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    Clinical and Treatment Evaluation of Anaphylaxis in Children Aged 0-2 Years: Multicenter Study
    (Springernature, 2024) Selmanoglu, Ahmet; Haci, Idil Akay; Koc, Fatih Sultan Mehmet; Yildiz, Yuksel Kavas; Yilmaz, Ebru Arik; Azkur, Dilek; Erdem, Semiha Bahceci
    BackgroundDiagnosing anaphylaxis in children within the first 2 years of life can be difficult due to the often confusing and nonspecific signs and symptoms.ObjectiveThis study focuses on the phenotype of anaphylaxis in children within the first 2 years of life and aims to increase awareness of anaphylaxis in this age group.MethodsThe study included children between 0 and 2 years who were diagnosed as having anaphylaxis by pediatric allergists in 11 tertiary hospitals.ResultsA total of 402 anaphylaxis episodes experienced by 360 patients (68.7% males) were included in the study. Food was the most common causative agent (n = 374, 93%), with the most common foods being cow's milk (n = 179, 44.6%). Drugs were the second most common trigger (n = 15, 3.7%). The most common clinical findings were cutaneous (95%) and respiratory (72%); nonspecific symptoms such as weakness (n = 63, 15.6%) and hoarseness (n = 14, 3.4%) were also reported. There was a biphasic course in 3 infants (0.8%). Only 3 of the 41 parents who had an adrenaline autoinjector used it during anaphylaxis.ConclusionInfants experience anaphylaxis most often when they are at home with their mothers, and the most common triggers are foods, particularly cow's milk and egg. Greater awareness of anaphylaxis symptoms and autoinjector use among mothers can facilitate management.ImpactInfant anaphylaxis cases may present with different symptoms compared to classic presentations, potentially leading to diagnostic oversight.The study elucidates the clinical course of anaphylaxis in children under 2 years of age.It details the treatment strategies employed in managing these cases.Anaphylaxis triggers were identified over several years.Cases from 11 regions of Turkey were included, representing a population reflective of national data.The study highlights the distinctiveness of anaphylaxis cases in children within the first 2 years of life.
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    Cold-induced urticaria in children: A multicenter, retrospective cohort study
    (Ocean Side Publications Inc, 2023) Citlak, Hilal Karabag; Azkur, Dilek; Yildiz, Yuksel Kavas; Demirel, Ali Can; Kot, Hakan; Vezir, Emine; Kilic, Mehmet
    Background: Studies of cold-induced urticaria (ColdU) in pediatric patients are limited and not well characterized. Objective: The objective of the study was to investigate the characteristics of ColdU in children. Methods: A multicenter, retrospective chart review was performed in children ages <= 18 years diagnosed with ColdU at 11 pediatric allergy and immunology centers in Turkey between September 1, 2010, and August 31, 2022. Results: A total of 83 children with ColdU were included, 54.2% were girls, and the mean age of symptom onset was 8.8 years. The median duration of ColdU at the time of diagnosis was significantly higher in the girls than in the boys (1.0 years [0.0-13.8 years] versus 0.3 years [0.0-15.0 years]; p = 0.007). All the patients underwent an ice cube test, and 71.1% were found positive (typical ColdU). The mean +/- standard deviation age of onset was significantly higher in the patients with typical ColdU versus atypical patients (9.4 +/- 4.5 years versus 7.3 +/- 4.5 years; p = 0.041). Swimming alone and in combination with the wind were significantly the most reported triggers in patients with cold-induced anaphylaxis (ColdA) when compared with patients with ColdU and with nonanaphylactic symptoms (70.0% versus 28.9% [p = 0.022], and 50.0% versus 4.1% [p < 0.001], respectively). Only patients with other chronic urticaria were found to be associated with the development of typical ColdU (p = 0.036). The median total serum immunoglobulin E (IgE) was significantly higher in typical ColdU than in atypical patients (72.5 IU/mL [3.86 - 2500 IU/mL] versus 30.0 IU/mL [0.83 - 1215 IU/mL]; p = 0.007); however, total serum IgE differences were not found to affect ColdU resolution between the two groups (p = 0.204). The resolution was documented in 30.4%. Conclusion: Those who were boys and had a positive ice cube test result could have an association with earlier onset of ColdU. Those swimming alone on a windy day were at highest risk for ColdA. It is still unclear what characteristics are associated with the resolution of ColdU, and this warrants further investigation.