BACKGROUND:Asthma-related cardiopulmonary interactions may affect right ventricular (RV) performance even when children are clinically stable. Two-dimensional speckle-tracking echocardiography (2D-STE) may detect subclinical myocardial dysfunction beyond conventional indices. This study aims to investigate the effects of childhood asthma on RV function by using 2D-STE. METHODS:In this prospective case-control study, children aged 6-18 years with physician-diagnosed asthma (n = 70) and age-matched healthy controls (n = 30) underwent standard transthoracic echocardiography, tissue Doppler imaging (TDI), and 2D-STE. Primary outcomes were RV global longitudinal strain (RV GLS) and strain rate. Conventional RV systolic indices and RV diastolic indices were also assessed. Clinical characteristics and spirometry were recorded. RESULTS:RV systolic mechanics were largely preserved in the asthma group. RV GLS, RV strain rate, and tricuspid annular plane systolic excursion (TAPSE) did not differ significantly between asthmatic children and controls. In contrast, tricuspid annular E' velocity was significantly lower in the asthma group (p = 0.007), and tricuspid E/E' ratio was significantly higher (p < 0.001). Interventricular septal diastolic thickness was also significantly increased among children with asthma (p = 0.027). Within the asthma cohort, TAPSE showed positive correlations with age (r = 0.478, p < 0.001), BMI (r = 0.398, p = 0.001), asthma duration (r = 0.431, p < 0.001), and FEV1 (r = 0.301, p = 0.011), whereas RV strain parameters were not significantly associated with demographic or respiratory variables. CONCLUSIONS:In predominantly mild-to-moderate, clinically stable pediatric asthma, RV systolic deformation by 2D-STE appears preserved, while TDI-derived indices indicate early RV diastolic involvement. Focused assessment of RV diastolic function may help to identify subclinical cardiopulmonary effects in selected children with asthma.

Background: Atopic dermatitis (AD) and food allergy (FA) are common allergic diseases in early childhood. AD may be concomitant with FA, particularly in young children. Although studies report the prevalence of FA in children with AD, there is insufficient data regarding different phenotypes of FA. Objective: The aim of our research was to determine the prevalence and clinical predictors of different phenotypes of concomitant FA in children with AD. Methods: This cross-sectional multicenter study included patients younger than 24 months old diagnosed with AD, recruited from 14 pediatric allergy centers. Patients were categorized into two groups using skin testing, allergen-specific IgE, and ultimately food challenge testing (FCT): those with FA and those without. Individuals with FA were classified into three distinct phenotypes: IgE-mediated, non-IgE-mediated, and concurrent IgE- and non-IgE-mediated. Results: The data of 530 children [59% male, median-age 7 months (IQR: 5–11)] were analyzed. IgE-mediated FA was found in 28.1% of participants, whereas 22.4% (n = 119/530) exhibited non-IgE-mediated FA. Concurrent IgE- and non-IgE-mediated FA was reported in 12.1% (n = 64/530) of patients. Cow’s milk (69.6%) and egg-white (68.9%) were identified as the most prevalent allergens. Cow’s milk was primarily responsible for non-IgE-mediated and egg-white for IgE-mediated FA. The most significant predictors of FA were severe AD and the presence of blood in stool with odds ratios of 8.25 (95% Cl: 3.04–22.39) and 10.04 (95% CI: 2.03–49.59), respectively (p < 0.01) (p < 0.005). Conclusions: The study’s findings indicate that children with early-onset and mild-to-moderate AD deserve to be comprehensively assessed for FA symptoms. The most significant indicators of concomitant FA in AD patients were the presence of blood in stool and severe AD. It is important to consider that those who exhibit IgE-mediated FA may also have concurrent non-IgE-mediated FA. We underline that it is important to consider that children with AD who exhibit IgE-mediated FA may also have concurrent non-IgE-mediated FA. Addressing these symptoms may assist healthcare practitioners in clinical practice to improve the quality of care for AD patients having FA.

Background: This study aimed to investigate serum 25-hydroxyvitamin D levels in children with asthma and evaluate its association with clinical and laboratory features of asthma, as well as asthma control status. Materials and Methods: Eighty-one asthmatic children (35 girls, 46 boys), aged between 5 and 18 years, who were followed at the Pediatric Allergy Outpatient Clinic, were included. Clinical characteristics, family history of atopy, allergy skin prick test results, pulmonary function test parameters, serum total IgE levels, and peripheral eosinophil percentages were retrospectively obtained from medical records. Asthma control status assessed by both physicians and patients. Blood samples were obtained from all children for the measurement of vitamin D levels. Patients were grouped according to serum vitamin D levels, asthma control status, and treatment regimens. Results: The mean serum vitamin D level was 17.9 +/- 8.3 ng/mL.Ofthe patients, one (1.2%) had severe vitamin D deficiency (<5 ng/mL); 32 (39.5%) had deficiency (serum vitamin D levels of 5-15 ng/mL); and 19 (23.5%) had insufficiency (serum vitamin D levels of 15-20 ng/mL). Serum vitamin D levels were sufficient (>20 ng/mL) in 29 (35.8%) patients. No significant relationship was found between serum vitamin D levels and total IgE levels, eosinophil percentages, allergy skin prick test results, or treatment regimens. Similarly, there was no statistically significant association between serum vitamin D levels and asthma control status assessed by either the physician or the patients and their parents. However, vitamin D deficiency was significantly associated with experiencing more than one asthma attack in the past year (p = 0.05). Conclusion: More than half of the asthmatic children included in the study had vitamin D deficiency or insufficiency. Although serum vitamin D levels were not significantly associated with asthma control status, lower levels were linked to an increased risk of frequent asthma attacks.

OBJECTIVE:Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction. We aimed to evaluate the demographic and clinical characteristics of patients presenting with anaphylaxis, as well as triggers and risk factors, and to determine the rate of adrenaline auto-injector (AAI) usage.METHODS:The study was planned in the pediatric allergy outpatient clinic over a 1-year period. The data of children diagnosed with anaphylaxis were evaluated retrospectively; demographic characteristics, causes of anaphylaxis, and treatment modalities were recorded in the created study form.RESULTS:Eighty children (29 females) with a median age of 6.5 years (range: 1 month-17 years) were evaluated. The most common triggers were foods under 2 years of age (73%), and drugs (70%) above 2 years of age. Nearly half of the anaphylaxis episodes (n=41, 51.3%) occurred at home. Cutaneous and respiratory symptoms were the most commonly reported complaints (98.8%). The median age of the patients at the first attack with severe anaphylaxis (n=29, 36.3%) was significantly higher than the rest (p:0.007). The age at onset of the reaction (p:0.006) and occurrence of the reaction in hospital conditions (p<0.001) were determined to be significant risk factors for severe anaphylaxis. Most of them received antihistamines (95.7%) and corticosteroids (91.3%), while 78.3% received adrenaline. Only 9.5% of patients with recurrent episodes of anaphylaxis used AAIs.CONCLUSION:Foods in infants and drugs in older children were the leading causative allergens of anaphylaxis. The most common clinical manifestations were respiratory and cutaneous symptoms. The older age at onset of the reaction and the occurrence of the reaction in hospital conditions were determined to be significant risk factors for severe anaphylaxis. It was determined that the frequency of AAI use was low among patients and their families.

Introduction: Beta-lactam (BL) antibiotics are the most often involved drugs in allergic reactions. Mild cutaneous reactions such as maculopapular exanthema or urticaria are the most common presenting complaints of BL allergy in the pediatric population. However, it can be challenging to distinguish BL-induced allergy from reactions due to infections or other reasons. In this study, we aimed to determine the clinical characteristics and potential risk factors of true BL allergy in children with suspected mild cutaneous reactions to BLs. Methods: We evaluated children who were admitted to our pediatric allergy clinic with suspected BL allergy in between January 2015 and March 2020. Patients with a history suggestive of immediate and non-immediate mild cutaneous reactions were included in the study. The oral challenge test (OCT) with the culprit drug was performed on all patients to confirm the diagnosis. Results: Two hundred fourteen (119 male and 95 female) patients with a median age of 4.9 years were evaluated. BL allergy was confirmed in 10.7% (23) of the patients, according to the OCT results. Most of the proven allergic reactions were of the immediate type (73.9%), and urticaria was the most common presenting complaint (60.8%) in proven BL-allergic patients. The negative predictive value of penicillin-G skin testing was 89.7% for immediate-type penicillin allergy and 93.4% for non-immediate reactions. Also, positive predictive value of penicillin-G skin testing was 50% for immediate and 25% for non-immediate reactions. In the multivariate logistic regression analysis, a history of proven drug allergy (Exp (B): 7.76, 95% CI: 1.88–31.97, p = 0.005) was found to be the risk for BL allergy. Conclusion: This study highlighted that OCTs should be performed to confirm the diagnosis in patients suspected of immediate and non-immediate mild cutaneous reactions to BLs and remove the overestimated “BL allergy” label. In these patients, a history of proven drug allergy might be a risk factor for true BL allergy.

BACKGROUND:Asthma is the most common chronic disease of childhood. Management of asthma mainly depends on compliance with long-term therapy. Art therapy, in which children express their experiences through artistic activities, is one of the psychosocial support treatments in chronic diseases. The aim of this study was to investigate the effects of expressive art therapy on asthma control and quality of life of asthmatic children.METHODS:A total of 20 children (9 females/11 males), aged 8-13 years, had a group art therapy program consisting of 90 min sessions per week for 8 weeks. Pulmonary function tests (PFTs) by spirometry, asthma control tests, and an asthma quality-of-life scale for children, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), were performed before and after art therapy.RESULTS:Although a statistically significant increase in PFTs (FEV1, PEF, p = 0.001) and improvement in the items of quality of life (activity limitation, symptoms, p < 0.001) were observed in our patients after art therapy, the increase in asthma control was not significant.CONCLUSION:Expressive art therapy can cause improvement in both pulmonary function tests and quality of life scales in children with asthma. Longer term art therapies planned by an experienced team may also be beneficial in achieving asthma control.

INTRODUCTION:Ibuprofen is the most common culprit drug causing nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity in children. We aimed to evaluate the frequency, clinical characteristics, and risk factors of confirmed ibuprofen allergy in children presenting with a history of suspected immediate type ibuprofen-induced hypersensitivity reactions.METHODS:We evaluated 50 (35 M, 15 F) children with a median age of 7 years, who were referred to our clinic with suspected immediate ibuprofen hypersensitivity. Patients were subjected to a diagnostic work up including drug provocation tests (DPTs) with the culprit drug. Reactions were classified according to the European Academy of Allergy and Clinical Immunology Task Force recommendations for pediatric patients. Proven ibuprofen allergic patients underwent DPT to find a safe alternative drug.RESULTS:Ibuprofen allergy was confirmed in 34% (n: 17) of children; 9 patients were diagnosed by DPTs and 8 patients diagnosed based on their histories. Angioedema was the most common clinical manifestation (n: 30, 60%). Among patients with proven ibuprofen allergy, 7 of them were classified as cross-intolerant. Cross-intolerance reactions were further classified as NSAID-exacerbated cutaneous disease (n = 1) and NSAID-induced urticaria/angioedema/anaphylaxis (n = 6). As an alternative drug, paracetamol was safely tolerated, whereas 1 patient developed angioedema and urticaria with nimesulide. Older age and male gender were identified as independent risk factors for immediate-type ibuprofen allergy.CONCLUSION:DPTs should be performed to confirm or exclude ibuprofen allergy in children and to find safe alternative drugs. Male gender and older age are risk factors for ibuprofen allergy. NSAID-induced hypersensitivity reactions in the pediatric population cannot be well defined using the adult classification system.

BACKGROUND:Food allergy is a component of the atopic march and may have effects on asthma. This study aimed to evaluate the risk factors for confirmed immunoglobulin E-mediated food allergies and their impact on the clinical picture in preschool children with asthma.METHODS:Clinical history and allergic assessment results were obtained from medical records and analyzed retrospectively. Preschool children with asthma were included in the study and the characteristics of food allergy and asthma were evaluated. The patients were grouped as those with food allergy (Group I, n = 60) and those without (Group II, n = 98).RESULTS:In patients with food allergy and asthma, the number of episodes requiring systemic steroids in the last year (p = 0.002), atopic dermatitis (p = 0.001), parental atopic disease (p = 0.009) and aeroallergen sensitivity rates (p < 0.001) was higher than patients without food allergies. The use of medium or high doses of inhaled steroids to achieve asthma control was more frequent in patients with food allergies (p = 0.014). Parental history of atopic disease [p = 0.007, odds ratio (OR): 3.27, 95% confidence interval (CI) 1.37-7.77)], atopic dermatitis (p = 0.017, OR: 2.80, 95% CI: 1.19-6.57), starting complementary food after 6 months (p = 0.004, OR: 3.9, 95% CI: 1.5-10.0) and having aeroallergen sensitivity (p < 0.001, OR: 6.01, 95% CI: 2.21-16.29) were identified as significant risk factors for food allergy.CONCLUSION:Asthmatic preschool children with food allergies are more likely to have a parental atopic disease, atopic dermatitis, aeroallergen sensitivity and starting complementary food after 6 months. These patients experience more asthma attacks and need higher doses of steroids.

Background:Local anesthetics (LA) are relatively safe and rarely cause immediate hypersensitivity reactions. The data on immediate LA hypersensitivity and its risk factors in children are limited. Aim:To evaluate risk factors of immediate LA hypersensitivity. Methods:The retrospective case-controlled study included 17 patients with confirmed immediate LA hypersensitivity. For each patient, three age- and gender-matched control subjects were included in the study. LA hypersensitivity was excluded by skin tests and subcutaneous drug provocation tests in all control subjects. Results:The most common allergic assessment in the patient/control group was for lidocaine (n=5; 29.4%, vs n=23; 45.1%). Suspected LA hypersensitivity reactions were found to be associated with cutaneous manifestations in 14 (82.4%) patients and in 7 (13.7%) of the controls. A history of exposure to local anesthetics twice or more was present in 11 (64.7%) patients vs 6 (11.8%) controls. In conditional regression analysis, repeated LA exposure (≥2) and cutaneous findings were determined as significant risk factors (Odds Ratio [OR]:5.7; 95% Confidence Interval [CI]:1.2-27.1; P=0.029 and (OR:17.3; 95% CI:3.6-82.5; P<0.001, respectively). Conclusion:Cutaneous manifestations and a history of LA exposure twice or more were predictive factors for LA allergy confirmed by skin test in children.

Palatability of the infant formulas lacking cow milk protein formulas is reported by parents to be an important drawback. The purpose of this study is to examine decisions made by mothers of infants having cow milk protein allergy, and physicians concerning the palatability of unflavored extensively hydrolyzed formulas and amino acid-based formulas. We conducted a multi-center, randomized, single-blinded, observational taste study involving 149 pediatricians from gastroenterology and allergy subspecialties at 14 tertiary healthcare units from different regions of Turkey and involving 94 mothers of infants with cow milk protein allergy. Blinding was performed for seven formulas available in the market, which were the most commonly prescribed for feeding: four AAFs (Neocate-Numil®, Aptamil Pregomin AS-Numil®, Alfamino-Nestle®, Comidagen-Mamma®), one AAF specifically designed to address the growing nutritional and lifestyle needs of children >1 year (Neocate Junior-Numil®), 2 eHFs (Bebelac Pepti Junior-Numil®, Similac Alimentum-Abott®). Considering all three formula characteristics, Neocate junior-Numil® ranked as the number 1 product among seven products by mothers (63.8%) and physicians (69.8%). The ratings of mothers were significantly higher than the physicians (8.1 points and 6.1 points, respectively; p < 0.001). No difference was found in terms of taste, smell, and appearance for Neocate junior-Numil® between the mothers' and physicians' ratings. Since caregivers have responsibility for careful selection of replacement products for infants with cow milk protein allergy, it is noteworthy that increased awareness and confidence in the palatability characteristics of these products should motivate mothers and physicians to comply with replacement treatment in the long term.

Antibiotic allergy is a big problem that may affect the treatment and life quality of patients with cystic fibrosis (CF). Aim To evaluate predictive factors for confirmed antibiotic hypersensitivity in children with CF. Methods In this case-controlled study, we examined 15 patients with CF who had been confirmed with antibiotic allergy. Additionally, we included a control group of age- and gender-matched 45 CF patients with no antibiotic allergy. The diagnosis of antibiotic allergy was confirmed in the presence of a compatible history and a positive response in the drug skin test or provocation test. Multiple drug hypersensitivity was classified according to the temporal relationship of antibiotics: (i) distant, (ii) simultaneous, and (iii) sequential. The data were analyzed by conditional logistic regression. Results beta-lactam allergy was confirmed in eight patients (ceftazidime n = 5, piperacillin-tazobactam n = 3) and non-beta-lactam allergy was confirmed in two patients (ciprofloxacin n = 1, azithromycin n = 1). Additionally, multiple drug hypersensitivity in five patients (distant n = 4, sequential n = 1), among whom two patients showed hypersensitivity against ceftazidime/piperacillin-tazobactam+ ciprofloxacin/levofloxacin, two patients showed hypersensitivity against ceftazidime+ ciprofloxacin n = 2, and one patient showed hypersensitivity against piperacillin-tazobactam+ amikacin+ trimethoprim-sulfamethoxazole. All patients (n = 13) with confirmed beta-lactam allergy were meropenem tolerant. Multivariate analysis indicated that immediate reactions (, p < 0.001) and allergic evaluation in the first six months after the reaction (p = 0.036) were significant risk factors for the prediction of antibiotic hypersensitivity. Conclusion Beta-lactam antibiotic allergy is the most commonly confirmed drug allergy in children with CF. However, unlike normal children, ceftazidime and piperacillin-tazobactam account for the majority.

BACKGROUND: Propofol rarely causes allergic reactions. On the other hand, its relationship with egg allergy is con-troversial. This study aimed to evaluate propofol sensitivity in patients with suspected allergic reactions to propofol and patients with proven immunoglobulin E-mediated egg allergy.METHODS: Patients who underwent propofol skin tests due to suspected hypersensitivity reaction to propofol (group 1) or children with confirmed immunoglobulin E mediated or mixed egg allergy (group 2) were included in the study as two groups. The data were obtained from the patients' medical records and retrospectively analyzed. Propofol sensitivity was confirmed by determining the positivity of skin tests. Egg allergy has been confirmed by in-vivo and in-vitro tests, including oral challenge tests.RESULTS: Thirty-two of the patients had a history of suspected hypersensitivity reactions after using propofol. The remaining 16 had a confirmed egg allergy. Propofol sensitivity was confirmed in 3 patients, one with a suspected hyper-sensitivity reaction to propofol and two with egg allergy. Both of the egg-allergic patients had histories of anaphylaxis after consuming small amounts of egg, and they had never been exposed to propofol.CONCLUSIONS: Propofol skin test may be positive in patients with severe immunoglobulin E-mediated hen's egg allergy. To avoid reactions that may occur during the use of propofol, detailed history of hen's egg allergy should be obtained, and in the presence of severe reactions, an alternative drug should be preferred. (Cite this article as: Siileyman A, Guler N. Is anaphylaxis with egg a risk factor for propofol sensitivity? Gazz Med Ital -Arch Sci Med 2022;181:545-51. DOI: 10.23736/S0393-3660.21.04673-8)

Objective: Cefazolin is a first-generation cephalosporin, particularly effective against gram positive agents such as staphylococci and streptococci.Despite this narrow spectrum, it is important in surgical prophylaxis.In this study, we aimed to evaluate the tolerability of cefazolin in patients with confirmed β-lactam allergy.Methods: Patients who underwent cefazolin allergic work-up due to suspected cefazolin allergy (Group 1) and children with confirmed β-lactam allergy other than cefazolin (Group 2) were included in the study as two groups.β-lactam allergy was confirmed by determining positivity of skin test and/or provocation test with culprit drug and penicillin.Cefazolin skin test was performed in all patients.The provocation test was also applied to all patients with negative skin tests.Results: A total of 35 patients were evaluated.Eleven of them had a history of suspected allergic reactions after using cefazolin.The remaining 24 had a confirmed β-lactam allergy.Cefazolin allergy was confirmed in 3 patients.We confirmed cefazolin allergy in 1 of 11 children with suspected reactions.Two of the patients with confirmed β-lactam allergy had also cefazolin allergy and both of them had allergy to more than one β-lactam antibiotics. Conclusion:The majority of patients with a β-lactam allergy can tolerate cefazolin.Our findings imply that children with confirmed allergy to more than β-lactam antibiotics and peniclillin are also sensitive to cefazolin.Children with selective cefazolin allergy are expected to be sensitive to the side chain.A detailed history and comprehensive allergic evaluation are crucial in deciding the use of cefazolin in β-lactam-allergic patients.

Objective: Macrolides are often accepted as safe antibiotics due to their low allergenicity. However, studies on macrolides, particularly studies evaluating cross-reactivity in macrolides, are highly rare in children. This study aimed to evaluate the clinical manifestations, confirmation rate, and frequency of cross-reactivity in children admitted with suspicious clarithromycin or azithromycin allergy. Materials and Methods: A total of 61 children suspected of macrolide antibiotic allergy (clarithromycin, n = 39 and azithromycin, n = 22) were evaluated. Allergy work-up including drug provocation tests were performed in all patients to confirm drug allergy. Results: Macrolide allergy was confirmed in 9.8% (n = 6) of patients (azithromycin, 18.2% [n = 4] and clarithromycin, 5.1% [n = 2]). There was no significant difference between the confirmation rate of clarithromycin and azithromycin (P = .117). Cross-reaction with clarithromycin was confirmed in 2 (33.3%) patients with azithromycin allergy. Conclusion: Drug skin tests are not capable of confirming or ruling out macrolide allergy, and oral provocation tests are essential for a definitive diagnosis. Cross-reactivity, albeit rare, can occur between clarithromycin and azithromycin, which are the most frequently used macrolides in children.

Klaritromisin ve azitromisin çocuklarda sık kullanılan oral makrolid antibiyotiklerdir. Makrolidler düşük alerjenitelerinden dolayı nispeten güvenli antibiyotiklerdir yine de hipersensitivite reaksiyonlarına neden olabilecekleri bilinmektedir. Azitromisin, klaritromisine kıyasla daha ağır reaksiyonlar yapabilmektedir. En sık reaksiyon makülopapüler döküntüdür ve makrolidlerle ilişkili anafilaksi son derece nadirdir. Bugüne kadar az sayıda makrolidlerle ilişkili anafilaksi olgusu bildirilmiştir. Makrolid alerjilerinin tanısı için deri testleri yeterli değildir ve kesin tanı için oral provokasyon testi yapılması gerekmektedir. Burada amoksisilin-klavulanik asit ve klaritromisini tolere edemediği provokasyon testi ile gösterilmiş ve oral azitromisin provokasyon testi sırasında anafilaksi gelişen bir vakayı sunduk.

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.

Objective: In this study, our aim was to investigate the effects of feeding habits such as the last feed before bedtime, feeding during sleep, bedtime, waking time and factors associated with the social environment on upper airway tract symptoms and asthma control. Material and Method: The study was conducted on children with preschool asthma and their age and sex matched healthy children. Results: The study group included 217 children, 103 of whom have asthma and 114 were (52.5%) healthy. The frequency of feeding in the last 2 hours before going to bed was 47.6% in children with asthma and 82.5% in healthy children (p<0.001). In children with asthma, there was a positive correlation between feeding within 0-2 hours before going to bed and hoarseness (r=0.429, p=0.001), snoring (r=0.430, p=0.001), rhinorrhea (r=0.429, p=0.001) and nasal congestion (r=0.469, p=0.001). In healthy children, the same positive correlation was detected with snoring (r=0.227, p=0.016) and the number of otitis (r=0.294, p=0.002). Caregivers other than mothers, the late awakening and the number of wake-ups during night were determined as risk factors for uncontrolled asthma. Conclusion: Not feeding in 0-2 hours before bedtime seems to be advisable for asthmatic preschool children since it can cause an increase in upper respiratory symptoms.

Cetirizine is a selective H1 histamine receptor antagonist derived from piperazine. Piperazine is a cyclic moiety molecule located in the structure of many drugs, including anxiolytics, antidepressants, and antipsychotics. Drug-induced dystonia is reported mostly due to antipsychotic and antiemetic drugs. It occurs due to the disruption of dopamine and acetylcholine balance in favor of acetylcholine. Although cetirizine is a relatively safe drug, it has rarely been reported to cause a dystonic reaction. To the best of our knowledge, there is no reported case of dystonia due to cetirizine in infancy. Here, we present a 7-month-old patient who developed a dystonic reaction after cetirizine administration.