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Table of contentsWORKSHOP 4: Challenging clinical scenarios (CS01–CS06)CS01 Bullous lesions in two children: solitary mastocytomaS. Tolga Yavuz, Ozan Koc, Ali Gungor, Faysal GokCS02 Multi-System Allergy (MSA) of cystic fibrosis: our institutional experienceJessica Hawley, Christopher O’Brien, Matthew Thomas, Malcolm Brodlie, Louise MichaelisCS03 Cold urticaria in pediatric age: an invisible cause for severe reactionsInês Mota, Ângela Gaspar, Susana Piedade, Graça Sampaio, José Geraldo Dias, Miguel Paiva, Mário Morais-AlmeidaCS04 Angioedema with C1 inhibitor deficiency in a girl: a challenge diagnosisCristina Madureira, Tânia Lopes, Susana Lopes, Filipa Almeida, Alexandra Sequeira, Fernanda Carvalho, José OliveiraCS05 A child with unusual multiple organ allergy disease: what is the primer?Fabienne Gay-CrosierCS06 A case of uncontrolled asthma in a 6-year-old patientIoana-Valentina Nenciu, Andreia Florina Nita, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen ZapucioiuORAL ABSTRACT SESSION 1: Food allergy (OP01–OP06)OP01 Food protein-induced enterocolitis syndrome: oral food challenge outcomes for tolerance evaluation in a Pediatric HospitalAdrianna Machinena, Olga Domínguez Sánchez, Montserrat Alvaro Lozano, Rosa Jimenez Feijoo, Jaime Lozano Blasco, Mònica Piquer Gibert, Mª Teresa Giner Muñoz, Marcia Dias da Costa, Ana Maria Plaza MartínOP02 Characteristics of infants with food protein-induced enterocolitis syndrome and allergic proctocolitisEbru Arik Yilmaz, Özlem Cavkaytar, Betul Buyuktiryaki, Ozge Soyer, Cansin SackesenOP03 The clinical and immunological outcomes after consumption of baked egg by 1–5 year old egg allergic children: results of a randomised controlled trialMerrynNetting, Adaweyah El-Merhibi, Michael Gold, PatrickQuinn, IrmeliPenttila, Maria MakridesOP04 Oral immunotherapy for treatment of egg allergy using low allergenic, hydrolysed eggStavroula Giavi, Antonella Muraro, Roger Lauener, Annick Mercenier, Eugen Bersuch, Isabella M. Montagner, Maria Passioti, Nicolò Celegato, Selina Summermatter, Sophie Nutten, Tristan Bourdeau, Yvonne M. Vissers, Nikolaos G. PapadopoulosOP05 Chemical modification of a peanut extract results in an increased safety profile while maintaining efficacyHanneke van der Kleij, Hans Warmenhoven, Ronald van Ree, Raymond Pieters, Dirk Jan Opstelten, Hans van Schijndel, Joost SmitOP06 Administration of the yellow fever vaccine in egg allergic childrenRoisin Fitzsimons, Victoria Timms, George Du ToitORAL ABSTRACT SESSION 2: Asthma (OP07–OP12)OP07 Previous exacerbation is the most important risk factor for future exacerbations in school-age children with asthmaS. Tolga Yavuz, Guven Kaya, Mustafa Gulec, Mehmet Saldir, Osman Sener, Faysal GokOP08 Comparative study of degree of severity and laboratory changes between asthmatic children using different acupuncture modalitiesNagwa Hassan, Hala Shaaban, Hazem El-Hariri, Ahmed Kamel Inas E. MahfouzOP09 The concentration of exhaled carbon monoxide in asthmatic children with different controlled stadiumPapp Gabor, Biro Gabor, Kovacs CsabaOP10 ...

AimsAnaphylaxis is a life threatening condition with a UK incidence increasing by over 6 fold between 1992–2012. Our aims were to assess the compliance of anaphylaxis management in children presenting to our Emergency Department against national guidance and to compare with our results pre the introduction of an anaphylaxis guideline locally in 2012.MethodsWe retrospectively reviewed Emergency Department attendances from April 2014–September 2015. Clinical records with a discharge code of “Anaphylaxis” were examined and compared against results from April 2012–March 2014.ResultsA total of 24 cases were identified in the first analysis and 18 in the second. Features of the acute reaction were well documented (Figure 1.) The time and circumstances around the reactions are illustrated in Figure 2. Nuts were a common trigger.Absract G69(P) Figure 1Documentation of features of an acute reactionAbsract G69(P) Figure 2Documentation of circumstances surrounding the reactionPharmacological management is illustrated in Figure 3. An initial mast cell tryptase was taken in 4 cases; it was indicated in 2 and repeated in 1; similar to previously.Absract G69(P) Figure 3Pharmacological management70% of children in the first analysis and 89% in the second were given an adrenaline auto-injector. 75% had documented evidence of how to use it compared to 82% in the re-audit. No additional children were identified as needing a device compared to 17% previously.41% and 39% of parents were given advice about the signs and symptoms of an anaphylactic reaction in the first and second subgroups respectively. No parents in either group were given information about biphasic reactionsConclusionAlthough standards are high with regards to the acute management of anaphylaxis, areas which have improved include documentation around the time and circumstance of the reaction and therefore identifying the trigger; decreasing the need for blood tests through the use of a mast cell tryptase. Areas for improvement include the use of mast cell tryptase and documenting advice to parents.Overall there is good adherence to published guidance, the introduction of a local guideline has improved results, simple measures such as patient information leaflets and personal action plans are an important step to provide consistency and education.

Aims Our children's hospital encompasses several acute clinical areas. These include paediatric medical and surgical inpatient wards (including the children's high dependency ward), the children's emergency department and the neonatal intensive care unit. Collectively these are busy and challenging environments where the provision of care is increasingly complex. These provide opportunities for errors to occur making unintended consequences to harm more likely. The Francis report published in February 2013 highlighted the need for openness and transparency in regards to patient safety. We reviewed clinical incidents reported within all acute clinical paediatric areas in order to characterise commonly recurring themes. Method Clinical incident forms from all acute paediatric clinical areas from 1 September 2012 until 31 August 2014 were retrospectively reviewed. Incidents were assessed for the degree of actual harm caused to patients. They were subsequently categorised according to the National Reporting and Learning System incident types for each clinical area. Medications incidents were further sub-classified by type. Results 872 incident forms involving all acute paediatric clinical areas were submitted over a 24 month period. 67% of all clinical incidents were reported as having insignificant harm to patients and only 2% as catastrophic. The types of incidents reported are shown in Figure 1. Medication errors accounted for a significant percentage of reported incidents within each clinical area (19% children's emergency department; 30% children's wards; 26% neonatal intensive care unit). Other commonly reported incidents were infrastructure problems and patient Abstract G325(P) Figure 1 Percentage of reported incident types Abstract G325(P) Figure 2 Percentage of medication incidents by specified types

Introduction Anaemia is the most common problem in children. Majority of the children are managed in the primary care settings. We had a 3 and a half year old girl presenting to children’s emergency department being unwell with profound pallor and lethargy. Her initial haemoglobin was 13 g/L(1.3 g/dl). She was stabilised and managed appropriately. Her most of the haematological investigations were normal apart from iron defiency . This case prompted us to investigate the common causes of severe anaemia in children. Objectives We aimed to investigate the underlying causes of profound anaemia in children presenting to DGH settings. For the purpose of the study we classified children with haemoglobin < 50 g/L (5 g/dl) as profoundly anaemia. Methods A retrospective analysis of case notes of children with haemoglobin < 50 g/L over the period from June 2011 to June 2013 was carried out. This data was obtained through the haematology laboratory records. Results In total 21 cases were identified, 7 cases were excluded as 6 presented on the neonatal unit and were felt to be of differing aetiology to out paediatric population. The other case was excluded as the child had a known diagnosis of sickle cell disease. Of the 14 remaining cases 8 were female, they ranged from ages of 11 days to 13.5 years (Figure 1.) The mean Hb level was 36 g/L(13–47.) Abstract G247(P) Figure 1 The most frequently occurring presenting symptoms included lethargy, jaundice and pallor (Figure 2) and the most frequently occurring diagnosis was iron deficiency anaemia (50%). The other causes included leukaemia (2 cases), G6PD deficiency, diamond blackfan anaemia, haemolytic anaemia (2 cases) and hereditary spherocytosis with concurrent parvovirus. Abstract G247(P) Figure 2 Conclusions Iron deficiency anaemia remains the most common cause for profound anaemia in children. Also children with underlying oncological or haematological disorders can present with anaemia as the clinical picture. This study highlights the common causes of severe anaemia in children and the need for thorough investigation of severe anaemia. References Bootha IW, Aukett MA. Iron deficiency anaemia in infancy and early childhood. Arch Dis Child 1997;76:549–554 doi:10.1136/adc.76.6.549 Oski FA. Iron deficiency in infancy and childhood. N Engl J Med 329:190–193 Galloway, MJ and Smellie, WS. Investigating iron status in microcytic anaemia. BMJ 2006;333:791-793.