Background Anaphylaxis, which is rare, has been reported after COVID‐19 vaccination, but its management is not standardized. Method Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre‐vaccination screening and management of allergic reactions to COVID‐19 vaccines, and literature was analysed. Results No death due to anaphylaxis to COVID‐19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1—anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2—anaphylaxis to oral/topical PEG containing products; 3—recurrent anaphylaxis of unknown cause; 4—suspected or confirmed allergy to any mRNA vaccine; and 5—confirmed allergy to PEG or derivatives. We recommend a prick‐to‐prick skin test with the left‐over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. Conclusions These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID‐19 vaccines and enable more people with history of allergy to be vaccinated.

A single dose of intramuscular dexamethasone added to nebulized L-epinephrine, or salbutamol therapies resulted in better outcome measures than bronchodilators alone in the late phase (fifth day) of mild to moderate degree bronchiolitis attack. However, effects of EPI + DEX combination was not different from SAL + DEX combination.

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Background: Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited and spontaneously resolve within days after drug discontinuation, sometime HRs reactions to AEDs can be severe and life threatening. Aim: This paper seeks to show examples on practical management of AEDs HRs in children starting from a review of what it is already known in literature. Results: Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications and genetic factors. The diagnosis work-up consists of in vivo (Intradermal testing and Patch testing) and in vitro tests [serological investigation to exclude the role of viral infection,

Interpretation of tuberculin reactions in revaccinated children is somewhat controversial among paediatricians. In this study, the effect of the number of BCG vaccines on tuberculin reactivity is evaluated. In 2810 healthy children aged 7 to 14 years with purified protein derivative (PPD) testing. Children were grouped according to the concordance of the number of the reported/documented vaccinations to the number of scars. Group 1 and 2 comprised of children 7 to 10 years of age and 11 to 14 years of age respectively, who had non-concordant scar numbers, and Group 3 and 4 included 7 to 10 and 11 to 14 years old children with concordant scar numbers. Mean tuberculin induration sizes were 8.0 +/- 5.7 mm for Group 1, 10.6 +/- 4.9 mm for Group 2, 9.8 +/- 4.9 mm for Group 3 and 10.9 +/- 4 mm for Group 4. As the time interval after the last dose of vaccination increased, mean induration sizes decreased in Group 1 and Group 3. In contrast, the mean reaction sizes of Group 2 and Group 4 showed a positive correlation with the period after the last dose of vaccine. It seems advisable that an induration size > or = 15 mm should not be attributed to BCG vaccination in countries with a high tuberculosis infection prevalence and routine BCG revaccination policies. A detailed investigation for tuberculosis infection and disease should be performed in those cases.

Background: Drug provocation test (DPT) without skin tests is increasingly recommended in the evaluation of children with low-risk beta-lactam (BL) allergies. However, risk definitions are unclear. Objective: The aim of this study was to compose a clinical predictive model that could identify the children at low risk who could safely undergo direct DPT. Methods: The clinical data of 204 children who underwent a full diagnostic algorithm for suspected BL allergy were analyzed. Clinical data were used to construct mathematical predictive model for confirmed BL allergies. A prospective new sample was used for external validation of the final model. Results: The presentations during the index reaction were anaphylaxis in 5.9% and cutaneous reactions in the majority. BL allergy was confirmed in 15.7% of suspected cases. A backward multiple logistic regression model showed that a family history of drug allergy (adjusted odds ratio [aOR], 5.52), anaphylaxis (aOR, 5.14), any atopic disease other than asthma (aOR, 4.38), and a reaction interval of 0‐6 hours during the index reaction (aOR, 5.32) were significantly associated with a confirmed BL allergy. A mathematical combined model based on these factors showed a sensitivity of 77.8% and a negative predictive value (NPV) of 94.3%. The validation study replicated sensitivity and NPV values of the main cohort. Conclusion: The risk definition in BL allergies should depend on population-specific predictive models, including a combination of significant risk factors rather than empiric risk approaches. This may help to accurately determinate children at low risk who may safely proceed to direct DPT.

Glucose-6-phosphatase catalytic subunit 3 (G6PC3) deficiency is a newly described syndrome characterized by severe congenital neutropenia associated with multiple organ abnormalities including cardiac and urogenital malformations. The underlying pathophysiology of increased apoptosis of myeloid cells and of neutrophil dysfunction in G6PC3 deficiency involves disturbed glucose metabolism, increased endoplasmic reticulum stress and deficient protein folding. Here, we report a new case of G6PC3 deficiency caused by a novel homozygous G6PC3 gene mutation p.Trp59Arg. The patient showed pancytopenia and a variable bone marrow phenotype with maturation arrest and vacuolization in myeloid lineage cells and a normocellular marrow, respectively. She also showed persistent lymphopenia with low CD4 T- and CD19 B-cell counts. Lymphopenia and even pancytopenia as well as a variable bone marrow phenotype can be part of this syndrome. These clinical findings in a patient with chronic neutropenia should alert the clinician to consider a diagnosis of G6PC3 deficiency.

Objective: Lower respiratory tract infections (LRTIs) are common in preschool children. Recent evidence suggests that vitamin D (vit D) enhances the production of cathelicidin, which is highly expressed in respiratory epithelium. The aim of the study was to investigate the relation of serum vit D and cathelicidin in preschool children with recurrent LRTIs. Material and Methods: This prospective study included 56 preschool children under 5 years of age with LRTIs and 52 healthy controls. Complete blood count, serum 25(OH)D3, cathelicidin and C-reactive protein levels were measured in all children. Results: The mean serum vit D level of the children with recurrent LRTIs was 24.8 ± 14.4 ng/mL and the healthy group was 25.1 ± 10.7 ng/mL and no significant difference was found between groups (p= 0.922). Vit D deficiency was detected in 15 (13.9%) of all the children participating in the study and vit D insufficiency in 30 (27.8%) subjects. The median serum cathelicidin levels in children with recurrent LRTIs (39.6 ng/ mL) were significantly lower than the healthy group (77.8 ng/mL) (p= 0.004). No significant correlation was found between serum cathelicidin levels and vit D, white blood cell count, absolute neutrophil count and C-reactive protein. The serum cathelicidin levels ≤ 37.3 ng/mL were found to be related to the risk of recurrent LRTIs in preschool children independent of age, gender, body mass index and serum vit D levels (OR: 0.99, 95% CI: 0.98-0.99, p= 0.006). Özet Giriş: Okul öncesi çocuklarda tekrarlayan alt solunum yolu enfeksiyonları (ASYE) sık görülmektedir. Son zamanlardaki bilgiler göstermektedir ki; vitamin D (vit D), solunum yolu epitelinde eksprese olan katelisidin üretimini arttırmaktadır. Bu çalışmanın amacı okul öncesi tekrarlayan ASYE olan çocuklarda serum vit D ve katelisidin ilişkisini araştırmaktır. Gereç ve Yöntemler: Prospektif olan bu çalışmaya tekrarlayan ASYE'si olan 5 yaş altı 56 hasta ve 52 sağlıklı çocuk alınmıştır. Tam kan sayımı, serum 25(OH)D3, katelisidin ve C-reaktif protein düzeyleri tüm çocuklarda ölçülmüştür. Bulgular: Tekrarlayan ASYE'si olan grubun ortalama serum vit D düzeyi 24.8 ± 14.4 ng/mL ve sağlıklı grubun ise 25.1 ± 10.7 ng/mL olup gruplar arasında anlamlı bir fark saptanmadı (p= 0.922). Çalışmaya katılan tüm çocukların 15 (%13.9)'inde vit D eksikliği ve 30 (%27.8)'unda vit D yetersizliği saptandı. Tekrarlayan ASYE'si olan grubun ortalama serum katelisidin düzeyi (39.6 ng/mL) ise sağlıklı gruptan (77.8 ng/mL) anlamlı olarak düşük saptandı (p= 0.004). Serum katelisidin düzeyleri ile vit D düzeyi, beyaz küre sayısı, mutlak nötrofil sayısı ve C-reaktif protein düzeyleri arasında anlamlı bir korelasyon saptanmadı. Serum katelisidin düzeylerinin ≤ 37.3 ng/mL olmasının yaş, cinsiyet, vücut kitle indeksi ve serum vit D düzeylerinden bağımsız olarak okul öncesi çocuklarda tekrarlayan ASYE ile ilişkili olduğu saptanmıştır (OR: 0.99, 95% Güven aralığı: 0.98-0.99, p= 0.006).