The use of epinephrine auto-injectors is life-saving in serious allergic reactions such as out-ofhospital anaphylaxis. However, several factors limit their use, including patients not obtaining their prescriptions, the difficulty of carrying auto-injectors, and fear of injection. Administering epinephrine as early as possible to a patient experiencing anaphylaxis significantly reduces mortality and morbidity. Many experts are therefore interested in developing life-saving medical treatments in forms that are easier to access and apply. Nasal epinephrine consists of 3 components: epinephrine, a unit-dose spray, and İntravair. This spray was developed in collaboration with both the Food and Drug Administration and the European Medicines Agency. In addition to its ease of use, nasal epinephrine has shown favorable pharmacokinetic and pharmacodynamic (PD) responses for various symptoms, including allergic and infectious rhinitis. Notably, it has been found that nasal epinephrine provides a better PD response than injections; the increase in heart rate and blood pressure within 1 minute of administration confirms receptor activation in this drug’s mechanism of action. These findings indicate that nasal epinephrine could be a choice for the treatment of serious allergic reactions, including anaphylaxis, and could be safe and effective. Cite this article as: Bozkurt HB, Pen.e İ. Evaluating the use of nasal epinephrine in anaphylaxis: Current status. Turk Arch Pediatr. 2025;60(6):572-576.

ObjectiveMaternal micronutrient status in early pregnancy may influence fetal growth and neurodevelopment. Vitamin D, vitamin B12, and iron deficiencies are common, but their associations with perinatal outcomes and later childhood development remain unclear. This study evaluated first-trimester maternal vitamin D, vitamin B12, and ferritin levels in relation to maternal, fetal, neonatal, and early neurodevelopmental outcomes at age ≥4 years.Study DesignThis ambispective cohort included 726 singleton pregnancies with at least one first-trimester serum 25-hydroxyvitamin D, vitamin B12, or ferritin measurement. Maternal, fetal, and neonatal outcomes were retrieved from electronic records, and 217 offspring underwent Denver II assessment at age ≥4 years. Micronutrient levels were classified using predefined thresholds, and multivariable regression assessed independent associations after adjustment for potential confounders.ResultsMaternal micronutrient status was not significantly associated with maternal complications. Vitamin D and vitamin B12 sufficiency were associated with higher birth weight (3331.2 ± 483.7 vs. 3194.5 ± 521.9 g, p = 0.034; and 3265.2 ± 557.2 vs. 3141.8 ± 551.3 g, p = 0.015, respectively), whereas vitamin D deficiency was associated with a higher small-for-gestational-age rate (10.3% vs. 2.5%, p = 0.027). These associations remained significant after multivariable adjustment. Low maternal vitamin B12 was independently associated with modest delays in head control and independent sitting, although milestone ages remained within normal ranges.ConclusionsFirst-trimester maternal micronutrient status may influence fetal growth and selected early motor milestones; however, developmental differences were modest and not reflected in neurodevelopmental screening. Larger prospective studies are needed to clarify long-term clinical significance.

Background/Objectives: Ferritin and soluble interleukin-2 receptor α (sIL-2Rα) are HLH-related biomarkers, but their comparative discrimination in pediatric critical illness is uncertain. We primarily compared their discrimination for adjudicated HLH in hyperferritinemic PICU children and secondarily assessed PICU mortality. Methods: This prospective single-center study enrolled 75 children aged 1 month–18 years with ferritin ≥500 ng/mL: 25 each with HLH, sepsis/septic shock, or other diseases. Both biomarkers were measured from the same admission sample. Research-use sIL-2Rα was reported in ng/mL without cross-calibration to the HLH-2004 U/mL scale; adjudicators were blinded to sIL-2Rα, whereas ferritin informed the reference process. Analyses used ROC, Firth regression, targeted post hoc paired AUC tests with Holm adjustment, bootstrap optimism correction, and cross-validation. Results: For adjudicated HLH, ferritin showed greater discrimination than sIL-2Rα (AUC, 0.898 vs. 0.690; ΔAUC, 0.208; Holm-adjusted p = 0.019). The exploratory 1614-ng/mL ferritin cutoff had 92% sensitivity and 76% specificity. Although sIL-2Rα remained associated with HLH after ferritin adjustment (OR, 1.089 per ng/mL; p = 0.002), adding it did not significantly improve discrimination beyond ferritin (p = 0.663). For secondary mortality, ferritin showed greater discrimination than sIL-2Rα (AUC, 0.754 vs. 0.495; Holm-adjusted p = 0.019). Adding ferritin to PRISM III increased the apparent AUC from 0.725 to 0.811, but the comparison was not statistically significant (p = 0.105); the bootstrap optimism-corrected AUC was 0.800. Conclusions: In this hyperferritinemic PICU cohort, ferritin showed greater discrimination for adjudicated HLH than the studied sIL-2Rα assay, and adding sIL-2Rα did not significantly improve discrimination. Findings should be interpreted in the context of the studied assay and reference process. The exploratory mortality model requires external validation.