Background: Anaphylaxis is an emergency that must be correctly recognized and treated by every health care professional. With the update of the World Allergy Organization (WAO) criteria in 2020, differences between the European Academy of Allergy and Immunology (EAACI)/The National Institute of Allergy and Infectious Diseases (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) and WAO criteria have come to the fore. Objective: The aim of our study is to compare the effectiveness of these 2 criteria in diagnosing anaphylaxis in pediatric patients. Methods: Patients aged 0-18 years who applied to Ankara Bilkent City Hospital Pediatric Immunology and Allergy Clinic between September 1, 2020 and September 1, 2023 due to systemic allergic reaction and were diagnosed with anaphylaxis were evaluated retrospectively. The clinical findings of the patients were re-evaluated accordingto WAO 2020 and NIAID/FAAN/ EAACI criteria. Results: Included in the study were 492 patients who met the inclusion criteria. Median age was 3.8 years (IQR: 0.9-11.4). The majority of patients were male (59.6%). There were 466 patients (94.1%) diagnosed with anaphylaxis according to both NIAID/FAAN/EAACI and WAO criteria. Three patients (0.6%) with isolated laryngeal involvement and 23 (4.7%) patients with isolated respiratory findings (bronchospasm) were diagnosed only according to WAO Criterion 2, for a total of 26 patients (5.3%). Conclusion: Although the majority of patients were diagnosed with both criteria, 5.3% were diagnosed only according to the WAO criteria. After contact with a suspected or known allergen, the presence of isolated respiratory or laryngeal findings without skin findings should be a warning before anaphylaxis progresses to more serious stages.

Background and Objectives: Childhood asthma represents a significant global public health issue and is the most common chronic disease among children. Hospitalization costs, especially for intensive care, are quite high. This study aimed to evaluate the characteristics, prognosis, and preventable risk factors of patients admitted to the Pediatric Intensive Care Unit (PICU) due to severe asthma exacerbations. Materials and Methods: We assessed patients admitted to the Ankara Bilkent City Hospital PICU from January 2013 to December 2022 diagnosed with asthma based on The Global Initiative for Asthma (GINA) criteria. The collected data encompassed demographic and clinical characteristics, intensive care treatments, hospitalization duration, atopic conditions, and respiratory viral panel results. The current clinical status was assessed using hospital records and caregiver interviews, with a focus on recent emergency admissions, ongoing treatments, exacerbation frequency, and asthma control based on GINA guidelines. Results: The study comprised 83 patients with a mean age of 72.9 (±45.5) months, predominantly male (63.9%). The average follow-up duration post-discharge was 40.7 ± 26.9 months. Patients received respiratory support in the PICU for a mean of 3.8 (±2.8) days and systemic steroid therapy for 4 (±1.5) days. Respiratory viral panel results identified pathogens in 42 patients, with rhinovirus being the most frequent. Post-discharge, 72.3% of patients continued follow-up at pediatric allergy clinics. Of the 60 patients contacted, 67.5% were on current asthma treatment and 48.2% had experienced an exacerbation in the past year. Asthma management steps remained unchanged for 33 patients, decreased for 13, and increased for 47 (44.6%). Asthma maintenance treatments pre-admission and post-discharge showed that 44.6% (n = 47) of the patients required an increase in their GINA treatment step after PICU admission, which was statistically significant (p < 0.001). History of atopic dermatitis was a significant risk factor for escalating treatment steps in both univariate and multivariate analyses (p = 0.018, p = 0.03). Conclusions: We found that admission to the PICU due to severe asthma exacerbation not only increases the risk of recurrent asthma exacerbations but also serves as a risk factor for stepping up maintenance treatment according to GINA guidelines during long-term follow-up.

Introduction: Beta-lactam antibiotics (BLAs) are the most common cause of drug hypersensitivity reactions in children, and it is important to find safe alternative antibiotics for these children. This study evaluates the selection, safety to alternative antibiotics in patients with confirmed BLA allergies based on diagnostic tests. Methods: At the Pediatric Immunology and Allergy Clinic of Ankara Bilkent City Hospital, a retrospective evaluation of diagnostic tests (including skin prick, intradermal, and drug provocation tests) was conducted to identify alternative antibiotics for patients with confirmed BLA. Patients were also contacted by telephone to assess their use of these alternative drugs. Results: The study included 80 patients with confirmed beta-lactam allergy (BLA). The BLAs causing reactions were categorized into two groups: penicillins (75%, n = 60) and cephalosporins (25%, n = 20). Among the penicillins, amoxicillin-clavulanic acid (ACA) was the most common at 68.8%, while among the cephalosporins, ceftriaxone was the most common at 16.3%. Of the 55 patients with ACA allergy, 53 underwent controlled administration with clarithromycin, with 52 showing no reaction. In addition, no reaction was observed in patients who received DPT with cefuroxime (n: 16), phenoxymethyl penicillin (n: 9), cefdinir (n: 1), and cefixime (n: 1), while there was no reaction in the controlled administration with clindamycin. Alternative treatments were tested in 13 patients with a confirmed ceftriaxone allergy. No adverse reactions were observed in 9 patients who underwent DPT with ACA and in 10 patients who were exposed to clarithromycin under controlled conditions. Finally, 54 of the 80 patients (67.5%) were successfully contacted and none reported a reaction to the alternative drugs. Conclusion: For patients with confirmed BLA, macrolides may be considered as preferred alternatives. In addition, beta-lactams with different side chains may be safe alternatives after diagnostic evaluation, taking into account the risk of cross-reactivity.