BACKGROUND:Cold-induced urticaria (ColdU) is a rare chronic inducible urticaria that can cause systemic reactions, including cold-induced anaphylaxis (ColdA), but pediatric data are limited. The aim of this study was to evaluate the clinical characteristics, comorbidities, management approaches, risk of anaphylaxis, and long-term course of ColdU in a pediatric cohort, and to identify risk factors for ColdA, determinants of disease resolution, and predictors of persistence into adulthood. METHODS:This retrospective multicenter study included 203 pediatric patients with ColdU across 30 centers in Türkiye. Clinical characteristics and management of patients were analyzed. Logistic regression was used to identify factors associated with ColdA and disease resolution. RESULTS:The median age at diagnosis was 14.3 years, and the median age at onset was 10 years; 56.1% of patients were female. ColdA occurred in 17.2%, with increased risk associated with male sex, autoimmune comorbidities, older age, and triggering by cold food/beverage ingestion. Most patients (82.2%) received second-generation H1-antihistamines; omalizumab achieved >90% symptom control in 12 refractory cases. Over a median 3.5-year follow-up, 30.5% achieved disease resolution (median duration: 18 months). The history of anaphylaxis and comorbid atopy significantly reduced the likelihood of remission. Some patients showed adult persistence, without clear predictors. DISCUSSION:ColdA may occur even without classic high-risk features; pediatric ColdU management should be guided by individualized risk assessment, prioritizing clinical risk factors-such as older age, high-risk cold triggers, angioedema, and autoimmune comorbidities-over isolated diagnostic parameters. In refractory cases, omalizumab is an effective and well-tolerated option. Prior anaphylaxis and comorbid allergic disease predicted poorer remission.

Background/Objectives: Inborn errors of immunity (IEI) are rare and complex pediatric disorders that create significant information gaps for families and non-specialist healthcare professionals. Large language models (LLMs) such as ChatGPT are increasingly used as on-demand health information resources; however, evidence on their performance in rare pediatric diseases remains limited. This study aimed to evaluate the reliability, quality, readability, understandability, reproducibility, and safety-related concerns of ChatGPT-4o responses to frequently searched questions about pediatric IEI posed by healthcare professionals and patients/caregivers. Methods: This cross-sectional evaluation used the publicly accessible ChatGPT-4o interface to generate responses to 20 frequently searched questions about pediatric IEI, equally distributed between healthcare professional (n = 10) and patient/caregiver queries (n = 10). Three pediatric allergy-immunology specialists independently evaluated response quality using the modified DISCERN (mDISCERN) and Global Quality Scale (GQS) tools, supplemented by a structured expert-based assessment of misinformation, safety-related concerns, suspected factual issues, missing disclaimers, and clinically meaningful inter-iteration inconsistency. Text readability was assessed using four validated indices (ARI, FRES, FKGL, GFR), comprehensibility using the Patient Education Materials Assessment Tool (PEMAT), and reproducibility using natural language processing methods. Results: ChatGPT-4o demonstrated strong overall performance, with median mDISCERN and GQS scores of 4 (IQR: 3-5) for both query types. Readability scores substantially exceeded recommended thresholds, with FKGL scores of 12.96 ± 0.69 and 10.83 ± 0.67 for professional and patient/caregiver queries, respectively. Mean PEMAT understandability scores were 71.80 ± 5.75% for professional queries and 80.80 ± 4.73% for patient/caregiver queries (p = 0.001). Reproducibility was high, with semantic similarity rates of 86.10 ± 3.84% and 87.30 ± 3.68%, respectively. Suspected factual issues were identified in 4 of 20 responses (20%), safety-related concerns in 3 (15%), clinically meaningful inter-iteration inconsistencies in 3 (15%), and missing medical disclaimers in all 20 responses (100%). Conclusions: ChatGPT-4o showed strong performance across validated quality metrics for pediatric IEI information support; however, its high reading level, universal absence of medical disclaimers, and occasional clinically meaningful inconsistencies limit its suitability as a standalone source for clinically sensitive guidance. These findings underscore the need for AI-driven patient education tools with improved readability, adaptive complexity adjustment, and safety-oriented communication.

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:Montelukast is a leukotriene receptor antagonist commonly used in allergic diseases. In this study, we investigated the frequency, severity and risk factors for neuropsychiatric side effects and sleep disorders associated with montelukast in children. METHOD:Children aged 6 months to 17 years prescribed montelukast for allergic rhinitis or asthma at 31 Paediatric Allergy and Immunology centres were enrolled in this cohort study. At enrollment, sociodemographic characteristics, prior diagnoses of neuropsychiatric diseases or sleep disorders, and indications for montelukast treatment were recorded, and the primary caregivers completed a baseline questionnaire about neuropsychiatric symptoms (insomnia, nightmares and depressed mood) of their children. All participants were followed up for 1 month, and a post-treatment follow-up questionnaire on neuropsychiatric symptoms was completed at the end of this period. Moreover, caregivers were instructed to contact the clinic if neuropsychiatric side effects or sleep disorders were observed during this period. RESULTS:Total of 1163 children were enrolled. There was a significant increase in the frequency of insomnia, nightmares, night terrors, drowsiness, behavioural problems, irritability, depressive mood, agitation, anxiety, hyperactivity, learning difficulties and headache during the 1 month period after montelukast treatment compared to the previous 1 month (p < 0.001 for all). Overall, caregiver reports of neuropsychiatric symptoms in children increased from 172 (14.8%) to 399 (34.3%) after 1 month of montelukast treatment (p < 0.001). CONCLUSIONS:Montelukast treatment increases the risk of neuropsychiatric symptoms and sleep disorders in children with allergic diseases, especially if there is concomitant use of antihistamines.

Summary:Background. Atopic dermatitis is a chronic disease that affects patient and parents life worsely. What time will the patient go into remission is not known. Therefore, clinical and laboratory indicators that can indicate remission are needed. Materials and Methods. The study was conducted in İzmir Health Sciences University, Tepecik Training and Research Hospital. The clinical and laboratory data of patients between January 2014 and December 2019 were scanned from the patient records and the hospital data system. Results. 102 patients with a median age of 8 (min 2- max 24) months were included in the study. The median age of onset of the symptoms was 3 (min 1-max 21) months. The patients most frequently (85.2%) presented with eczema and lesions were most common (60.7%) in the extremities. Most of the patients (56.9%) had mild dermatitis. In the 6th month, 26.5% who continued follow-up had clinical improvement. Food allergy was present in 33.3% of the patients. The most common food allergen was egg (52.9%). Food allergy was associated with the severity of atopic dermatitis (p = 0.033), and the symptoms started earlier (p = 0.002). There is no relationship between the severity of atopic dermatitis and gender, family history, presence of additional atopic disease, response to treatment, total IgE and eosinophil count (p > 0.05); however, it was determined that the symptoms started earlier in patients with moderate/severe atopic dermatitis (p = 0.002). Conclusions. Food allergy is more common in the early-onset and moderate/severe atopic dermatitis. Accurate diagnosis of food allergy is necessary to increase the success of treatment and to prevent unnecessary diets.

Abstract Objectives The aim of this study was to examine the self-efficacy and healthy lifestyle behavior levels in adolescents with asthma. Materials and methods Socio-demographic questionnaire form, questions about adherence to asthma medication, asthma control test, healthy lifestyle behaviors scale, and self-efficacy scale for children and adolescents with asthma were administered to 150 patients whom age range between 12–18, in follow up with asthma in the pediatric allergy outpatient clinic. Results There was no statistically significant relationship between healthy lifestyle behaviors scale and self-efficacy scale scores between adolescents with controlled and uncontrolled asthma. When patients were grouped regarding the treatment compliance, both healthy lifestyle behaviors scale and asthma self-efficacy scale scores were found to be higher in patients with treatment compliance. When the patients were grouped on the basis of gender, regular follow-up visits, and smoking, there was no significant difference between healthy lifestyle behaviors and self-efficacy scale scores. Conclusions The findings showed us the importance of the relationship between healthy living and adolescent self-efficacy in adherence to treatment, while there are many more components in asthma control.

Objective: The restrictions imposed by the coronavirus disease 2019 (COVID-19) pandemic have caused significant changes in people's lives. This study aimed to investigate anxiety levels and changes in health and hygiene behaviors in mothers of children with asthma in early COVID-19 lockdown in Turkey.Materials and Methods: This study was a cross-sectional survey conducted on children with asthma, 6 to 11 years of age, between June 1 and 30, 2020, in Turkey. A sociodemographic data form, health and hygiene behavior form, childhood asthma control test, and state-trait anxiety inventory were administered to the mothers of the children.Results: The asthma group included 123 children (Female: 39.0%) and median age, interquartile range (IQR) [minimum-maximum]: 8.0 (6) [6-12] years; the control group included 88 children (Female: 47.7%) median age, IQR [minimum-maximum]: 8.0 (7) [5-12] years. Increased hygiene behaviors and high compliance with social isolation measures were recorded in the early lockdown, with no difference between the groups. Before the pandemic, the most frequently used cleaning products were general-purpose cleaners. During the early lockdown, however, the most frequently used product was disinfectants and was similar in both groups.In both groups, the rate of using nutritional supplements increased during the pandemic period, but the rate was higher in children with asthma both before and during the early lockdown (P < 0.001). The anxiety levels of the mothers in asthma and control groups were similar.Conclusion: This study is the first in Turkey demonstrating that, in mothers of children with asthma, lifestyle changes related to health and hygiene and anxiety levels are similar to those of other children and their mothers during the early lockdown period of COVID-19 pandemic.

Objective: Infantile colic (IC) is crying spells that begin in the first three months after birth, last longer than three weeks and occur at least three days a week. In this study, it was aimed to examine the use of alternative and complementary medicine applications for treating IC and the factors affecting the chosen method.Materials and Methods: Infants were questioned for the diagnosis of IC using the "IC diagnostic criteria" defined in Rome IV. A total of 113 patients were included in the study. Demographic data, medication or (use of complementary and alternative drugs for IC, methods used and treatment responses) were asked by parents of infants with IC. The obtained data were analyzed statistically.Results: It was found that 91.2% of the patients used at least one of the complementary and alternative medicine methods. It was found that those with a high level of education used hot application, hairdryer, car driving, and evil eye beads more (p<0.05), those with higher income levels used hot application, hairdryer and prayer more (p<0.05).Conclusion: The education and income level of the family affect the alternative and complementary medicine methods used in IC. Evidence-based studies are needed on this subject.

Twenty-four normal right-handed male subjects classified hierarchical visual stimuli (small letters arranged to form larger letters), which were presented separately to each cerebral hemisphere. Previous studies using similar paradigms have yielded mixed evidence for the specialization of local, analytic processing in the left hemisphere and global, holistic processing in the right hemisphere. No statistically significant evidence for such a pattern of specialization was evident in the results of the present study. However, when meta-analytic techniques were used to combine the present results with those from previous studies, there was evidence that the hypothesized left-hemisphere/local, right-hemisphere/global specialization does in fact exist.

Objective: Allergic rhinitis and allergic asthma are the most common chronic diseases in children. Allergen immunotherapy has also been shown to improve symptoms and medication scores in patients with allergic rhinitis and/or asthma. In our study, it was aimed to evaluate the patients who have completed allergen immunotherapy in terms of clinical improvement and new allergic sensitizations in the skin prick test. Materials and Methods: Patients who received allergen immunotherapy between 1999 and 2018 were included in the study. Age, sex, diagnosis, medications, sensitizations in the first skin test, immunoglobulin E level, eosinophil count, allergen immunotherapy content and duration, and time after the end of immunotherapy were recorded from patient files. It was asked from the patients to compare their clinical findings before and after allergen immunotherapy as the same, better, or worse. Skin prick tests were performed with inhalant allergens in all patients. Results: A total of 154 patients were included in the study, 68 of whom were subcutaneous and 86 were sublingual immunotherapy. Age, sex, disease severity, immunoglobulin E levels, and eosinophil counts of patients were similar in the subcutaneous and sublingual immunotherapy groups. In the subcutaneous immunotherapy group, self-reported clinical improvement for allergic rhinitis and asthma were 53.3% and 60.4%, respectively. In the sublingual immunotherapy group, self-reported clinical improvement for allergic rhinitis and asthma were 61.9% and 61.6%, respectively. New sensitization in the subcutaneous immunotherapy group was 12.1% and it was 3.5% in the sublingual immunotherapy group. Conclusion: More than half of our patients who received immunotherapy reported clinical improvement according to self-report. In the subcutaneous immunotherapy group, new sensitizations were higher than the sublingual immunotherapy group, but it was thought that longer follow-up time in the subcutaneous immunotherapy group may have also contributed to this result.

Aim: Bronchial asthma and allergic rhinitis are mediated by similar allergic inflammatory mechanisms. Platelets play a role in allergic reactions which are inflammatory processes. The mean platelet volume (MPV) is a marker of platelet activation. This study aimed to investigate MPV value differences between children with allergic rhinitis during symptomatic or asymptomatic periods to determine whether MPV is a useful indicator of inflammation in allergic rhinitis. Materials and Methods: The records of those patients with allergic rhinitis were analyzed retrospectively. Patients over two years of age who had complete blood count results from both their asymptomatic and the symptomatic periods were included in this study. Clinical characteristics (age, age at diagnosis, symptoms, and comorbid allergic diseases) and laboratory data (thrombocyte count, MPV, white blood cell count, eosinophil count, and percentage, immunoglobulin E level, and skin prick test results) were recorded from the patient files and the hospital registry system. Results: MPV values during the symptomatic periods were statistically significantly higher than those from the asymptomatic period (p<0.001) in all patients. When the patients were grouped according to having asthma or not, MPV was found to be higher in the symptomatic period compared to the asymptomatic period in the group with asthma, but there was no difference between these two periods in the group without asthma (p=0.017, p=0.102 respectively). Additionally, MPV levels were significantly higher in the asthma group during both the symptomatic and the asymptomatic periods (p=0.04, p=0.013, respectively). Conclusion: This study suggests that MPV cannot be used as an inflammation indicator in the symptomatic period for patients with allergic rhinitis. Asthma influences MPV values. It is recommended to conduct more detailed and prospective studies to show MPV inflammation in AR.

BACKGROUND:Atopic dermatitis (AD) is a chronic inflammatory skin disease. A third of pediatric AD patients have also food allergy. Although food challenge test is gold standard test for the diagnosis of food allergies, they should be administered by experienced physicians, considering that the test is time-consuming and carries some risks. Documentation of the efficacies of specific IgE (sIgE), skin prick test (SPT), and atopy patch test (APT) are important for determining the necessity of oral food challenge tests(OFC).METHODS:Fifty-three AD patients with suspected cow's milk allergy (CMA) were included in our study. Diet-related questions were asked to the patients. Blood samples were taken for measurement of total blood count, total IgE, and milk sIgE. OFC, SPT, and APT were performed using pasteurized cow milk.RESULTS:The mean age of the study population was 1.4±0.8 years, and the male:female ratio was 1.12. Cow milk allergy was detected in 45.3% of the patients after OFC. A comparison between CMA(+) and CMA(-) patients revealed no significant difference in sIgE positivity (P=0.940), but there was a significant difference in SPT (P=0.000) and APT (P=0.001) positivity. When our study group was divided into immediate reaction, delayed onset reaction, and not reactive subgroups after OFC, efficacy of SPT was more prominent in immediate reaction subgroup while APT was more efficient in delayed reaction subgroup.CONCLUSIONS:Our study showed that using SPT test with APT test in allergic reactions with IgE and other mechanisms such as AD will increase the diagnostic yield, thereby reducing the need for OFC.

Chronic urticaria (CU) is a rare disease in childhood, and studies in children are limited. In this study, the aim was to investigate the clinical and laboratory findings and demographic characteristics of children with CU and to determine the factors affecting prognosis. The study included 141 patients aged 0-18 years who were diagnosed with CU in the pediatric allergy outpatient clinic between January 1, 2013, and December 31, 2018. Risk factors related to prognosis were investigated by comparing the duration of CU and treatment response with clinical and etiological features. IBM SPSS version 24 was used for statistical analyses. In the study group, the female/male ratio was 69/55, and the median age at first visit was 9.5 years (min:1, max:17). Among patients, 63 (44.5%) had an accompanying atopic disease, and 23 (16.3%) had chronic disease. Of the patients, 124 (88%) had chronic spontaneous urticaria, and 17 patients (12%) had chronic inducible urticaria (CIU). Of those with CIU, 72.2% had symptomatic dermographism, 16.7% had cholinergic urticaria, and 11.1% had cold urticaria. After the evaluations, the most common pathological findings in our patients were intestinal parasitosis (n = 14), anemia (n = 10), and urinary tract infection (n = 8). The median total duration of urticaria was 47 weeks (min:8, max:284). The duration of urticaria was longer in patients with atopy (p < 0.05), and the group that went into remission with standard-dose antihistamine was the group with highest eosinophil count (p = 0.022). In most children with CU, the underlying cause/disease cannot be determined. In our study, treatable triggers were found in some of the patients. Therefore, it is appropriate for each patient to be evaluated with selected laboratory tests after detailed history and physical examination.

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.

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.

Vascular rings are congenital anomalies of the aortic arch that can cause compression of the trachea and/or esophagus. The compression of the trachea can cause stridor, recurrent respiratory infections, chronic cough/ wheezing, the compression of the esophagus can cause dysphagia, feeding difficulties and/or vomiting. Bronchiectasis is a structural disorder that progresses with bronchial dilatation and distortion and causes chronic lung disease. While the most common causes of bronchiectasis are cystic fibrosis and lung infections, congenital anomalies are rare. A 17-year-old girl admitted with a complaint of persistent cough with sputum. It was learned that the patient had recurrent lung infections since infancy. Computed tomography of thorax revealed that bronchiectasis is at upper and middle lobes of the right lung and lower lobe of the left lung and the aberrant subclavian artery the right in the posterior of the esophagus and the trachea. The diagnostic investigations, which for the other causes of bronchiectasis, were normal and, she was operated for a vascular ring. The patient is presented as interesting because it has a congenital anomaly, which is a rare cause of bronchiectasis and is diagnosed in the adolescent period.

1 Clinic of Pediatric Allergy and Immunology, SBU İzmir Tepecik Training and Research Hospital, İzmir, Turkey 2 Division of Pediatric Infectious Diseases, SBU İzmir Tepecik Training and Research Hospital, İzmir, Turkey 3 Division of Pediatric Allergy and Immunology, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey 4 Division of Pediatric Infectious Diseases, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey DOI: 10.5578/ced.20219714 • J Pediatr Inf 2021;15(3):e127-e132 Original Investigation / Özgün Araştırma

Objective The aim of this study was to investigate the peer victimization and anger expression in adolescents with asthma. The relationship between asthma control and psychological features was also examined.Methods The study was a cross-sectional study with a healthy control group. The sample of the study was composed of 61 adolescents who were previously diagnosed by a physician with asthma of various intensities. Sixty adolescents with no chronic disorders were enrolled as the control group. Peer victimization was examined using the Multidimensional Peer Victimization Scale (MPVS). The State-Trait Anger Expression Inventory (STAXI) was used to assess anger expression styles. Emotional and behavioral symptoms of the adolescents were measured using the Strengths and Difficulties Questionnaire (SDQ).Results Adolescents with asthma reported more peer victimization in the subscales of physical, social, verbal, attacks on property, and frightening in the MPVS; and having more problems in emotional, social, and peer relations areas in the SDQ (p < .001 for all subscales) compared to the control group. The results were similar between the groups regarding the conduct problems and hyperactive behaviors. The adolescents with asthma reported more anger repression and less anger expression than the control group (p < .001 for both subscales).Conclusions The results indicated that the adolescents with asthma were subjected to more peer victimization and experienced more difficulties in anger expression than the controls. Based on the findings of this study, we suggest that these psychological factors should be kept in mind during the management of asthma in adolescents.