Background: Asthma is a prevalent chronic condition in children and has been associated with sleep disturbances. The aim of this study was to determine the prevalence of sleep disturbances in children with asthma and to identify the clinical predictors of impaired sleep quality. Methods: The study included children aged 6–16 years with asthma who were followed at the Pediatric Allergy and Immunology Department of Ankara Bilkent City Hospital. A control group of participants with comparable age and demographic characteristics and without any history of chronic, allergic, or psychiatric conditions was also recruited. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC), while asthma control was evaluated using the Childhood Asthma Control Test (C-ACT) or ACT. Asthma severity and treatment steps were categorized according to the Global Initiative for Asthma (GINA). Results: A total of 210 children diagnosed with asthma (mean age: 11.2 ± 3.4 years; 54.3% male) were included in the study. According to the SDSC, 45.2% of children with asthma had clinically significant sleep disturbances. Compared to healthy controls (n = 199), asthmatic children had significantly higher total SDSC scores [63 (IQR: 50–74) vs. 53 (46–61); p < 0.001] and all subscale scores (p < 0.001). Among asthmatic children, poor asthma control, GINA Step ≥3 treatment, and asthma exacerbations within the last six months were significantly associated with sleep disturbances. In multivariate logistic regression analysis, ACT/C-ACT scores were identified as independent predictors of sleep disturbance, with higher scores associated with lower odds of sleep disturbance (OR: 0.20; 95% CI: 0.11–0.35; p < 0.001). Conclusion: Poor asthma control was strongly associated with sleep impairment. Routine assessment of sleep quality could support asthma management in pediatric populations.
Obinutuzumab is a humanized anti-CD20 monoclonal antibody widely used in the treatment of B-cell lymphomas. Infusion-related reactions may limit its use and compromise optimal oncologic management. Drug desensitization represents an effective strategy to allow continuation of first-line therapy in selected patients. Case report: We report a patient with marginal zone lymphoma who developed an immediate hypersensitivity reaction during the first infusion of obinutuzumab, characterized by generalized erythematous rash, pruritus, urticaria, dyspnea, nausea, and oxygen desaturation. At the time of the reaction, vital signs were as follows: blood pressure 105/67 mmHg, heart rate 92 beats/min, and oxygen saturation 87% on room air. According to the Brown severity classification, the reaction was classified as moderate anaphylaxis (Grade 2) because there was respiratory involvement without persistent hypotension, collapse, or neurological compromise despite transient oxygen desaturation. Skin prick and intradermal tests were conducted using dilutions of 1/1 (25 mg/mL), 1/10 (2.5 mg/mL), 1/100 (0.25 mg/mL), and 1/1000 (0.025 mg/mL) prepared similarly to other biologic agents. Skin tests performed with dilutions prepared 4 weeks after the reaction were found to be negative. Given the clinical necessity of continuing treatment, a modified desensitization protocol was performed under close monitoring. Mild breakthrough reactions occurred during the initial desensitization steps but were successfully managed. Subsequent infusions were completed without further adverse reactions. Conclusion: This case highlights the feasibility and safety of obinutuzumab desensitization in patients with immediate hypersensitivity reactions. Given the limited number of reported cases in the literature, this report provides valuable clinical evidence supporting individualized desensitization strategies.
Ambroxol is a commonly used mucolytic agent for respiratory tract infections; however, immediate hypersensitivity reactions are rarely reported in children. We describe a 13-year-old male with allergic rhinitis and atopic dermatitis who developed generalized urticaria, angioedema, dyspnea, and syncope shortly after receiving loratadine–ambroxol prescribed for an upper respiratory infection. Skin testing with amoxicillin, azithromycin, paracetamol, and ambroxol yielded negative results. Drug provocation testing (DPT) was subsequently performed, showing negative responses to amoxicillin, azithromycin, and paracetamol. During the ambroxol challenge (3–27 mg), the patient developed rhinorrhea, sneezing, ocular and nasal pruritus, followed by dyspnea, wheezing, bilateral eyelid angioedema, generalized urticaria, oxygen desaturation, tachycardia, and hypotension—findings consistent with grade III anaphylaxis according to the Brown classification. He required two intramuscular doses of epinephrine, with complete clinical recovery. Ambroxol was permanently contraindicated, and an epinephrine autoinjector was prescribed. This case reinforces that severe ambroxol-induced hypersensitivity can occur despite negative skin testing, highlighting the value of DPT. Given the widespread use of ambroxol and its potential to trigger life-threatening reactions, clinicians should prioritize rational prescribing in upper respiratory infections and report severe adverse events to pharmacovigilance systems. This case adds to the limited pediatric evidence confirming ambroxol-induced anaphylaxis through controlled drug exposure.
Background: Chronic spontaneous urticaria (CSU) affects up to 1% of the population, and 40% of patients develop concomitant angioedema (CSU-AE). While clinically significant laryngeal involvement in mast cell–mediated CSU-AE is considered rare, and large cohorts report no fatal airway compromise, patients frequently present to emergency departments with symptoms perceived as potentially airway affecting. Objective: To describe retrospective clinical observations of CSU-AE patients presenting with symptoms suggestive of upper airway involvement and to contextualize these findings within the existing literature. Methods: We performed a retrospective descriptive review of consecutive CSU patients evaluated between October 2017 and July 2018 at two tertiary referral centers (Milan, Italy and Sofia, Bulgaria). Medical records were screened for angioedema localization, history of physician-documented laryngeal involvement during emergency evaluations, history of airway interventions, medication exposure, and acute treatment response. Results: Among 1,098 patients, 530 (48%) experienced angioedema and wheals in the context of CSU-AE. Thirteen patients (2%) had objectively documented laryngeal involvement prompting emergency assessment; three patients (all female) underwent endotracheal intubation. No fatalities or loss of consciousness occurred. None had concurrent wheals during the reported laryngeal episodes. History of NSAID exposure preceded some laryngeal exacerbations, though not in intubated cases. None of the patients was receiving ACE inhibitor treatment, all had normal C1 inhibitor (antigen and function) and normal C4. Laryngeal symptoms resolved within hours following standard acute therapy with corticosteroids and/or antihistamines (AHs). Due to the retrospective design, diagnostic work-up for alternative angioedema mechanisms (genetic testing) was incomplete. Conclusions: These observations do not indicate an increased intrinsic airway risk in CSU-AE. Rather, they illustrate diagnostic and management challenges in emergency settings and highlight the importance of mechanism-aware clinical assessment to avoid unnecessary invasive airway interventions. Laryngeal angioedema in CSU-AE is rare and presents with a mild clinical phenotype that does not typically require airway intervention.
Background: Ceftriaxone, a third-generation cephalosporin, is widely prescribed for severe infections. Although generally considered safe, it may cause immediate hypersensitivity reactions (HSR), including anaphylaxis, representing a significant clinical concern. Objective: To describe a case series of ceftriaxone-induced hypersensitivity reactions, highlighting clinical presentation, management patterns, and implications for rational antibiotic use. Methods: We retrospectively analyzed eight patients evaluated in our allergy department between 2023 and 2025 for immediate HSR to ceftriaxone. Demographic characteristics, clinical manifestations, reaction severity according to Brown’s classification, management, prior exposure, and skin test results were recorded. All patients underwent skin prick testing, which if negative, was followed by intradermal testing. Results: Patients (aged 10–44 years; with five females) presented reactions ranging from urticaria to grade III anaphylaxis. Most reactions occurred outside hospital settings, increasing the risk of delayed recognition and treatment. Despite several reactions fulfilling criteria for anaphylaxis, intramuscular epinephrine was not administered systematically, with management frequently limited to antihistamines and corticosteroids. Four patients reacted after the first reported dose; previous exposure was documented or suspected in most cases. Skin testing supported an immunoglobulin E-mediated mechanism in the majority of patients, and one patient developed anaphylaxis during intradermal testing. A progressive increase in patients was observed over the study period (1 patient in 2023, 2 in 2024, and 5 patients in 2025). One patient successfully completed treatment through a standardized 12-step desensitization protocol. Conclusions: Ceftriaxone-induced HSR could be severe and occur frequently outside controlled medical settings. Under-recognition of anaphylaxis and underuse of epinephrine remain significant concerns. Rational antibiotic prescribing, improved adherence to anaphylaxis management guidelines, and structured allergy evaluation—including desensitization if necessary—are essential to optimize patient safety.
