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    Characteristics of persistent diaper dermatitis in children with food allergy
    (Wiley, 2019) Celiksoy, Mehmet Halil; Topal, Erdem; Okmen, Zeynep Haziroglu; Alatas, Cem; Demirtas, Mehmet Semih
    Background/Objectives Diaper dermatitis is often caused by irritant contact occurring beneath the diaper of an infant, and it is aggravated by factors such as dampness, friction, urea, and feces. Food-allergic patients are known to exhibit various skin lesions ranging from urticaria to eczema. This study aims to determine the relationship between persistent diaper dermatitis and food allergy. Methods A retrospective chart review was conducted of pediatric patients with a diagnosis of persistent diaper dermatitis between August 2015 and November 2017. Results The study included 157 patients diagnosed with persistent diaper dermatitis (67 male, 72 female; median age: 13 months). Diaper dermatitis was more common and included the whole perineum in children who had multiple food allergies (P = 0.001). In children with multiple food allergies, the course of diaper dermatitis was more severe, and the condition did not respond to topical treatment (P = 0.025). A longer elimination diet was required for patients with Type I reactions and persistent diaper dermatitis (P = 0.018). In patients with Type II and mixed reactions, diaper dermatitis was more diffuse and covered the whole perineum (P = 0.025). In patients with Type II and mixed reactions, diaper dermatitis was more severe and did not respond to topical treatment (P = 0.025). Conclusions Persistent diaper dermatitis lasting longer than a month may be associated with food allergy. The diaper rash may also be the only indicator of the food allergy. Elimination of the responsible food may allow these patients to recover from persistent diaper dermatitis.
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    Demographics and clinical characteristic of patients diagnosed with hen’s egg allergy
    (2019) Topal, Erdem; Arga, Mustafa; Celiksoy, Mehmet Halil; Kaynak, Mustafa Sinan; Duman, Yücel; Demirtas, Semih; Alatas, Cem; Tonbul, Hayrettin; Dalkilic, Huri Maral
    Aim: To assess the demographics, clinical characteristics and natural course of patients diagnosed with hen’s egg allergy.Material and Methods: Patients who were diagnosed with hen’s egg allergy were included in this study. The patients’ medical records were analyzed to collect demographic and clinical data.Result: 88 patients diagnosed with hen’s egg allergy were included in the study. 46 (52.3%) of the patients were male, their median age was 33 months and their median follow-up period was 18 months. 44 (50%) of the patients had comorbid atopic disease. 49 (55.7%) of the children’s parents had a diagnosis of atopic disease, while 5 (5.7 %) had a diagnosis of food allergy. In terms of the patients’ clinical symptoms, 86 (97.7%) had cutaneous symptoms, 16 (18.2%) had gastrointestinal system symptoms, 13 (14.8%) had respiratory system symptoms. In the follow-up, 43 (48.9%) of the patients were found to develop tolerance. When the patients allergic to egg white and those allergic to egg yolk were compared in terms of clinical findings, atopic eczema exacerbation was found to be more frequent (p=0.012) in patients allergic to egg white; while urticaria (p=0.005) and cough (p=0.012) were found to be more frequent in patients allergic to egg yolk.Conclusion: In clinical presentations that develop as a result of egg allergy, the most frequent symptoms are dermatological, gastrointestinal system and respiratory system symptoms, respectively. However, while atopic eczema exacerbations are more frequent in patients allergic to egg white, symptoms related with respiratory tract are more common in patients allergic to egg yolk. Keywords: Allergy; Cow’s Milk; Persistence; Predictive Factors; Tolerance.
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    The effect of modification of inhaler spacer’s visual user guideline on the correct use of the inhaler spacer
    (2018) Topal, Erdem; Demirtas, Mehmet Semih; Kutluturk, Yesim; Kutluturk, Kazim; Turker, Kenan; Sayan, Yekbun Gamze; Alatas, Cem
    Aim: To determine the effect of modification of visual user guideline of inhaler spacer device on the skill of correct usage. Material and Method: The medical faculty intern students at İnönü University were enrolled in the study. The participants were interviewed face-to-face and requested to fill out questionnaires for modified and non-modified visual user guideline. Result: A total of 172 students were included in the study; 104 (60.5%) of the students were male. The study group included 90 students who were evaluated with the modified visual user guidelines; the other group included 82 students who were evaluated with the non-modified visual user guidelines. 76 (84%) out of 90 participants in the group who was given modified visual user guideline performed the inhaler spacer device technique correctly. In contrast, only 12 (15%) of 82 participants in the group who was given non-modified visual user guideline carried out the inhaler spacer device technique correctly (p=0.001). The most common mistakes made in non-modified visual user guideline group were; taking 5-6 deep and slow breaths; 28 (34.1%), shaking MDI and removing cap; 45 (54.9%), and placing mouthpiece between teeth and lips or placing facemask; 57 (69.5%), respectively. Having compared the both groups for the steps of inhaler spacer device use, the modified visual user guideline group fulfilled all the steps more correctly. Conclusion: The visual user guideline of the inhaler devices in our country are insufficient. We are of the opinion that especially visual improvements on user guideline will increase the correct usage of the device by parents.
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    Effects of modifying visual inhaler spacer usage instructions on correct usage rate of untrained users
    (Wiley, 2020) Topal, Erdem; Arga, Mustafa; Ozmen, Hakan; Dogru, Mahmut; Alatas, Cem; Mustu, Elif Busra; Celiksoy, Mehmet Halil
    Background Pressurized metered-dose inhalers (pMDIs) used with spacers are considered the method of choice for delivery of inhaled drugs in preschool-age children. The aim of this study was to determine the effects of modifying the visual inhaler spacer usage guidelines on the correct usage rate. Methods The parents and caregivers of patients <6 years old who were prescribed inhalers with spacers for the first time were included in our study. The participants were randomly divided into a modified visual inhaler spacer usage guidelines group and an unmodified visual inhaler spacer usage guidelines group. All study participants underwent face-to-face interviews and completed questionnaires. Results A total of 510 participants with a median age of 31 (range, 20-46) years were included in this study. The modified visual guidelines group included 254 (49.6%) participants, and the unmodified visual guidelines group included 256 (50.4%) participants. One hundred sixty-five (65.2%) of the 254 participants in the modified visual guidelines group correctly demonstrated the inhaler spacer technique. In contrast, only 21 (8.2%) of the 256 participants in the unmodified visual guidelines group correctly demonstrated the inhaler spacer technique (p < 0.001). When comparing the inhaler spacer usage steps between the 2 groups, the modified visual guidelines group demonstrated the steps more correctly and more quickly (p < 0.001). Conclusion The current visual inhaler spacer usage guidelines are insufficient. We believe that improving the visual inhaler spacer usage guidelines, in particular, will increase the correct usage rate and decrease the number of usage errors.
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    Independent predictive factors for the persistence and tolerance of cow's milk allergy
    (Wiley, 2019) Topal, Erdem; Celiksoy, Mehmet Halil; Arga, Mustafa; Kaynak, Mustafa Sinan; Duman, Yucel; Demirtas, Semih; Alatas, Cem
    Background Cow's milk protein allergy (CMPA) is usually transient, with most children tolerating ingested cow's milk by 3 years of age. This study aimed to determine factors that promote or hindering the development of tolerance to CMPA. Methods A logistic regression model was used to determine independent risk factors associated with tolerance and persistence of CMPA. Result A total of 178 children diagnosed with CMPA were included in the study. The patients' median age was 32 months (minimum-maximum, 14 to 144 months), and their median follow-up period was 30 months (minimum-maximum, 12 to 54 months). In the follow-up, CMPA persisted in 62 (34.8%) patients. The patients were divided into 2 groups according to patient's age. Group I was <3 years old and group II was >= 3 years old. The factors independently associated with the persistence of CMPA for group I were as follows: comorbid food allergies (p = 0.021), the presence of an immunoglobulin E (IgE)-mediated reaction (p = 0.001), and respiratory system symptoms (ie, tachypnea) (p = 0.036). The presence of gastrointestinal-related discomfort (p = 0.001) was an independent risk factor associated with the development of tolerance. The presence of comorbid food allergies (p = 0.03) was the only independent predictive factor for CMPA persistence for group II. Conclusion The prognosis in cases of CMPA, a food allergy, is good, with tolerance developing over time. The presence of IgE-mediated CMPA, respiratory-related symptoms (ie, tachypnea), and the presence of comorbid food allergies have negative effects on tolerance.
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    A rare presentation of chronic granulomatous disease; intracranial mass associated with aspergillosis
    (2019) Topal, Erdem; Alatas, Cem; Gocum, Erkan; Kutuk, Sinan; Sigirci, Ahmet; Koker, Mustafa Yavuz