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    Comparison of the efficacy of nebulized budesonide and systemic steroids in children admitted to the emergency service with acute asthma attacks
    (2021) Sahin Akkelle, Bilge; Aydogan, Metin; Siraneci, Rengin
    Aim: Systemic steroids are used when necessary in the treatment of acute asthma attacks, but they have a high potential for side effects. The role of nebulized steroids in acute asthma attacks is controversial and there are few studies on the subject. In our study, it was aimed to evaluate the efficacy of nebulized budesonide treatment in children presenting with acute asthma attack.Materials and Methods: In this study, patients aged 5-18 years who presented to emergency service with a mild acute asthma attack were evaluated. Patients with mild acute asthma attack who did not respond to nebulized salbutamol treatment at 3 doses (0.15 mg/kg/dose) administered within the first hour, were included in the study. The patients were randomly divided into two groups. Group A received single-dose systemic steroid (1mg/kg) while Group B received single-dose nebulized budesonide (500µg). The groups were compared in terms of demographics, % O2 saturation, pulmonary index score (PIS), and duration of hospital stay. Results: A total of 61 cases were enrolled to the study (Group A n=33, Group B n=28). There was no statistically significant difference between groups in terms of mean age and gender (P>0.05). In both groups, % O2 saturation values at 4th hour of treatment increased and PIS regressed significantly compared to the baseline values (P0.001). It was also found that the % O2 saturation values at 4th hour were higher in patients treated with nebulized budesonide compared to patients treated with systemic steroids (p:0.02). There was no statistically significant difference between the groups in terms of duration of hospital stay (P>0.05). Conclusion: Based on the results of our study, a single dose (500µg) of nebulized budesonide was shown to be as effective as systemic steroid therapy in the treatment of mild acute asthma attacks.
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    Food-induced anaphylaxis in early childhood and factors associated with its severity
    (Ocean Side Publications Inc, 2021) Aydogan, Metin; Topal, Erdem; Yakici, Nalan; Acar, Hazal Cansu; Demirkale, Zeynep Hizli; Arga, Mustafa; Uysal, Pinar
    Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (inter quartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.
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    Proven Food-Induced Acute Urticaria and Predictive Factors for Definitive Diagnosis in Childhood
    (Karger, 2021) Aydogan, Metin; Topal, Erdem; Uysal, Pinar; Acar, Hazal Cansu; Cavkaytar, Ozlem; Demirkale, Zeynep Hizli; Aydogmus, Cigdem
    Background: Urticaria can be the only sign of a food allergy or can be seen together with other signs and symptoms of a food allergy. Objective: To determine the demographic, etiologic, and clinical features of food-induced acute urticaria in childhood. Methods: Patients suspected of food-induced acute urticaria were included in this prospective cross-sectional multicenter study. Results: Two hundred twenty-nine urticaria cases were included in this study. Seventeen patients who did not meet the inclusion criteria of the study were excluded. Of the 212 included cases, 179 (84.4%) were diagnosed with definitive food-induced acute urticaria. The most common foods causing acute urticaria were cow's milk, hen's eggs, and nuts in 56.4, 35.2, and 19% of cases, respectively. The positive predictive value of a history of milk-induced acute urticaria together with a milk-specific IgE >5 kU/L for cow's milk-induced acute urticaria was 92% (95% CI: 81-96%). A history of cow's milk-induced and/or hen's egg-induced acute urticaria was consistent with a definitive diagnosis of food-induced urticaria (Chen's kappa: 0.664 and 0.627 for milk and eggs, respectively). Urticaria activity scores were higher in patients with food-induced acute urticaria (p = 0.002). Conclusion: Cow's milk, hen's eggs, and nuts were the most common allergens in the etiology of childhood food-induced acute urticaria. Although the urticaria activity score provides guidance for diagnosis, an oral food challenge is often essential for the definitive diagnosis of a patient with a history of food-induced acute urticaria.