STUDY POPULATION. Data were analyzed from the anaphy-laxis registry of German-speaking countries, which included 197 reported anaphylactic reactions from children and adolescents between 2006 and 2009. This database is based on an online questionnaire for providers of allergy specialty care in Germany, Austria, and Switzerland. METHODS. The questionnaire included demographic data, clinical symptoms, the cause of reaction, accompanying or possible aggravating factors, history of previous reaction , and treatment. To focus on reactions that involved life-threatening symptoms, only children who experienced reactions with at least 1 pulmonary or cardio-vascular symptom were included in the analysis. RESULTS. The most frequently affected organ systems involved in anaphylaxis cases of children and adolescents were the skin (89%) and respiratory tract (87%). Car-diovascular (47%) and gastrointestinal manifestations (43%) were noted less frequently. The most common triggering allergens were foods (58% of cases), followed by insect venoms (24%) and drugs (8%). Peanut was the most frequent food allergen provoking anaphylaxis, followed by tree nuts, cow's milk, and egg. Accompanying or aggravating factors, such as exercise, drug use, coexisting infection, psychological stress, and menses, were noted in 18% of all cases. Only 26% had a history of a previous reaction. Treatment data demonstrated that antihistamines were given 87% of the time and corticosteroids were given 85% of the time, but epi-nephrine was given only 22% of the time. CONCLUSIONS. Use of registry data can provide insight into the features of children presenting with anaphylaxis. Food allergens were the most common triggers for anaphylaxis and possible aggravating factors were noted in nearly 1 in 5 cases, with exercise being the most common. The low frequency of epinephrine administration suggests ongoing need for education for both families and physicians. REVIEWER COMMENTS. This study aimed to characterize children with life-threatening anaphylactic reactions by selecting those with cardiovascular and/or pulmonary involvement. Consistent with other studies, food aller-gens (most commonly peanut) were the most frequent trigger for reaction. The rate of accompanying or aggravating factors suggests that these should be considered in evaluation of all children with anaphylaxis. The low rate of epinephrine use is concerning, especially given that this study focused on more severe reactions, although this is consistent with most other studies of anaphylaxis from around the world. et al. Clin Exp Allergy. 2011;42(2):284-292 PURPOSE OF THE STUDY. To evaluate the rate at which adrenaline autoinjectors are used during anaphylactic reactions by patients who have had them prescribed, and to assess the number of devices used for each reaction. STUDY POPULATION. Participants (N 5 969) were children and teenagers aged 18 years or less who had been prescribed an adrenaline autoinjector for at least 1 year, recruited from 14 pediatric allergy clinics throughout the Unite...

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Symptomatic adrenal insuYciency, presenting as hypoglycaemia or poor weight gain, may occur on withdrawal of corticosteroid treatment but has not previously been reported during inhaled corticosteroid treatment. This case series illustrates the occurence of clinically significant adrenal insuYciency in asthmatic children while patients were on inhaled corticosteroid treatment and the unexpected modes of presentation. General practitioners and paediatricians need to be aware that this unusual but acute serious complication may occur in patients treated with inhaled corticosteroids. (Arch Dis Child 2001;85:330-334)

Knemometry has been used to measure lower leg growth during 32 nine day courses of dexamethasone in 26 babies ranging from 24 to 32 weeks' gestation at birth. Mean leg length velocity was 0-37 mm/day in the 10 days before steroids. Administration of dexamethasone was associated with a decrease in velocity in all babies, and in 15 leg shortening was documented. Mean leg length velocity during steroid treatment was -0 003 mm/day. After the course of dexamethasone was completed there was an immediate increase in leg length velocity to a mean of 0*52 mm/day over the first 10 days then falling to a value similar to the growth velocity observed before treatment. Leg length had reached the value predicted by growth before steroids about 30 days after dexamethasone. The reduction in leg length velocity occurred despite a significant increase in energy intake and decrease in oxygen requirements. (Arch Dis Child 1993; 69: 505-509)

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SUMMARY Simple, incentive based behaviour modification, with or without a modest programme of psychotherapy involving outpatient visits every four to six weeks, seems to be associated with a useful cure rate in children with lower bowel function disorders.Appreciable social disadvantage seems to be the most important factor mitigating against a successful outcome, associated with non-compliance with treatment. Failure to respond to treatment was associated with important psychological problems. These were more common in the socially disadvantaged groups.Children from satisfactory social backgrounds who have lower bowl disturbances can be effectively treated by fairly simple programmes. More elaborate and expensive strategies should be reserved for those whose psychosocial circumstances make it possible to predict a less satisfactory outcome.Faecal soiling with or without faecal retention is a common cause of referral to general paediatric outpatient services and accounts for some 25% of the gastroenterological workload. Primary or secondary referral to child psychiatry services is also considerable. Methods of treatment include pharmacological, 2 behavioural,3 behavioural and medical,4 dietary,6 psychological,7 and surgical.8 The diversity of treatment is a reflection both of the multifactorial nature of the problem and the difficulty encountered in applying recommended management programmes in clinical practice because of the considerable demands they make on valuable outpatient time.The published results of treatment show cure rates of between 45% and 70% and failure rates of between 25% and 35%o, depending on selection of cases, criteria of assessment of outcome, and (possibly) intensity of treatment. In view of the non-fatal and self limiting nature of the problem the issue of cost effectiveness is a major one. A regimen with a high success rate that overwhelms available resources or diverts attention from more serious matters would clearly be unsatisfactory. This study was devised not to find a regimen with an optimal cure rate but to test the effectiveness of fairly modest programmes of behaviour therapy or psychotherapy, or both, that would not seriously tax the resources of busy district paediatric or child psychiatry services. For example, one British study involved weekly or biweekly visits in comparison with the monthly or six weekly visits employed here.We report our experience with 47 children who presented with faecal soiling, with or without constipation, who were treated by incentive based behavioural modification, plus or minus psychotherapy, and consider factors that might predict the outcome for a non-intensive approach. In particular, we wish to draw attention to social background as a prognostic indicator, a factor not previously reported. Material and methods

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