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Özdemir Ö. An asthmatic child with allergic bronchopulmonary aspergillosis (ABPA). Turk J Pediatr 2018; 60: 446-452. Allergic bronchopulmonary aspergillosis (ABPA) results from a TH2 hypersensitivity lung disease in response to bronchial colonization of Aspergillus fumigatus in the respiratory tract. ABPA is a very rare disease in the pediatric population; the prevalence is anticipated to be about 1-2% in adult asthma patients and 2-15% in cystic fibrosis patients. In pediatric asthma patients, only rare case reports on ABPA have been published. We present a case of a 12-year-old boy admitted to our hospital with worsening (mild persistent) asthma symptoms such as a recurrent cough, episodic wheezing, and dyspnea for the last two years. He was diagnosed with pneumonia several times and suspected of having tuberculosis during this time. Chest X-ray showed bilaterally perihilar opacities and computed tomography findings revealed central bronchiectasis. With the clinical and laboratory findings, the patient fulfilled 7/8 major diagnostic criteria for ABPA. Treatment with oral corticosteroids and itraconazole was effective. To the best of our knowledge, this is the first reported case of pediatric ABPA with previously documented asthma from Turkey.

Aim: This study aimed to determine the knowledge, attitude, and behavior of family physicians working in family health centers in Sakarya province related to childhood asthma. Material and Methods: One hundred seventy-two physicians participated in this study, which was conducted as a survey. The questionnaire included 46 questions that measured the attitude and behavior, sociodemo-graphic characteristics, professional practices, theoretical/clinical knowledge of the family physicians. Results: A total of 172 physicians including 144 certificated general practitioners, 7 family medicine specialists, and 21 contracted family medicine residents were enrolled in the study. Less than half (44.2%) of the participants agreed that family physicians could make a diagnosis of asthma, 61.6% agreed that family physicians could follow up and maintain treatment, and 86% agreed that family physicians could give treatment in cases of mild asthma attack. Some 44.6% of the physicians stated that they always/frequently referred patients with asthma, 92% stated that they always/ frequently interrogated if the disease was under control, and 79.7% stated that they always/frequently reminded their patients about triggers and the use of inhaler drugs. The mean number of correct answers was 6.23±1.56 for 10 theoretical questions and 10.33±1.90 for 16 clinical questions. It was observed that age, sex, district of work place, time since graduation, repre-santative visits, and the frequency of prescriptions were the charcatristics of family physicians that caused significant changes in attitute and behavior. Being a specialist or residents, working in a central district, and absence of poster/brochure in family health center were found to be factors that affected success in questions related to clinical cases. It was observed that general practitioner family physicians interrogated the control status more frequently than specialists and residents, reminded their patients with asthma about triggers and inhaler drug use with a higher rate and exhibited a positive attitude in terms of giving treatment for asthma attacks. Conclusion: In this study, a deficiency was observed in terms of basic information related to asthma and in terms of practical applications. It was observed that family physicians' attitudes about asthma did not always coincided with their behaviors. No significant correlation was found when the relations of attitude, behavior, and knowledge level were evaluated between themselves. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a major cause of absenteeism in schoolage children. Studies have shown that teachers' knowledge of asthma reduces school attendance rates. Collaboration between patients, physicians, family and teachers is an important factor in the success of treatment and decrease in the frequency of attacks in asthma patients. In order for teachers to take a more active role in this cooperation, their knowledge levels should be increased by providing trainings on childhood asthma. The aim of this study was to evaluate the knowledge levels of elementary (primary and secondary) and high school teachers working in İstanbul regarding childhood asthma. Methods: This questionnaire was conducted between June and December 2012 with the participation of 825 teachers working in 22 randomly selected schools. The questionnaire was given to the teachers participating in the study, which questioned the general information, symptoms, triggering factors of asthma crisis, emergency intervention and treatment information about childhood asthma. Results: In our study, the level of general knowledge about childhood asthma was found to be the highest and the level of knowledge about asthma triggering factors was the lowest. Regarding gender, the mean scores of the female teachers about asthma were significantly higher than male teachers. The total asthma awareness scores of the teachers working in public schools were found to be significantly lower than the teachers working in private schools (p=0.001). Having asthma experience was found to cause a significant increase in childhood asthma knowledge scores of teachers (p=0.001). When the comparison was made according to the expertise in teaching, experienced teachers had more knowledge about asthma triggering factors, whereas the teachers with less professional experience were more knowledgeable about the emergency intervention in asthma attack (p=0.016). Conclusion: Our study will contribute to the national asthma control program. We believe that informing teachers about asthma is important in asthma control and will contribute to the guidelines for training programs. [ABSTRACT FROM AUTHOR]

Biological therapy (biotherapy) performed using biological response modifiers is sometimes utilized to manage allergic disorders. Here, biological agents modifying Th2 type response dominant diseases e.g. allergic rhinitis are discussed under the light of current literature. Seventy-88% of asthmatic patients have sinonasal symptoms and chronic rhinosinusitis patients with nasal polyposis are more likely to develop concomitant asthma. Due to common pathophysiology of allergic asthma and sinonasal diseases, it is supposed that patients concurrently suffering from both diseases relieve from their symptoms with omalizumab. Like the beneficial effects of omalizumab as add-on treatment in uncontrolled persistent asthma, omalizumab has been shown to improve symptoms and quality of life in patients with ragweedand birch-induced seasonal and perennial allergic rhinitis. The use of anti-IgE (omalizumab) in asthma management has also some advantages, comprising simultaneous treatment of other IgE-mediated disorders such as allergic rhinitis, an superior safety profile and an easily applicable dosing. Nasal polyp patients have mucosal eosinophilia because of significantly increased levels of IgE antibodies and with significantly increased IL-5 tissue expression. High IL-5 level was recently found to be associated with Staphylococcus aureus enterotoxins rather than atopy have provoked researchers to investigate the clinical role of IL-5-blocking strategies. Consequently, mepolizumab and reslizumab have been tried in nasal polyp patients for proof-of-concept studies. The anti-IL-5 monoclonal antibodies reduced nasal polyp scores, but did not considerably improve nasal symptom scores. Due to the important role of IL-4 and IL-13 in the pathogenesis of eosinophilic nasal polyposis, dupilumab was tried as a possible therapeutic agent as well. [ABSTRACT FROM AUTHOR]

The prevalence of allergic diseases including atopic dermatitis has increased over the last few decades. Atopic dermatitis is a widespread allergic disease and the first step of allergic march, for which there is presently no known treatment. Under the recent literature data, use of probiotics in early life beginning from pregnancy is thought to be an effective method and appears to be a hopeful tactic for prevention, but very little is known about its long-term preventive effect. Here, our aim is to give an outline of the results from these prevention/treatment studies and to discuss current approaches. Probiotics are universally described as "live microorganisms that, when administered in adequate amounts, confer a health benefit on the host" by the World Health Organization. In most studies, single strains or a mixture of strains of lactic acid bacteria and bifidobacteria was used prenatally, postnatally, or perinatally. Several meta-analyses have shown a moderate benefit of probiotics for eczema prevention, and the most reliable effect has been observed with a combined perinatal (prenatally + postnatally) administration in infants at high risk of allergic disease by heredity. In addition, use of multi-strain (mixture of different bacterial species or of Lactobacillus species) probiotics appeared to be most effective for eczema prevention. Probiotics also could be an option in eczema therapy, especially for moderate to severe eczema in children and adults. No preventive and therapeutic effect has been shown for other allergic disorders. To date, expert bodies do not generally propose probiotics for allergy prevention, although the World Allergy Organization suggests considering using probiotics in pregnant women, during breastfeeding, and/or to the infant if at high risk of developing allergic disease. [ABSTRACT FROM AUTHOR]

Vitamin D is a steroid hormone that has important effects on bone metabolism and neuromuscular functions. Recent research has indicated that it also has a role in the development and treatment of allergic diseases by affecting the immune system through different mechanisms. After vitamin D is activated by liver and kidney in the body, it shows its effect by attaching to its receptor on the cell membrane. The vitamin D receptor is expressed on all tissue cells, particularly on those of the respiratory and intestinal epithelium by which extra-skeletal functions of vitamin D such as anti-inflammatory effects and immunomodulation are mediated. As a consequence, it is assumed that vitamin D and its receptor have effects on various systems in the human body. Some researchers suggest that deficiency or excess of vitamin D in the diet causes an increase in asthma and allergic diseases. Therefore, vitamin D supplementation is currently advised by some authors for the prevention and treatment of allergic diseases. It has commonly been reported that vitamin D is particularly found to be useful in preventing asthma attack and in managing resistant asthma. Currently, there has been an increase in the literature regarding the role of vitamin D in the treatment of atopic dermatitis and chronic urticaria-angioedema. [ABSTRACT FROM AUTHOR]

Pandemic influenza virus (H1N1) has a higher attack rate than seasonal influenza virus and is more contagious than seasonal influenza infection. H1N1 infection might cause more severe disease leading to death, if patients have a debilitating chronic disease such as asthma or are pregnant, elderly, and younger than 5 years. The case of a 12-year-old asthmatic patient with pneumonia and convulsion secondary to H1N1 infection during her asthma attack is presented. The 12-year-old asthmatic patient presented with one-month history of coughing and dyspnea. When she was admitted, her fever was 36.5°C, respiratory rate was 42/minute, blood pressure was 105/54 mmHg, pulse was 154/minute, and oxygen saturation was 96%. Her physical examination revealed rhonchi and crackles on her lung. When her asthma attack improved at the day 3 after admission, she began to experience fever, fatigue, anorexia, and myalgia. She then had diarrhea and vomiting. Laboratory test results revealed anemia (Hemoglobin: 10.7g/dL), leucopenia (3.470) and thrombocytopenia (137,000). She had a C reaktif protein (CRP) level of 81, Sedimentasyon (ESR) of 89 mm, Aspartat aminotransferaz (AST) level of 430 U and Alanin transaminaz (ALT) level of 320 U. Her chest X-ray demonstrated bilateral consolidations at the lung bases. Cefuroxime was replaced with meropenem, azithromycin, and vancomycin when her fever did not resolve. During this febrile episode, she had an afebrile tonic-clonic convulsion. Lumbar puncture and magnetic resonance imaging (MRI) revealed normal findings. Her fever and symptoms were thought to be due to H1N1 infection, and oseltamivir was started; her fever resolved next day. On the 10th day after her admission, H1N1 was detected in her nasopharyngeal swab. When an asthmatic patient has an unknown origin of fever that leads to pneumonia and convulsion, pandemic influenza infection should be kept in mind. [ABSTRACT FROM AUTHOR]

The increased prevalence of atopic/autoimmune diseases is nowadays defined as an endemic. Recent epidemiologic data showed that children with allergic/autoimmune disease have a different intestinal flora from healthy ones. Therefore, regulation of intestinal microflora composition by probiotics offers the possibility to influence the development of autoimmune/atopic diseases. And probiotics have been reported as capable preventive and therapeutic strategy in allergic/autoimmune diseases. The aim is to summarize/evaluate the available knowledge of probiotic use from randomized/nonrandomized controlled clinical trials, apart from reviews and meta-analyses. Those clinical trials involving studies of atopic/autoimmune disease indicated that not all patients receiving the probiotic agent benefited. But subsets of these patients, such as those with IgE-associated eczema and ulcerative colitis, seemed to have benefited the most. There is inadequate but quite promising evidence in the literature to recommend the addition of probiotics to foods. Nonetheless, probiotics still cannot be generally recommended for prevention/treatment of allergic/autoimmune diseases. [ABSTRACT FROM PUBLISHER]

Development of the child's immune system tends to be directed toward a T-helper 2 (Th2) phenotype in infants. To prevent development of childhood allergic/atopic diseases, immature Th2-dominant neonatal responses must undergo environment-driven maturation via microbial contact in the early postnatal period. Lactic acid bacteria and bifidobacteria are found more commonly in the composition of the intestinal flora of nonallergic children. Epidemiological data also showed that atopic children have a different intestinal flora from healthy children. Probiotics are ingested live health-promoting microbes that can modify intestinal microbial populations in a way that benefits the host; and enhanced presence of probiotic bacteria in the intestinal microbiota is found to correlate with protection against atopy. There is insufficient but very promising evidence to recommend the addition of probiotics to foods for prevention and treatment of allergic diseases, especially atopic dermatitis. Clinical improvement especially in allergic rhinitis and IgE-sensitized (atopic) eczema has been reported too. Literature data for food allergy/hypersensitivity and asthma are not adequate for this guaranteed conclusion; however, clinical benefit of probiotic therapy depends on numerous factors, such as type of bacterium, dosing regimen, delivery method, and other underlying host factors, e.g., the age and diet of the host. The selection of the most beneficial probiotic strain, the dose, and the timing of supplementation still need to be determined. Accordingly, probiotics can not be recommended generally for primary prevention of atopic disease; and if probiotics are used in atopic infants/children for any reason, such as therapy or prevention, cautionary approach ought to be taken. [ABSTRACT FROM AUTHOR]