Introduction: Beta-lactam antibiotics (BLAs) commonly cause hypersensitivity reactions in children. These reactions are categorized into immediate reactions, which include urticaria, angioedema, bronchospasm, and anaphylaxis, and non-immediate reactions, such as maculopapular rashes and delayed-onset urticaria/angioedema. Rashes in children, often caused by infections, may be misdiagnosed as BLA allergy. However, over 90% tolerate the medication following an allergic evaluation. Methods: We aimed to evaluate patients with negative single-day drug provocation test (sdDPT) results for subsequent reactions and to determine the negative predictive value (NPV) of sdDPT for immediate (less than 1 h) and non-immediate (more than 1 h) suspected BLA allergy. In addition, non-immediate reactions were assessed by classifying them as occurring within 1–6 h or after 6 h. Patients who underwent sdDPT for suspected BLA allergy and tested negative between 2019 and 2023 were included in the study. They were questioned via telephone interviews about their reuse of the tested drug. Results: 404 patients who underwent sdDPT for suspected BLA allergy were evaluated. The NPV of BLA sdDPT was determined to be 97.3%. When patients were categorized based on the time interval between the last dose and the reaction, the NPV was 97% for those experiencing a reaction within the first hour of drug use and 96.7% for reactions occurring after more than 1 h. Non-immediate reactions were further evaluated, revealing an NPV of 98.7% for reactions occurring between 1 and 6 h, and 92.5% for reactions occurring after 6 h. Conclusion: Our findings demonstrate that sdDPT has a high NPV for both immediate and non-immediate reactions. However, the NPV of sdDPT was lower for reactions occurring more than 6 h after the last dose.

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.

Introduction: Sesame allergy has been seen with increasing frequency in recent years and is one of the important causes of food anaphylaxis. The aim of our study was to examine the clinical and laboratory features of patients with sesame allergy and to evaluate the characteristics of sesame-related anaphylaxis. Methods: Patients diagnosed with sesame allergy at Ankara Bilkent City Hospital between January 2017 and June 2024 were included in the study. Demographic, clinical, and laboratory data of the patients were obtained from medical records. Results: Sesame allergies were detected in 70 patients during the study period. Of these patients, 44 (62.9%) were male, and the median age at the onset of symptoms was 12 (interquartile range [IQR]: 9–18) months. Thirty-two patients presented with anaphylaxis (45.7%), 31 with urticaria/angioedema (44.3%), and 7 with atopic dermatitis (10%). A total of 59 patients (84.3%) had other food allergies. The most common food allergy was tree nut allergy (54.3%). Sesame-specific IgE levels were higher in patients with anaphylaxis (median 2.8 kU/L IQR: 1.2–17.8) than in those who did not (median 1.6 kU/L IQR: 0.7–4.7). In the multivariate logistic regression model, the presence of a concomitant food allergy (odds ratio: 18.7; CI 1.9–182.6) and being over 1 year of age at the time of the index reaction (odds ratio: 4.1; CI 1.1–15.4) were identified as risk factors for anaphylaxis. Conclusion: Sesame allergy is among the important causes of food allergy and anaphylaxis and generally presents with early-type reactions. It can be seen together with nut and other food allergies.

Background: Liposomal amphotericin B (LAMB) is a crucial agent in the treatment of invasive fungal diseases caused by a wide variety of yeasts and molds. In the presence of an infection caused by a fungal agent resistant to alternative antifungal drugs, desensitization may be the only option to continue treatment. However, there is insufficient information and consensus with regard to amphotericin B desensitization protocols in the pediatric age group. Objective: We present our experience with five cases of patients in whom successful desensitization protocols were applied with LAMB, along with a review of the literature on pediatric cases. We also provide a sample desensitization protocol that we successfully applied. Methods: Pediatric patients who continued their treatment with the successful rapid desensitization protocol conducted at the Paediatric Allergy and Immunology Clinic of the Ministry of Health Ankara City Hospital between September 2019 and September 2023 were examined. Desensitization protocols were applied based on Castells’ desensitization protocol. Results: Five patients ages between 5 and 12 years were referred to us due to the development of anaphylaxis during their treatment with LAMB. Anaphylaxis is diagnosed clinically, according to the European Academy of Allergy and Clinical Immunology guidelines: anaphylaxis (2021 update). A 16-step desensitization protocol was prepared by using LAMB solutions at four different dilutions (0.001, 0.01, 0.1, and 1 mg/mL). Each solution consisted of four steps, with a 15-minute infusion for each step. The patients were premedicated with 1 mg/kg/dose methylprednisolone and an antihistamine. Conclusion: The data we present on the successful application of a sample protocol to five cases, particularly in a pediatric setting, are noteworthy valuable contributions to the field, which demonstrates the feasibility and success of rapid desensitization with LAMB in pediatric patients. This can provide important insights and potentially serve as a reference for medical professionals working with similar cases in the future.