Özge Kangallı Boyacıoğlu

Background/Objectives: Regional data on contact sensitization in children remain limited and are needed to optimize pediatric patch test series. We aimed to determine the frequency of contact sensitization, identify the most common allergens, and evaluate factors associated with positive patch test results in children with clinically diagnosed contact dermatitis. Methods: We retrospectively reviewed 121 children with clinically diagnosed contact dermatitis who were patch tested with the T.R.U.E. Test to investigate an allergic cause; some also had concomitant atopic dermatitis. Demographic and clinical characteristics, atopic comorbidities, laboratory findings, and patch test results, including reaction intensity, were analyzed. Associations between patch test positivity and clinical variables were assessed using chi-square, Fisher’s exact, and Mann–Whitney U tests. Results: At least one positive reaction was observed in 36 children (29.8%). Nickel sulfate was the most common allergen (8.3%), followed by fragrance mix and gold sodium thiosulfate (5.8% each) and p-phenylenediamine (5.0%). Of 62 positive reactions, 6 were extreme (+++), including three bullous reactions (p-phenylenediamine, n = 2; black rubber mix, n = 1). The positivity rate was lower in children with concomitant atopic dermatitis than in those without (15.8% vs. 36.1%; p = 0.031). No significant associations were found with age, sex, other atopic diseases, family history of atopy, aeroallergen sensitization, total IgE, absolute eosinophil count, or symptom duration. Conclusions: Nearly one-third of children with contact dermatitis showed contact sensitization on patch testing. Markers of atopy were not significantly associated with patch test positivity in this cohort. Allergens outside the European Baseline Series, such as gold, should be considered when designing regional pediatric panels.

Background: Clinical remission in pediatric inflammatory bowel disease (IBD) may not coincide with microscopic inflammation resolution. This study evaluated the relationship between recorded colonoscopic and histopathological findings in children with IBD and examined changes in reported microscopic activity among patients with paired pre- and post- treatment biopsy assessments.Methods: Medical records of children with ulcerative colitis (UC), Crohn disease (CD), or indeterminate colitis/IBD- unclassified (IBD-U) followed at a tertiary pediatric gastroenterology center between 2003 and 2016 were retrospectively reviewed. The original pathology report's categorical assessment of active or inactive inflammation was abstracted; validated histological scores were not available. Endoscopic findings were abstracted descriptively without retrospective application of validated endoscopic scores. PUCAI was used for UC. For Crohn disease, disease activity was assessed using the Pediatric Crohn's Disease Activity Index (PCDAI). Exploratory colonoscopic (0-5) and histopathological (0-8) feature counts were correlated using Spearman's rank coefficient; these transparent counts are not validated activity scores. Paired changes in reported microscopic activity were assessed using the exact McNemar test.Results: Seventy-one children were included: 34 (47.9%) had UC, 32 (45.1%) had CD, and 5 (7.0%) had IBD-U. Lower gastrointestinal histopathology was available for 64 patients; cryptitis was reported in 25 (39.1%), crypt abscesses in 16 (25.0%), basal plasmacytosis in 15 (23.4%), and increased plasma-cell infiltration in 15 (23.4%). Among 64 patients with complete component data, colonoscopic and histopathological feature counts were moderately correlated (Spearman rho=0.487, p<0.001); correlations were rho = 0.485 (p = 0.004) in UC and rho=0.654 (p<0.001) in CD. Among 47 patients with paired pre- and post-treatment biopsy assessments, reported microscopic activity decreased from 28/47 (59.6%) to 15/47 (31.9%; exact McNemar p = 0.011). The corresponding changes were 17/27 (63.0%) to 11/27 (40.7%) in UC (p = 0.146) and 11/19 (57.9%) to 4/19 (21.1%) in CD (p = 0.065).Conclusion: Recorded colonoscopic and histopathological feature burdens were related, but microscopic inflammation could persist despite clinical improvement. These domains should therefore be interpreted as complementary rather than interchangeable. Because the exploratory counts were not validated activity scores and treatment timing and combinations were incompletely captured, the results require cautious interpretation.

Background: Active tobacco and nicotine product use may adversely affect asthma in adolescents, but evidence from pediatric allergy clinics simultaneously evaluating active use, passive smoke exposure, asthma control, respiratory symptoms, and lung function remains limited. We examined associations between tobacco/nicotine exposure and asthma-related outcomes in adolescents receiving specialist allergy care. Methods: In this retrospective observational study, 238 adolescents aged 14–18 years with physician-diagnosed asthma were screened at a tertiary pediatric allergy clinic in İzmir, Türkiye, between January 2023 and July 2026; 208 met the eligibility criteria and were analyzed. Participants were classified at the most recent follow-up assessment as active tobacco/nicotine users (cigarettes, electronic cigarettes/e-puff, waterpipe, or multiple products; n = 50), passive-only exposed ( n = 77), or unexposed ( n = 81). Baseline spirometry was obtained at the initial visit, whereas Asthma Control Test (ACT) score, respiratory symptoms, asthma attacks during the preceding year, and treatment adherence were assessed at the most recent follow-up. Multivariable logistic regression evaluated uncontrolled asthma (ACT p < 0.001), and uncontrolled asthma occurred in 62.0%, 29.9%, and 34.6%, respectively ( p < 0.001). After adjustment, active use was associated with uncontrolled asthma (adjusted odds ratio [aOR], 3.15; 95% confidence interval [CI], 1.45–6.81; p = 0.004), whereas passive-only exposure was not (aOR, 0.82; 95% CI, 0.42–1.62; p = 0.574). Active use was also associated with ≥1 asthma attack in the primary model (aOR, 2.20; 95% CI, 1.02–4.76; p = 0.044), but this estimate was not robust after excluding active users with concurrent passive exposure. In the continuous-ACT sensitivity analysis, active use was associated with a 2.43-point lower ACT score (adjusted β , −2.43; 95% CI, −3.87 to −0.99; p = 0.001). Conclusions: Among adolescents with asthma receiving specialist allergy care, current active tobacco/nicotine product use was associated with poorer asthma control. The association with recent asthma attacks was less robust, and passive-only exposure was not independently associated with the studied outcomes. Because exposure was self-reported and the study was retrospective and single-center, the findings should be interpreted as associations rather than causal effects.

Introduction: The timing of tolerance acquisition in childhood IgE-mediated food allergy is clinically important but has been less well studied than persistence as a binary outcome. We examined clinical and immunological determinants of time to open oral food challenge (OFC)-confirmed tolerance. Methods: This retrospective cohort study included 157 children with physician-established IgE-mediated food allergy evaluated at a tertiary pediatric allergy clinic between January 2023 and July 2026. Time zero was defined as elimination-diet initiation; tolerance was defined exclusively by a successful supervised open OFC. One mutually exclusive index allergen was assigned to each child and used consistently to define the time-to-tolerance outcome. Kaplan-Meier analysis and parametric accelerated failure time (AFT) models were used. The log-logistic model, adjusted for index allergen and the prespecified clinical and immunological covariates, was selected for multivariable analysis and internally validated using 1,000 bootstrap resamples. Results: Of 157 children, 120 achieved OFC-confirmed tolerance and 37 were right-censored. The mutually exclusive index-allergen distribution was hen’s egg (n = 103), cow’s milk (n = 35), tree nut (n = 16), other food (n = 2), and fish (n = 1). In the index-allergen-adjusted log-logistic AFT model, food-induced anaphylaxis (adjusted time ratio [TR]: 2.13, 95% CI: 1.34–3.36; p = 0.001), allergic rhinitis (adjusted TR: 1.80, 95% CI: 1.26–2.55; p = 0.001), and each 10-fold increase in total IgE (adjusted TR: 1.54, 95% CI: 1.20–1.98; p < 0.001) were associated with a longer time to tolerance. Tree-nut index allergy was also associated with longer time to tolerance than hen’s egg (adjusted TR: 2.74, 95% CI: 1.19–6.29; p = 0.018), although this estimate was based on few tolerance events. Conclusion: Previous food-induced anaphylaxis, allergic rhinitis, higher total IgE, and index food type were associated with the timing of open OFC-confirmed tolerance in children with IgE-mediated food allergy. Routine quantitative IgG, IgA, and IgM measures were not independently associated with tolerance timing.

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.

Background: Cold‐induced urticaria (ColdU) is a rare chronic inducible urticaria that can cause systemic reactions, including cold‐induced anaphylaxis (ColdA), but pediatric data are limited. The aim of this study was to evaluate the clinical characteristics, comorbidities, management approaches, risk of anaphylaxis, and long‐term course of ColdU in a pediatric cohort, and to identify risk factors for ColdA, determinants of disease resolution, and predictors of persistence into adulthood. Methods: This retrospective multicenter study included 203 pediatric patients with ColdU across 30 centers in Türkiye. Clinical characteristics and management of patients were analyzed. Logistic regression was used to identify factors associated with ColdA and disease resolution. Results: The median age at diagnosis was 14.3 years, and the median age at onset was 10 years; 56.1% of patients were female. ColdA occurred in 17.2%, with increased risk associated with male sex, autoimmune comorbidities, older age, and triggering by cold food/beverage ingestion. Most patients (82.2%) received second‐generation H1‐antihistamines; omalizumab achieved >90% symptom control in 12 refractory cases. Over a median 3.5‐year follow‐up, 30.5% achieved disease resolution (median duration: 18 months). The history of anaphylaxis and comorbid atopy significantly reduced the likelihood of remission. Some patients showed adult persistence, without clear predictors. Discussion: ColdA may occur even without classic high‐risk features; pediatric ColdU management should be guided by individualized risk assessment, prioritizing clinical risk factors—such as older age, high‐risk cold triggers, angioedema, and autoimmune comorbidities—over isolated diagnostic parameters. In refractory cases, omalizumab is an effective and well‐tolerated option. Prior anaphylaxis and comorbid allergic disease predicted poorer remission.

Pediatric eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder defined by esophageal dysfunction and eosinophilic infiltration of the esophageal mucosa. Its incidence is increasing, particularly among children. However, assessing disease severity and monitoring treatment response over time remain challenging. Conventional histological methods often fail to capture ongoing inflammation or predict symptom recurrence. This study aimed to evaluate the utility of a multimodal approach incorporating clinical symptom scoring (Pediatric Eosinophilic Esophagitis Symptom Score [PEESS]), endoscopic findings (Eosinophilic Esophagitis Reference Score [EREFS]), and subepithelial imaging (endoscopic ultrasonography [EUS]) for the diagnosis, treatment monitoring, and long-term follow-up of pediatric EoE. We conducted a retrospective review of 23 pediatric patients diagnosed with EoE between 2018 and 2022 at a tertiary care center. Diagnosis was based on clinical presentation, endoscopic appearance, and histological confirmation (≥15 eosinophils/high-power field). All patients received a combination of proton pump inhibitors, topical corticosteroids, and personalized elimination diets. PEESS and EREFS scores were assessed before and after treatment. EUS was performed in a subset of patients to evaluate esophageal wall changes. The median age at diagnosis was 11 years. Atopic comorbidities were identified in 82.6% of patients. Post-treatment, both PEESS and EREFS scores showed significant improvements. Histological remission was achieved in 95.6% of cases. Among the 8 patients who underwent EUS, persistent esophageal wall thickening was observed despite mucosal healing, suggesting ongoing subepithelial inflammation. Long-term dietary management without steroids was successful in a subset of patients after initial remission. PEESS and EREFS are valuable, complementary tools for assessing treatment response in pediatric EoE. EUS provides additional insights into residual disease activity beyond mucosal healing. This multimodal evaluation may facilitate personalized, less-invasive, and more effective long-term management of pediatric EoE.

Purpose: To evaluate patients with suspected penicillin allergy in whom skin testing was omitted during immediate and delayed reactions before drug provocation test (DPT). Methods: This retrospective study analyzed patients aged 0–18 years with suspected penicillin allergy between 2020 and 2023. Data on hypersensitivity reaction history, laboratory tests, PEN-FAST scores, and DPT records were collected. Results: We evaluated 75 patients (male: 61.3%; median age at index reaction: 4 [range: 1–15] years) with suspected penicillin allergy. Nearly all reactions occurred at home (98.7%) following oral administration, with antihistamines being the most common treatment (56%). Urticaria was the most frequent manifestation in immediate reactions (30.7%), whereas maculopapular exanthema was predominant in delayed reactions (33.7%). Amoxicillin-clavulanic acid was the most frequently implicated drug (85.3%). The median PEN-FAST score was 3 (range: 0–5). Immediate reactions were significantly more common in females (p < 0.05). In total, 78 DPTs were performed, and four patients tested positive, all experiencing mild cutaneous reactions. No life-threatening reactions were observed. At the 3-month follow-up, 90.7% of patients tolerated beta-lactam antibiotics, though 4% chose to avoid them despite negative DPT results. Conclusion: In our study, we successfully performed DPT without major complications by omitting skin testing in both immediate and delayed reactions. Our findings suggest that in delayed reactions, direct DPT can safely replace skin testing. Notably, we also propose that after in vitro tests, DPT may be safely used in immediate reactions without additional in vivo testing. Also, this is the first study to evaluate PEN-FAST in children with suspected penicillin allergy in our country, offering practical value for clinicians and patients. What is Known:• The label of drug allergy in children is assigned far more frequently than the actual diagnosis of true allergic reactions.• Due to unverified drug allergy diagnoses, patients face challenges such as inadequate treatment and the development of antibiotic resistance. What is New:• In cases with immediate reactions, including anaphylaxis, direct drug provocation test (DPT) performed without prior skin testing can be conducted without severe reactions.• The PEN-FAST score has been observed to be highly effective in ruling out beta-lactam allergy in pediatric patients with low scores.

Evaluation of Asthma Knowledge Level of Patients Over 11 Years of Age with Asthma Diagnosis - The Journal of Current Pediatrics