Background Symptomatic dermographism (SD) is the most common subtype of chronic inducible urticaria, yet its prevalence and clinical relevance in pediatric urticaria remain incompletely characterized. Objective assessment of SD and its relationship with disease activity in children is limited. Methods In this prospective observational study, children aged 1–18 years with acute or chronic urticaria were enrolled at a tertiary care center. Dermographometer testing using FricTest® 4.0 was performed at baseline and repeated after 6 weeks. SD was defined as a wheal diameter ≥3 mm with pruritus at 10 min after provocation. Disease activity and control were assessed using the Urticaria Activity Score over 7 days (UAS7) and the Urticaria Control Test (UCT). Results A total of 144 children (median age 9 years; 49.3% male) were included, of whom 79.2% had chronic urticaria. SD was identified in 24.3% of patients, with similar prevalence between acute and chronic urticaria. Children with SD were older and more frequently reported skin stroking or scratching as a trigger (p < 0.001). Dermographometer wheal diameter correlated with UAS7 (r = 0.33, p < 0.001). Lower dermographometer thresholds and more positive FricTest pins were associated with greater disease activity. At 6-week follow-up, children with SD showed improved dermographometer responses but were less likely to achieve well-controlled disease. SD at presentation was more frequent among children who progressed to chronic urticaria. Conclusion SD is common in pediatric urticaria and is associated with higher disease activity and poorer short-term disease control. Dermographometer-based provocation testing may complement patient-reported outcome measures.

Background: Anaphylaxis is a life-threatening allergic reaction with rising incidence worldwide. Young children's limited ability to express symptoms adds unique diagnostic challenges. Objective: To study on anaphylaxis in children, including triggers, symptoms, treatment, atopic status impact, and adrenaline injection time intervals. Methods: In-patient medical records of children who were diagnosed with anaphylaxis during 2014-2021 were reviewed. Results: One hundred thirty-three anaphylaxis events were identified. Food (47%) was the most common trigger, followed by drugs (31%), blood components (17%), insects (3%), and idiopathic causes (2%). Ten cases of refractory anaphylaxis, 2 cases of biphasic reactions, and 1 case of persistent anaphylaxis were found. There were no reported fatalities. The most common presentations involved the skin (94%), followed by the respiratory (73%), gastrointestinal (47%), and cardiovascular (42%) systems. In atopic patients, wheezing was more prominent than in those without atopy (p-value = 0.017). In the non-atopic patients, there was a higher incidence of cardiovascular symptoms, particularly hypotension (p-value = 0.001), compared to individuals with atopy. Children under 5 years old with mild-moderate anaphylaxis required more time to reach the hospital (147.0 vs. 45.0 minutes, p = 0.033) and to receive adrenaline injections (35.0 vs. 9.0 minutes, p-value = 0.017) than those with severe anaphylaxis. Conclusion: Childhood anaphylaxis is prevalent. Children with mild-moderate anaphylaxis experienced delays in hospital visits and adrenaline administration. Education on allergies is needed to improve the identification and prompt response to anaphylactic reactions, especially in young children.

BACKGROUND:Dyslipidemia and obesity contribute to a pro-inflammatory state. Eosinophilic airway inflammation can be indirectly measured by fractional exhaled nitric oxide (FeNO) produced in the airways of asthmatic subjects. OBJECTIVE:To compare exhaled nitric oxide (NO) and alveolar NO in asthmatic children with and without dyslipidemia. METHODS:Asthmatic children (5-18 years old) had fasting serum low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol (HDL-C) concentrations, and C-reactive protein (CRP) concentrations measured. FeNO was measured at constant flow rates of 20, 50, 100, and 300 ml/s by the chemiluminescence method. NO concentrations in tissue of the upper airways (CawNO) and the total flux of NO in the conducting airways (JawNO) were determined through FeNO at 20, 100, and 300 ml/s using a mathematical model. The atopic status was assessed using the skin prick test for aero-allergens. RESULTS:One hundred forty-one asthmatic children were enrolled with a mean (standard deviation) age of 11.82 (3.38) years. Sixty-four (45.4%) children had dyslipidemia and 20 (14.2%) were obese. Children with low HDL-C concentrations had significantly higher CawNO and JawNO than those with normal HDL-C concentrations (both p = 0.03). Asthmatic children with obesity had higher CRP concentrations than those with a normal weight (p < 0.001). Atopic children had a significantly higher FeNO, CawNO, and JawNO than non-atopic children (all p < 0.05). CONCLUSIONS:This study suggests an effect of HDL-C on CawNO and JawNO in asthmatic children. An intervention that normalizes HDL-C concentrations may be beneficial for airway inflammation in asthmatic children.

BACKGROUND:Unintentional exposure is common in children with food allergies. OBJECTIVE:To assess the benefits of newly developed food allergy application. METHODS:Caregivers of children with confirmed immediate reactions to food were enrolled to use the "Kinchew" application for one month. Kinchew provides the detail of food allergens after typing the name of specific food in the chat box. Then, the app provides the product image and detail of food allergens. Kinchew also has a menu for recording food diaries and videos on managing food allergies. Kinchew users were asked to assess their confidence in dealing with food allergies assessed by the questionnaire using 5 points Likert scale. The number of patients who experienced allergic reactions from unintentional food exposure was recorded after using Kinchew. RESULTS:Seventy caregivers were enrolled. Wheat was the most common causative food in 67% of the participants. All participants used Kinchew with a total use of 1,754 times, classified as food items searching 1080 times (62%), and recorded their food diary 674 times (38%). The number of patients who experienced allergic reactions from unintentional exposure significantly decreased from 61 (87%) to 31 (44%), p < 0.001.The user's confidence in choosing food improved significantly compared to the baseline score. In the subgroup analysis of the type of causative food, a significant improvement in confidence in food choosing was demonstrated in wheat and multiple food allergy groups. CONCLUSIONS:Well-designed food allergy mobile applications could improve caregivers' confidence in dealing with food allergies and reduce unintentional food exposure.

Background:A tamarind seed extract-based solution containing xyloglucan forms a protective layer over the nasal epithelium. However, there is no previous study evaluating xyloglucan efficacy in children with allergic rhinitis (AR). Objective:To evaluate the safety and efficacy of xyloglucan as an adjunctive treatment for AR in children. Methods:This randomized, double-blind, placebo-controlled crossover study assessed the efficacy of xyloglucan nasal spray in managing AR symptoms in children. Participants 6-18 years with AR were randomized to receive either xyloglucan or placebo in addition to their current AR therapy for 2 weeks, followed by a 2-week washout and crossover to the alternate treatment for 2 weeks. Primary outcomes were changes in visual analog scale scores analyzed using linear mixed models, adjusting for treatment, period, sequence, and compliance. Subgroup analyses included children with moderate symptoms and good compliance. Results:Seventy-nine children with AR were enrolled, median age 10 years (IQR: 8-12). Treatment with xyloglucan was associated with a significantly greater reduction in nasal congestion compared to placebo (β = -1.013, 95% confidence interval [CI], -1.729 to -0.298, P = 0.006). In children with moderate symptoms and good compliance, the effect on nasal congestion was more pronounced (β = -1.588, P = 0.046). Improvements in rhinorrhea, sneezing, and itching were observed but did not reach statistical significance. Both treatments were well tolerated, with only mild adverse events in both groups. Conclusion:Xyloglucan nasal spray, as an adjunct to standard AR treatment, demonstrated potential benefits in alleviating rhinitis symptoms, particularly nasal congestion, in children with AR. This clinical trial was registered with the Thai Clinical Trials Registry (No. TCTR20240318004).

BACKGROUND:Aeroallergen sensitization evaluation aids in diagnosing and managing chronic rhinitis. OBJECTIVE:To investigate changes in allergen sensitization over time in children with rhinitis. METHODS:Children with chronic rhinitis who underwent aeroallergen skin prick tests (SPT) between 2009 and 2019 were re-evaluated with a second SPT between 2022 and 2024. Sensitization changes were assessed by comparing initial and re-evaluation SPT results. A negative converter was defined as a previously positive test that became negative. RESULTS:Among 300 children (mean age 11.5 years), positive SPT rates increased from 71.3 % to 83.7 % (p < 0.001). House dust mites (HDM) were the most common sensitization (77 %), followed by cockroaches (24 %). Sensitization patterns changed in 56.7 % of children. HDM sensitization increased across all age groups, while cat sensitization rose significantly in those initially tested before age 5. Negative conversion rates varied by allergen, highest for Careless Weed (85.7 %) and lowest for HDM (1.52 %). Children who became negative converters for Bermuda grass had smaller initial wheal sizes than those who remained positive (3 mm vs. 5.8 mm, p = 0.003). CONCLUSION:Allergen sensitization patterns evolve over time, influenced by allergen type and patient age. Repeat testing may be necessary, especially for children with uncontrolled rhinitis.

Background: House dust mite subcutaneous immunotherapy (HDM SCIT) is a therapeutic option for allergic rhinitis (AR) patients who are unable to properly manage symptoms with standard medications. Objective: This study aimed to determine long-term efficacy and identify predictive factors in the clinical remission of AR patients who completed and discontinued HDM SCIT. Methods: This study included 240 AR patients, who completed a three-year course of HDM SCIT at two tertiary hospitals and were currently being discontinued. We followed-up the patients to ask about their current symptoms and allergy medication. Clinical remission was defined by patients who no longer required daily intranasal steroid or oral antihistamine. We compared patients in clinical remission to those still taking medication. Results: The enrolled patients had a median age of 21.0 (11.0-36.0) years at the time they began HDM SCIT. The clinical remission of AR was achieved in 174 (72.5%) patients. Starting HDM SCIT before the age of 15 and not having asthma were identified as significant and independent predictors of remission (aOR 4.44; 95%CI, 1.72-11.50; p-value 0.002, and 2.67, 95%CI 1.00-7.12; p-value 0.049), respectively, as determined by multivariate logistic regression analysis. There were no significant differences in HDM SCIT duration or sensitization patterns between patients in remission and those on medication after discontinuing HDM SCIT for at least one year. Conclusions: HDM SCIT exhibited persistent long-term efficacy after treatment discontinuation. Starting HDM SCIT before the age of 15 and without asthma comorbidity might be predictors of AR remission with HDM SCIT.

OBJECTIVE:To evaluate the impact of peak expiratory flow (PEF) monitoring using a smart peak flow (SPF) device on the quality of life (QoL) and satisfaction among children with asthma. METHODS:This 3-month prospective cohort study enrolled 71 children aged 7 to 17 years with physician-diagnosed asthma. Participants used the SPF device twice daily, with measurements recorded automatically. Quality of life was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and asthma control was assessed using the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Adherence to PEF measurements and satisfaction with the device were evaluated. RESULTS:Seventy-one children (mean age 11.4 years) completed the study. Adherence to twice-daily PEF measurements decreased significantly over three months (from 50.0% at 1 month to 39.9% at 3 months, p < 0.001). Children with good adherence (38.0%) showed significant improvements in PAQLQ scores, while those with poor adherence (62.0%) did not. COVID-19 infection resulted in a significant decrease in %PEF rate and increased peak flow variability. Despite device-related issues, overall satisfaction was high (85.19% for good adherence users vs. 88.64% for poor adherence users, p = 0.671). CONCLUSION:Regular PEF monitoring improves QoL in children with asthma by enabling early detection of symptom changes and better management. However, maintaining adherence to regular PEF monitoring is challenging. Further research with control groups is needed to validate these findings.

BACKGROUND:Anaphylaxis is a life-threatening allergic reaction with rising incidence worldwide. Young children's limited ability to express symptoms adds unique diagnostic challenges.OBJECTIVE:To study on anaphylaxis in children, including triggers, symptoms, treatment, atopic status impact, and adrenaline injection time intervals.METHODS:In-patient medical records of children who were diagnosed with anaphylaxis during 2014-2021 were reviewed.RESULTS:One hundred thirty-three anaphylaxis events were identified. Food (47%) was the most common trigger, followed by drugs (31%), blood components (17%), insects (3%), and idiopathic causes (2%). Ten cases of refractory anaphylaxis, 2 cases of biphasic reactions, and 1 case of persistent anaphylaxis were found. There were no reported fatalities. The most common presentations involved the skin (94%), followed by the respiratory (73%), gastrointestinal (47%), and cardiovascular (42%) systems. In atopic patients, wheezing was more prominent than in those without atopy (p-value = 0.017). In the non-atopic patients, there was a higher incidence of cardiovascular symptoms, particularly hypotension (p-value = 0.001), compared to individuals with atopy. Children under 5 years old with mild-moderate anaphylaxis required more time to reach the hospital (147.0 vs. 45.0 minutes, p = 0.033) and to receive adrenaline injections (35.0 vs. 9.0 minutes, p-value = 0.017) than those with severe anaphylaxis.CONCLUSION:Childhood anaphylaxis is prevalent. Children with mild-moderate anaphylaxis experienced delays in hospital visits and adrenaline administration. Education on allergies is needed to improve the identification and prompt response to anaphylactic reactions, especially in young children.

BACKGROUND Allergen skin prick test (SPT) and serum specific immunoglobulin E (sIgE) are effective diagnostic tests in allergic rhinitis (AR), however, positive results may not always correlate with clinical allergies. A nasal provocation test (NPT) can identify the causative allergen for immunotherapy, but it's not routinely performed. OBJECTIVE To establish the cutoff value for the house dust mite (HDM) SPT mean wheal diameter (MWD) and HDM sIgE level for identifying children with HDM-induced AR diagnosed from NPT. METHODS Children aged 5 to 18 years old with chronic rhinitis were evaluated by HDM SPT, sIgE, and NPT. Children with positive NPT results indicated HDM-induced AR. The cutoff values of the HDM SPT and sIgE level for predicting positive NPT were determined using a receiver operating characteristic curve. RESULTS A total of 245 children with a mean age of 9.53 ± 3 years were enrolled. HDM SPT results were positive (≥ 3 mm) in 160 (65.3%) children. HDM NPT results were positive in 176 (71.8%) children. Among children with positive HDM SPT (n = 160), 153 children (95.6%) were confirmed as having AR on NPT findings. The cutoff values for positive NPT responses were 6.6 mm for HDM SPT (yielding 100% specificity and 100% positive predictive value) and 17.0 kUA/L for sIgE (98.6% specificity and 99.2% positive predictive value). CONCLUSIONS This study proposes HDM SPT and sIgE cutoff values for use in the diagnosis of HDM-induced AR based on NPT. These cutoff values can be used to identify HDM-induced AR children who might benefit from immunotherapy.

Pediatric Allergy and ImmunologyVolume 34, Issue 2 e13927 LETTER TO THE EDITOR Safety of direct oral provocation in children with mild beta-lactam hypersensitivity reactions Chayaniss Pachasidchai, Chayaniss Pachasidchai Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: Writing - original draft, Methodology, Formal analysis, ​Investigation, Funding acquisition, Data curation, Resources, ConceptualizationSearch for more papers by this authorYiwa Suksawat, Yiwa Suksawat Department of Pediatrics, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorPailin Yooma, Pailin Yooma Department of Pediatrics, Saraburi Hospital, Saraburi, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorPotjanee Kiewngam, Potjanee Kiewngam Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorWanlapa Jotikasthira, Wanlapa Jotikasthira Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorAdithep Sawatchai, Adithep Sawatchai Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​Investigation, Data curation, Formal analysisSearch for more papers by this authorNatchanun Klangkalya, Natchanun Klangkalya Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​InvestigationSearch for more papers by this authorWatcharoot Kanchongkittiphon, Corresponding Author Watcharoot Kanchongkittiphon [email protected] orcid.org/0000-0002-1084-5985 Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Correspondence Watcharoot Kanchongkittiphon, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand. Email: [email protected] Contribution: Conceptualization, Methodology, Formal analysis, Validation, Supervision, Writing - review & editing, ​InvestigationSearch for more papers by this authorWiparat Manuyakorn, Wiparat Manuyakorn orcid.org/0000-0003-4278-1186 Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: Conceptualization, Methodology, Formal analysis, ​Investigation, Validation, SupervisionSearch for more papers by this author Chayaniss Pachasidchai, Chayaniss Pachasidchai Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: Writing - original draft, Methodology, Formal analysis, ​Investigation, Funding acquisition, Data curation, Resources, ConceptualizationSearch for more papers by this authorYiwa Suksawat, Yiwa Suksawat Department of Pediatrics, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorPailin Yooma, Pailin Yooma Department of Pediatrics, Saraburi Hospital, Saraburi, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorPotjanee Kiewngam, Potjanee Kiewngam Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorWanlapa Jotikasthira, Wanlapa Jotikasthira Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​Investigation, Data curationSearch for more papers by this authorAdithep Sawatchai, Adithep Sawatchai Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​Investigation, Data curation, Formal analysisSearch for more papers by this authorNatchanun Klangkalya, Natchanun Klangkalya Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: ​InvestigationSearch for more papers by this authorWatcharoot Kanchongkittiphon, Corresponding Author Watcharoot Kanchongkittiphon [email protected] orcid.org/0000-0002-1084-5985 Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Correspondence Watcharoot Kanchongkittiphon, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand. Email: [email protected] Contribution: Conceptualization, Methodology, Formal analysis, Validation, Supervision, Writing - review & editing, ​InvestigationSearch for more papers by this authorWiparat Manuyakorn, Wiparat Manuyakorn orcid.org/0000-0003-4278-1186 Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Contribution: Conceptualization, Methodology, Formal analysis, ​Investigation, Validation, SupervisionSearch for more papers by this author First published: 24 February 2023 https://doi.org/10.1111/pai.13927Citations: 2 Editor: Marina Atanaskovic-Markovic Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1Zambonino MA, Corzo JL, Muñoz C, et al. Diagnostic evaluation of hypersensitivity reactions to beta-lactam antibiotics in a large population of children. Pediatr Allergy Immunol. 2014; 25(1): 80-87. 10.1111/pai.12155 PubMedWeb of Science®Google Scholar 2Caubet JC, Frossard C, Fellay B, Eigenmann PA. Skin tests and in vitro allergy tests have a poor diagnostic value for benign skin rashes due to β-lactams in children. Pediatr Allergy Immunol. 2015; 26(1): 80-82. 10.1111/pai.12314 CASPubMedWeb of Science®Google Scholar 3Aberer W, Bircher A, Romano A, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003; 58(9): 854-863. 10.1034/j.1398-9995.2003.00279.x CASPubMedWeb of Science®Google Scholar 4Romano A, Atanaskovic-Markovic M, Barbaud A, et al. Towards a more precise diagnosis of hypersensitivity to beta-lactams – an EAACI position paper. Allergy. 2020; 75(6): 1300-1315. 10.1111/all.14122 PubMedWeb of Science®Google Scholar 5Koosakulchai V, Sangsupawanich P, Wantanaset D, Jessadapakorn W, Jongvilaikasem P, Yuenyongviwat A. Safety of direct oral provocation testing using the amoxicillin-2-step-challenge in children with history of non-immediate reactions to amoxicillin. World Allergy Organ J. 2021; 14(7):100560. 10.1016/j.waojou.2021.100560 CASPubMedGoogle Scholar 6Tucker MH, Lomas CM, Ramchandar N, Waldram JD. Amoxicillin challenge without penicillin skin testing in evaluation of penicillin allergy in a cohort of marine recruits. J Allergy Clin Immunol Pract. 2017; 5(3): 813-815. 10.1016/j.jaip.2017.01.023 PubMedWeb of Science®Google Scholar 7Blanca M, Torres MJ, García JJ, et al. Natural evolution of skin test sensitivity in patients allergic to beta-lactam antibiotics. J Allergy Clin Immunol. 1999; 103(5 Pt 1): 918-924. 10.1016/S0091-6749(99)70439-2 CASPubMedWeb of Science®Google Scholar 8Vyles D, Chiu A, Routes J, et al. Oral amoxicillin challenges in low-risk children during a pediatric emergency department visit. J Allergy Clin Immunol Pract. 2020; 8: 1126-1128. 10.1016/j.jaip.2019.09.022 PubMedWeb of Science®Google Scholar 9vyles D, Chiu A, Routes J, et al. Antibiotic use After removal of penicillin allergy label. Pediatrics. 2018; 141:e20173466. 10.1542/peds.2017-3466 PubMedWeb of Science®Google Scholar 10Labrosse R, Paradis L, Lacombe-Barrios J, et al. Efficacy and safety of 5-day challenge for the evaluation of nonsevere amoxicillin allergy in children. J Allergy Clin Immunol Pract. 2018; 6: 1673-1680. 10.1016/j.jaip.2018.01.030 PubMedWeb of Science®Google Scholar Citing Literature Volume34, Issue2February 2023e13927 ReferencesRelatedInformation

The control of asthma and quality of life are expected to be correlated. The aim of this study is to identify the association of quality of life and peak expiratory flow rate (PEFR) with step-down treatment in asthmatic children. Children aged 7-17 years with asthma were evaluated for pediatric asthma quality of life questionnaire (PAQLQ), asthma severity, duration of inhaled corticosteroid (ICS) use, and medication use at the enrollment and 3 months after. They were asked to use peak expiratory flow (PEF) meter twice daily. Of 57 children, the mean age was 11.7±3.4 years, 57.9% were male. The median duration of ICS use was 4.7 (3.0-8.3) years. Thirty-two children (56.1%) had moderate persistent asthma. Twice daily compliance of PEFR measurement dropped from 64% to 52.5% after 3 months. Thirty-one (62%) children with ≥50% PEF meter usage defined as good compliance had an average morning and evening PEFR of 115.6 ± 29.2 and 117.5 ± 30.0 % predicted. A significant difference between duration of ICS use and PEF meter usage compliance was observed (3.6 years vs. 7.6 years in children with compliance ≥50% and <50%, respectively, p-value 0.001). Children with good compliance of PEF meter usage who had PAQLQ of 7 had a greater odds of ability to step-down asthma medications in the next 3 months (odds ratio 7.3; 95% confidence interval, 1.3-42.6, p-value 0.027). In asthmatic children with at least 50% PEF meter usage, PAQLQ score correlates with ability to step-down treatment in children with asthma.

Introduction: Wheezing is a common problem in preschool children. Currently, there are no reliable biomarkers that can predict subsequent wheezing in preschool children. This study aimed to compare serum periostin levels between preschool children with and without recurrent wheezing and investigate its utility for predicting acute wheezing exacerbation. Methods: Children aged 2-5 years with recurrent wheezing and healthy control children were enrolled. They were evaluated for serum periostin level at enrollment and subsequently followed for wheezing episodes in a 1-year prospective study. Results: A total of 122 children were enrolled. Children in the recurrent wheezing group (n = 80) had a greater median serum periostin level (1,122.32 pg/mL [<10-6,978.93]) than that of the healthy control group (n = 40) (<10 pg/mL [<10-2,116.69]), p value = 0.006. After 1-year follow-up, subjects who experienced subsequent wheezing exacerbation episodes had a greater median of periostin level (5,321 pg/mL) compared with those with no exacerbation (<10 pg/mL), p value = 0.014. ROC curve analysis revealed that the level of serum periostin >1,200 pg/mL, corresponding to 78.9% sensitivity and 64.6% specificity, with an AUC of 0.701, p value = 0.009, could be a predictor for acute wheezing exacerbation within 1 year. Besides, subjects with serum periostin >1,200 pg/mL had greater odds of subsequent wheezing episodes compared with those with lower levels of serum periostin (adjusted odds ratio 10.0, 95% confidence interval: 2.3-43.5). Conclusions: Preschool children with recurrent wheezing have a greater serum periostin level than healthy control. Serum periostin may be a valuable biomarker for predicting acute wheezing exacerbations in the following year.

Beta-lactam antibiotics (BLs) are frequent causes of drug allergies. We perform direct oral challenge for children with low-risk BLs allergies. Children age 4-18 years who had report BLs allergy were enrolled. Risks were assessed by evidence-based criteria. Low risk patients underwent direct oral challenge by 2 graded dose (10/90%) and continued for a total of 5 days. A total of 46 children met the criteria for a direct oral BLs challenge, having the mean age was 8.6 years (range from 4-18 years), 25 (54.3%) were females. The mean age at BLs allergy diagnosis was 4 years (range from 0.8 -12.7 years). Of these, 34 patients (74%) were penicillin allergy and 12 patients (26%) were cephalosporin allergy. Symptoms of allergic reaction included 22 (47.8%) maculopapular rash, 15 (32.6%) non-specific rash, 9 (19.6%) urticarial rash, and 3 isolate GI symptom. Six children (13%) had previously taken a culprit medication before labeled with drug allergy. Regarding direct oral challenge, 45 (97.8%) children tolerated the challenge without any reactions. One child (2%) developed a reaction on the second dose with urticarial rash resolved with an oral antihistamine. There was no anaphylaxis occurred. Children categorized as low-risk by risk-stratification criteria can perform safe and effective direct oral challenge test to BLs allergy diagnosis.

Purpose : This study evaluated the correlation between dyslipidemia and pulmonary function parameters assessed by spirometry and force oscillation technique in asthmatic children. Methods : Asthmatic children (aged 5–18 years old) were measured for fasting serum lipid profiles, including low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) and C-reactive protein (CRP). Pulmonary function tests were assessed by spirometry and forced oscillation technique (FOT). Results : One hundred forty-one asthmatic children were enrolled with the mean (sd) age of 11.82 (3.38) years. Eighty-eight children (62.4%) were males, 64 children (45.4%) had dyslipidemia, and 20 (14.2 %) children were obese. Of 64 children with dyslipidemia, high LDL-C was the most common dyslipidemia (65.6%), followed by TC (57.8%), non-HDL-C (53.1%), TG (35.9%), and low HDL-C (15.6%). There were no significant differences in spirometry parameters and FOT parameters between asthmatic children who had dyslipidemia and normal lipid levels. Asthmatic children who had high LDL-C had significantly higher expiratory phase respiratory resistance at 5 Hz (R 5 ), whole breath R 20 and expiratory phase R 20 evaluated by FOT than those with normal LDL-C (p < 0.05). There were no significant differences in weight, height, obesity status, and CRP level between children with high and normal LDL-C. Conclusion : The prevalence of dyslipidemia in children with asthma is high. LDL-C is associated with more elevated respiratory resistance assessed by FOT in asthmatic children. Intervention lowering LDL-C may have a benefit on lung function in asthmatic children.

The current study was aimed to assess benefits of newly developed mobile application in food allergy patients and caregivers.