PCIW represents an easily accessible therapeutic offer in the vocational context. There often is a mix of work-related and personal problems that suggests the cooperation of occupational and psychosomatic physicians.

AIMS OF THE STUDY: Given the long history of underestimating chronic pain in children and adolescents, we lack valid data on its assessment and treatment. The psychological and economic burden for patients, their families and society is substantial. The aim of this study was to assess patient characteristics of the first ambulatory interdisciplinary clinic for children and adolescents with chronic pain in Switzerland and compare them with data from other international centres.METHODS: All patients of the ambulatory interdisciplinary pain clinic at the University Children's Hospital in Basel during the period from 4 January 2012 to 4 July 2016 were included in this retrospective study. Data were collected from the patients' medical records and from a questionnaire, which the patients and their parents received and completed in advance of their first visit. Demographic information, pain, referral, social environment, therapies and school absences of the patients were statistically analysed with means, percentages, 95% confidence intervals (CIs) and standard deviations (SDs).RESULTS: Of the 135 patients included in this study, 80% were female and the mean age of all patients was 13.95 years (95% CI 13.5-14.4). The commonest pain presentations were: musculoskeletal (38%, 95% CI 0.30-0.46), back (25%, 95% CI 0.18-0.33), multiple regions (21%, 95% CI 0.15-0.28) and headache (7%, 95% CI 0.03-0.12). Mean duration of pain until the patients came to the clinic was 24.5 months (95% CI 19.82-29.22). Physiotherapy (71%, 95% CI 0.63-0.79) and non-opioids (50%, 95% CI 0.42-0.59) were the most used therapies before the first meeting. Psychotherapy (52%, 95% CI 0.44-0.61), most often using a psychosomatic therapeutic approach (psychosomatic therapy) 34% (95% CI 0.26-0.42), physiotherapy (36%, 95% CI 0.27-0.44) and non-opioids (33%, 95% CI 0.25-0.42) afterwards. The mean number of school absences during the last month before the first visit was 5.1 days per month (95% CI 3.48-6.73). The parents of our study participants suffered more often from psychiatric diseases than the mean Swiss population. CONCLUSIONS:The average of more than 2 years of pain before referral to the clinic seems to be a long time. Assuming that specialised support is mandatory for young patients with complex pain syndromes, the referral time should be reduced. Furthermore, patients with headache were underrepresented in Basel compared with other centres. Interestingly, in our study, patients' parents suffered more often from psychiatric diseases than the mean Swiss population.

Introduction Delayed allergy to red meat, also termed alpha-gal syndrome, is increasingly reported in adults and African communities, while pediatric cases remain rare. Case presentation Here, we report on a 7-year-old Caucasian boy presenting with recurrent wheals since the age of 5 years old. Episodes with hives occurred around every 3 weeks, mainly in the evening. One of these episodes was also associated with angioedema. No clear trigger was identified. At the first visit, after excluding an infection and autoimmune thyroiditis, chronic spontaneous urticaria was suspected and symptomatic treatment with antihistamines was prescribed. Six months later, the boy presented at the emergency room with generalized urticaria, dyspnoea, and emesis. Symptoms resolved after administration of epinephrine and antihistamines. A detailed medical history after this event revealed that he had eaten three sausages as well as jelly beans containing gelatine several hours prior to this episode. More precisely, after eating the sausages and jelly beans during the day, he had shown some hives before going to bed, and later developed the other symptoms in the middle of the night, suggesting alpha-gal syndrome. In his history, several tick bites are reported. Immunoglobulin E levels for alpha-gal were clearly elevated, confirming the diagnosis of a delayed-appearing immunoglobulin E-mediated allergic reaction to alpha-gal. Emergency medication was prescribed and avoidance of red meat and gelatine-containing foods was recommended. Under this exclusion diet, the boy remained asymptomatic, with the exception of two accidents in the follow up of 3 years, one developing during a barbecue and the second after exceptionally eating marshmallows. Conclusion A detailed clinical history led to the diagnosis of alpha-gal syndrome. Although alpha-gal syndrome is typically seen in adults, our case illustrates that children can also present with this potentially life-threatening allergy. Since alpha-gal syndrome is rare in Europe, the disease is not well known and often overlooked for several years, especially in children.

Zusammenfassung Kinder und Erwachsene mit rheumatischen Erkrankungen (RE) haben nicht nur durch ihre Grunderkrankung, sondern auch durch die vielfach notwendige immunsuppressive Therapie (IT) ein erhöhtes Risiko, an bestimmten Infektionen zu erkranken. Durch die IT hat sich die Lebensqualität bei vielen Patienten mit RE verbessert, sodass ihr internationales Reiseverhalten dem gesunder Reisenden ähnelt. Eine Untersuchung deutet an, dass Patienten mit Immunsuppression oftmals unzureichend auf Reisen vorbereitet sind und ihr Impfschutz schlechter als bei Immungesunden ist. Da auch während und nach Reisen das Erkrankungsrisiko für allgemeine und reisespezifische Infektionen bei Patienten mit Immunsuppression erhöht ist, sind reisemedizinische Beratungen bei Patienten mit RE wichtig. Hier können ein Reiserücktritt oder Reisemodifikationen und spezifischer Schutz inklusive Reiseimpfungen besprochen werden. Zu den gängigen Indikationsimpfungen bei Reisen zählen Impfungen gegen Hepatitis A, Typhus, Tollwut, Meningokokken, FSME (Frühsommer-Meningoenzephalitis), saisonale Influenza, Japanische Enzephalitis, Cholera, Poliomyelitis und Gelbfieber. Bei Patienten mit RE ergibt sich die Impfindikation dabei aus der möglichen Exposition gegenüber impfpräventablen Infektionen, dem individuellen Reiseverhalten, der Schwere der möglichen Infektion unter Abwägung der Risiken, die mit der Reiseimpfung assoziiert sind. Dafür müssen auch der allgemeine Gesundheitszustand, die Aktivität und Schwere der RE und der Grad der IT beachtet werden. Allgemein gilt für Patienten mit RE und IT, dass auch bei Reiseimpfungen Lebendimpfstoffe kontraindiziert sind, während Totimpfstoffe verabreicht werden können. Da eine reduzierte Impfantwort möglich ist, können Antikörpermessungen nach der Impfserie und spezifische Impfschemata oder zusätzliche Booster bei Patienten mit RE indiziert sein.