Oz (Ingilizce):Objective: The diagnostic gold standard of food allergy is the oral food challenge. Oral food challenge may induce allergic reactions, ranging from mild cutaneous symptoms to severe, potentially life-threatening reaction. Our aim was to investigate the prevalence and severity of reactions during oral food challenge. Materials and Methods: A retrospective charts review of children undergoing oral food challenge at the our Allergy Clinic between September 2012 and September 2013 was performed. Results: A total of 63 oral food challenges were included the study. Most frequently involved foods were cow's milk, pistachio nut and egg. Oral food challenge were carried out to confirm the diagnosis in 50 (79.4%) patients and were carried out to demonstrate the development of food tolerance in 13 (20.6%). 13/63 (20.6%) were positive. Twelve patients were defined mild reactions and one patient was anaphylaxis. There were no significant differences between the oral food challenge negative group and oral food challenge positive group in terms of sex, age at the time of oral food challenge, concomitant atopic disease, history of IgE mediated food allergy, peripheral eosinophils per cent, serum specific gE and total IgE (p> 0.05). But there was a positive correlation between the size of skin prick test and oral food challenge positivity (rho: 0.307, p= 0.019). Conclusion: The majority of reactions during oral food challenge were mild. The size of skin prick test was the risk factor for the development of reaction during oral food challenge. Therefore, oral food challenge should be done by the experts and size of skin prick test should be taken into consideration before oral food challenge.
Characterized by progressive cerebellar ataxia, cutaneous and conjuctival telangiectasia, ocular apraxy, immunodeficiency, and increased risk of malignancy, ataxia-telangiectasia is a rare neurodegenerative disorder that shows signs of autosomal recessive transmission. The ataxia-telangiectasia gene is located in chromosome 11q22-23. Various degrees of abnormalities in T and B cell immunities have also been described. It is known that the incidence of both T cell and B cell leukemia and lymphoma increased compared with the general growth of the population in Turkey. T cell malignancy can be seen at any age though B cell malignancy is more common at older ages. This report presents the case of two siblings who were diagnosed with ataxia-telangiectasia. The two siblings formerly had another sibling who was diagnosed with ataxia-telangiectasia and died from leukemia. Taking these two cases as the staring point, this study focuses on the clinical
Acute generalised exanthematous pustulosis (AGEP) is a rare skin reaction characterized by sterile, small pustules on the erythematous background. Drugs, especially antibiotics are major caustic factors in etiology. The diagnosis of disease is made by the scoring system which determined by “European Severe Cutaneous Adverse Reactions (EuroSCAR)”s’ working group. The four-year-old patient applied with the complaint of numerous pustular skin eruptions on the erythematous background and had the history of amoxicillinclavulanic acid treatment which was given two days ago. The biopsy samples were taken from pustular lesions. The diagnosis of AGEP was made according to EuroSCAR score, evaluating clinical feature and the histopatological examination of the biopsy sample. In this presentation, we aimed to emphasize that AGEP can rarely be seen in childhood age and to review the clinical properties, diagnosis and treatment of disease.
Objective: The diagnostic gold standard of food allergy is the oral food challenge. Oral food challenge may induce allergic reactions, ranging from mild cutaneous symptoms to severe, potentially life-threatening reaction. Our aim was to investigate the prevalence and severity of reactions during oral food challenge. Materials and Methods: A retrospective charts review of children undergoing oral food challenge at the our Allergy Clinic between September 2012 and September 2013 was performed. Results: A total of 63 oral food challenges were included the study. Most frequently involved foods were cow’s milk, pistachio nut and egg. Oral food challenge were carried out to confirm the diagnosis in 50 (79.4%) patients and were carried out to demonstrate the development of food tolerance in 13 (20.6%). 13/63 (20.6%) were positive. Twelve patients were defined mild reactions and one patient was anaphylaxis. There were no significant differences between the oral food challenge negative group and oral food challenge positive group in terms of sex, age at the time of oral food challenge, concomitant atopic disease, history of IgE mediated food allergy, peripheral eosinophils per cent, serum specific gE and total IgE (p> 0.05). But there was a positive correlation between the size of skin prick test and oral food challenge positivity (rho: 0.307, p= 0.019). Conclusion: The majority of reactions during oral food challenge were mild. The size of skin prick test was the risk factor for the development of reaction during oral food challenge. Therefore, oral food challenge should be done by the experts and size of skin prick test should be taken into consideration before oral food challenge.
Objective: Cow’s milk allergy is the most common form within the food allergy its prevalence increased recent years in children. In this study, we aim to determine the primary care physician’s knowledge about diagnosis of cow’s milk allergy, treatment and adrenaline auto injector usage. Materials and Methods: One hundred twenty-six voluntary primary care physicians who are working in Malatya city were included in the study. Interview with each participant were carried out and cow’s milk allergy form which was prepared previously was filled in. Results: The median age was 42 (26-62), median length of professional experience was 16 (2-39) years and 89 (70.6%) of participant were male gender. The mean examined patient number by primary care physicians was 37.4 (± 14.6) for each day and the mean examined patient number whose age was under 3 years was 8.5 (± 4.5). Of the 25.4 percent of primary care physicians did not have knowledge about skin prick test, serum specific Ig E level and/or oral challenge test for diagnosis of cow’s milk allergy. Although 73% of participant knew the elimination milk and dietary product from infant who was considered to have allergy to cow’s milk and mother, only 13.5% of them knew the prescribe hypoallergenic formula for infant with cow’s milk allergy. 64.3% of participant knew the prescribe the adrenaline auto injector in case of anaphylaxis due to cow’s milk. Knowledge of adrenaline auto injector use, appropriate side for injection and dose were 34%, 34.1% and 30.2%, respectively. There was no significant effect of primary care physicians’s age and length of professional experiences on the knowledge of cow’s milk allergy and adrenaline autoinjector usage. Conclusion: The knowledge of primary care physician about diagnosis of cow’s milk allergy, treatment and adrenaline auto injector usage are insufficient. Therefore it should be useful to training programs about these topics for primary care physician.
Currently, allergen specific immunotherapy is administered to allergic rhinitis or asthmatic patients with uncontrolled symptoms despite medical treatment and avoidance of environmental allergens. Local or systemic reactions can occur after subcutaneous immunotherapy. Although almost all severe systemic reactions are reported to begin within 30 minutes after administration of injections, late onset reactions could be seen. Our case was 15 years old female patient with asthma whose complaints could not controlled by medical treatment and subcutaneous immunotherapy with “Dermatophagoides farinae” extract that she was sensitized was administered to her. Severe systemic reaction (anaphylaxis) has developed in the patient within fourth hours of post-injection observation period at the maintenance dose of 0.8 mL. We want to emphasize that severe late onset systemic reactions are rare but could occur after subcutaneous immunotherapy injections.
Ataksi-telenjiektazi ilerleyici serebellar ataksi, kutanoz ve konjunktival telenjiektaziler, okuler apraksi, immun yetmezlik ve artmis malignensi riski ile karekterize nadir gorulen otozomal resesif gecis gosteren norodejeneratif bir hastaliktir. Ataksi-telenjiektaziden sorumlu gen 11q22-23 de lokalizedir. Humoral ve hucresel immunitede degisik derecelerde bozukluklar bildirilmistir. Hem T hucreli, hemde B hucreli losemi ve lenfoma sikligi genel populasyona gore artmistir. T hucreli tumorler hastaligin seyri sirasinda herhangi bir yasta gorulurken, B hucreli tumorler daha cok ileri yasta gorulur. Bu sunumda daha once ataksi-telenjiektazi tanisi konulup losemi nedeniyle olen kardes oykusu olan ataksi-telenjiektazili iki kardes olgusu tartisildi. Bu olgular nedeniyle ataksi telenjiektazinin klinik bulgulari, etkilenen sistemler ve tedavisi uzerinde duruldu. Anahtar kelimeler: Ataksi Telenjiektazi; Immun Yetmezlik; Serebellar Atrofi.
Objective: Ataxia-telangiectasia is rare, an autosomal recessive, neurodegenerative disorder characterized by progressive cerebellar ataxia, cutaneous and conjunctival telangiectasia, immunodeficiency, and increased risk of malignancy. In this study, we aim to determinate demographics, neurological, dermatological and immunological manifestation of children diagnosed with ataxia-telangiectasia in our clinics. Materials and Methods: We did a retrospective medical chart review of pediatric allergy and immunology database for children diagnosed with ataxiatelangiectasia in Inonu and Ondokuz Mayis University Faculty of Medicine between 2006 and 2013. Results: Ataxia-telangiectasia was diagnosed in 25 patients. The mean age was 10.08 ± 4.14 (died children were included) and 16 (64%) of the patients were male. The mean follow up period was 5.32 ± 3.84 years. Ataxia was the first sign of disease which was noticed by the parents and median diagnosis age was 4 years old (min: 1.5, max: 12). Neurological and dermatological manifestations were seen in all patients. Also immunological manifestations were seen in 85% of all patients. The most frequent neurologic sign was ataxia and present in all patients, followed by dysmetria (96%), dysarthria (92%), bradykinesia (80%) and ocular apraxy (60%), respectively. Telangiectasia was present in all patients and the most frequent localization was conjunctiva. Pigmentary anomalies were present in 17 (68%) patients, molluscum contagiosum in 2 (8%) patients and verruca in 1 (4%) patient. The most frequent form of immunologic deficiency was IgA deficiency (80%) which was followed by Ig G deficiency (60%) and lymphopenia (12%). Growth failure was present in 96% of patients and head circumference was under -1 SD in 56% of patients. In follow up, 5 (20%) patients had experienced recurrent otitis media, 18 (%72) patients had experienced recurrent pulmonary infection. Bronchiectasis was developed in 7 (28%) patients and hemophagocytic sendrome was developed in one patient. Seven patients died (three due to non-Hodgkin lymphoma, two due to pulmonary infection, one due to hemophagocytic sendrome and one due to acute lymphoblastic leukemia). Conclusion: Ataxia and telenjiectasia were the most frequent signs of the disease and followed by immunological and pigmentary anomalies. Therefore, ataxia telenjiectasia should be consider in diagnosis if the patients who have dermatological signs such as telangiectasia and pigmentary anomalies and growth failure with ataxia.
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