, were associated with differences in healthcare-seeking patterns, likely reflecting variation in access to healthcare services and health awareness. The multivariable model demonstrated moderate sensitivity, indicating that while key factors associated with allergy-related healthcare-seeking behavior were identified, some cases could not be fully captured. Conclusion: Complementary feeding practices, early introduction of allergenic foods, and socioeconomic factors were associated with parental allergy-related healthcare-seeking behavior in early childhood. These findings highlight the need for targeted parental education, optimization of infant feeding recommendations with consideration of allergy risk, and improved clinical guidance for families reporting allergy-related symptoms. Prospective studies are warranted to confirm these associations and to support the development of effective preventive strategies.

Objective: The prevalence of food allergy (FA) has gradually increased. Bloody stool is among the symptoms associated with non-immunoglobulin E (IgE) mediated FA in infants. In our study, we shared the clinical characteristics of the patients who applied to our clinic with bloody stool. Material and Methods: The data of the patients with bloody stool were reviewed. Patients’ characteristics and the time of onset of tolerance in patients with FA were recorded, retrospectively. Results: The 110 patient files were reviewed. 68% of the patients were diagnosed with FA (63 proctocolitis/12 enterocolitis), 22% with an anal fissure, and 9% with nonspecific colitis. The most common causative food was cow milk (57%), the second was the combination of egg and milk (24.2%), and the third was egg (18.2%). The presence of atopic dermatitis (AD) and eosinophil count at the time of admission did not affect tolerance development time but it was shown that skin prick test (SPT) positivity and the high level of total IgE at the time of admission delayed the development of tolerance [(p=0.02), (r=0.510, p=0.009)]. Conclusion: Bloody stool is one of the common complaints in infants. It does not always indicate a FA. The clinic is mild when the underlying disease is non-IgE mediated FA. However, accompanying IgE-type sensitivities negatively affect the prognosis. Elevated total IgE and SPT positivity at the time of diagnosis may give an impression that tolerance of baked products could be delayed in this type of allergy.

Amaç: Atopik yürüyüş, alerjik hastalıkların atopik dermatitten (AD) alerjik astım ve rinite ilerlemesini açıklayan bir modeldir. Çalışmamızda AD tanısı konan ve en az 5 yaşına kadar takip edilen hastalarda alerjen duyarlılığı ve alerjik hastalık varlığını değerlendirirken, klasik atopik yürüyüş tanımının beklentilere ne kadar cevap verdiğini araştırmak amaçlanmıştır. Gereç ve Yöntemler: Başvuru sırasında yaşları 2 yaş ve altında olan, AD tanılı, ve en az 5 yaşına kadar düzenli olarak takip edilen hastaların dosya kayıtları geriye dönük olarak incelendi. Klinik ve laboratuvar bulguları kaydedildi. Hastaların 5 yaşında iken alerjik hastalık varlığı ve alerjen duyarlılık durumları not edildi. Bulgular: Kriterleri karşılayan AD tanılı 41 hasta belirlendi. Başvuru sırasında 28 (%68.3) hastada besin duyarlılığı saptandı. Hastaların 5 yaşına geldiğinde 13 (%31.7)’ünde astım, 12 (%29.2)’ sinde alerjik rinit tanısı saptandı. Sonuç: AD’li hastalarda astım ve alerjik rinit sıklığı normal popülasyon verilerine göre daha yüksek bulundu. Ancak gıda duyarlılığı ile astım ve/veya alerjik rinit gelişimi arasında bir ilişki gösterilemedi. AD’de etkili cilt bakımının, alerjik hastalıkların gelişmesine karşı koruyucu olabileceği düşünüldü. Klinisyenlerin çocuklarda atopik hastalık modellerinin heterojenliğini anlamaları ve bu değişkenliği ortadan kaldırabilmeleri için AD’li bebeklerin sonraki yaşamlarında takip edilmeleri faydalı olacaktır.

Objective A misdiagnosed “penicillin allergy” is a common problem in childhood. Recently, skipping skin tests (STs) and performing a direct oral challenge test (OCT) have become an increasingly common approach in children with suspected β-lactam (BL) allergy. In our study, we aimed to evaluate the safety and efficacy of OCT without using ST in children who had a history of hypersensitivity reactions with BL antibiotics. Materials and Methods We retrospectively evaluated direct OCT outcomes in children with both nonimmediate and immediate-type reaction history with BL antibiotics. STs were not performed before the challenge test. The patients were monitored for 4 hours after the challenge and continued using the drug in two divided doses for 3 days at home. Results In this study, 72 patients were included, with median age of 7 years (interquartile range: 4; min: 1 year to max: 16 years), and of these, 56% were male. Forty-five subjects (63%) reported immediate-type adverse reactions. The most common clinical manifestation was urticaria/angioedema (51%, n: 37) and maculopapular exanthema in 46% (n: 33) of patients, respectively. The most commonly suspected drug was 71% amoxicillin-clavulanate. A 3-day OCT without preceding ST was performed in all patients. Only three patients (4.2%) showed a positive response to the oral drug challenge test. None of these reactions observed was more severe than index reactions. Conclusion Performing OCT without STs is a safe and convenient method to exclude BL hypersensitivity in the pediatric age group.

Background/aim: Allergic bronchopulmonary aspergillus (ABPA) is a lung disease caused by hypersensitivity from Aspergillus fumigatus. Diagnostic criteria, staging systems and treatment methods for ABPA disease have been reported in studies evaluating populations, the majority of which are adult patients. Our study aimed to discuss the use of ABPA diagnostic criteria in children, the success of other alternative regimens to oral corticosteroids in the treatment of ABPA, and the changes that occur during treatment, in the light of the literature. Materials and methods: Between January 2017 and 2020, patients diagnosed with ABPA at the Dokuz Eylul University Child Allergy and Immunology clinic were identified; demographic characteristics, clinical and laboratory findings, diagnostic scores and stages, and treatment protocols were analyzed retrospectively. Results: The mean age of patients diagnosed with ABPA was 14.33 +/- 1.96. At the time of ABPA diagnosis, the median total IgE level was 1033 IU/mL (1004-6129), and the median AF specific IgE was 10.64 (2.59-49.70) kU/L. Bronchiectasis was detected in HRCT of 5 cases. We detected significant improvement in spirometric analysis with omalizumab treatment in our patient with steroid-related complications. Conclusion: Today, although risk factors have been investigated for ABPA, it has not been revealed clearly. Both diagnostic criteria and treatment regimens have been described in research studies, mostly adults. In pediatric patients; clarification of diagnosis and treatment algorithms is necessary to prevent irreversible lung tissue damage and possible drug side effects.

Purpose High serum immunoglobulin (Ig) E levels are associated with allergies, parasitic infections, and some immune deficiencies; however, the potential effects and clinical implications of low IgE levels on the human immune system are not well-known. This study aims to determine the disorders accompanying very low IgE levels in children and adults. Methods The patients whose IgE levels were determined between January 2015 and September 2020 were analyzed, and the patients with an IgE level < 2 IU/mL were included in this study. Demographic data, immunoglobulin levels, autoantibody results, and the diagnoses of the patients were noted from the electronic recording system of the hospital. Result The IgE levels were measured in 34,809 patients (21,875 children, 12,934 adults), and 130 patients had IgE levels < 2 IU/mL. Fifty-seven patients were children (0.26%); 73 were adults (0.56%). There was a malignant disease in 34 (9 of them children) (26%), autoimmune diseases in 20 (3 of them children) (15.4%), and immunodeficiency in 17 (14 of them children) (13.1%) of the patients. The most common reasons were other diseases, immunodeficiency and malignancy in children, and malignancy, autoimmune disorders, and other diseases in the adults, in rank order. The IgE level did not show any correlation with the levels of other immunoglobulins. Conclusion Although rare, a low IgE level has been shown to accompany malignancies, autoimmune disorders, and immune deficiencies. Patients with very low IgE levels should be carefully monitored for systemic disorders.

Omenn syndrome is a combined immunodeficiency characterized by a generalized erythematous skin rash, enlarged lymph nodes, hepatosplenomegaly, severe susceptibility to infections, eosinophilia, and hyperimmunoglobulinemia E. A 3-month-old girl was admitted to our hospital with a history of recurrent sepsis. Physical examination revealed severe erythroderma, hepatosplenomegaly, lymphadenopathy, and failure to thrive. Laboratory findings revealed leukocytosis, lymphocytosis with high CD3 T-cells, a high CD4:CD8 ratio, absence of CD19 B-cells, high eosinophil count, and low immunoglobulin levels. A heterozygote RAG1 gene mutation was found. She had itchy, scaling, ichthyosiform erythroderma and protracted diarrhea. Cyclosporin treatment up to 10 mg/kg effectively resolved erythroderma and lowered total eosinophil counts, and she gained weight during treatment. Since extensive erythroderma with generalized itching causes patient discomfort in Omenn syndrome, cyclosporin treatment can be considered while waiting for treatment with hematopoietic stem cell transplantation.

Increased arginase activity in the airways decreases L-arginine and causes deficiency of bronchodilating and anti-inflammatory nitric oxide (NO) in asthma. As, it is suggested that L-arginine may have therapeutic potential in asthma treatment, we aimed to investigate the effects of inhaled L-arginine on oxygen saturation (SaO₂) and airway histology in a murine model of acute asthma. Twenty eight BALB/c mice were divided into four groups; I, II, III and IV (control). All groups except the control were sensitized and challenged with ovalbumin. After establishement of acute asthma attack by metacholine administration, the mice were treated with inhaled L-arginine (Group I), saline (Group II) and budesonide (Group III), respectively. SaO₂was measured by pulse oximeter just before and 5 min after methacholine. A third measurement of SaO₂was also obtained 15 min after drug administration in these study groups. Inflammation in the lung tissues of the sacrificed animals were scored to determine the effects of the study drugs. The number of eosinophils in bronchoalveolar lavage (BAL) was determined. The results indicated that inflammatory scores significantly improved in groups receiving study drugs when compared with placebo and L-arginine was similar in decreasing scores when compared with budesonide. SaO₂had a tendency to increase after L-arginine administration after acute asthma attack and this increase was statistically significant (p=0.043). Eosinophilia in BAL significantly reduced in group receiving L-arginine when compared with placebo (p<0.05). Thus in this study we demonstrated that L-arginine improved SaO₂and inflammatory scores in an acute model of asthma.

Acute urticaria is a common condition in childhood that concerns both patients and pediatricians. The aim of this study was to evaluate the general approach of pediatricians to children with acute urticaria. A data collection form consisting of 17 questions was created to evaluate pediatricians' general knowledge and practical approaches about urticaria. This form was distributed at the hospitals where pediatricians and pediatric residents work. The data was recorded in SPSS for Windows v.15 (SPSS, Inc., Chicago, IL, USA). The frequency (%) was used for descriptive data, while Pearson χ2 and Fisher's Exact tests were used for comparisons between groups. P<0.05 was considered significant. The study was approved by the local ethics committee. Pediatricians suggest that foods and food additives are the most common etiological factors in the development of urticaria and, therefore, often advise dietary changes. Second-generation antihistamines are preferred for treatment and are administered for about 5-7 days. Pediatric residents were found to prefer parenteral drug administration for the treatment of urticaria. A different generation antihistamine therapy was applied for treatment of patients who did not respond to the initial treatment. It was also determined that patients were referred to allergists when urticaria was accompanied by angioedema or when patients were resistant to conventional treatment. Pediatricians' knowledge regarding the diagnosis and treatment of urticaria was less extensive than expected. According to the results, there was some confusion among physicians regarding the etiological role of some foods in acute urticaria and the strategies for removal of these foods from the diet during the treatment. Participants' treatment approaches were partially correct and sufficient. In general, there were no differences observed between pediatric residents and pediatricians in terms of the management of patients with urticaria, except the route of administration.

Increased arginase activity in the airways induces reduced bioavailability of L-arginine and cause deficiency of bronchodilatating and anti-inflammatory nitric oxide (NO). Therefore, arginine and arginase inhibitors may have therapeutic potential in the treatment of asthma. Using a murine model of asthma, we aimed to investigate the effects of inhaled L-arginine and arginase inhibitor Nω-hydroxy-nor-L-arginine (nor-NOHA) and co-treatment on airway histology of asthmatic lung tissue. Forty-two BALB/c mice were divided into six groups: I (control), II (placebo), III, IV, V and VI. All mice except for control group were sensitised by an intraperitoneal injection of ovalbumin with alum adjuvant and then challenged with an aerosol of ovalbumin on three days of the week for eight weeks beginning from the 21st day of the study. Lung histology and bronchoalveolar lavage cell (BAL) counts were evaluated after treatment with inhaled L-arginine, nor-NOHA, l-arginine-nor-NOHA combination, budesonide and placebo. Interleukin(IL)-4 and IL-5 levels are determined in lung homogenates with ELISA. L-Arginine group was similar to budesonide group in lowering all histological parameters. Results of groups treated with nor-NOHA were also similar to budesonide group except for epithelial thickness. The number of eosinophils in BAL decreased significantly in groups receiving study drugs. Decrease was only noted in IL-4 levels in group receiving nor-NOHA. We demonstrated that inhaled l-arginine administration alleviated all histological parameters similar to budesonide and treatment with arginase inhibitor improved not all but some of the pathological changes in chronic asthma. Combination therapy had no additive effect on either treatment.