Ibuprofen is the most commonly used non-steroidal anti-inflammatory drug (NSAID) and is the only NSAID approved for use in infants less than three months of age. 1 It is available over-the-counter for the treatment of fever, inflammation and pain, and is often prescribed to treat inflammatory conditions. Over the past decade, there has been a reported shift towards Ibuprofen consumption as an over-the-counter drug, with 70% of ibuprofen being purchased without prescription in 2015, as well as an overall increase in consumption. 1 However, there has been a paralleled increase in reports of severe adverse reactions to NSAID, such as anaphylaxis, with Ibuprofen being the most common trigger of all NSAIDs. 1,2 Despite the obvious need, there is little research on the diagnosis and management of patients and in particular children with reported Ibuprofen reactions. We aimed to evaluate diagnosis and management of NSAID allergy in children (defined as children that are 18 years old or younger). This cohort study, with both retrospective and prospective recruitment, took place between January 2017 and July 2019 at the Montreal Children's Hospital. All children presenting to the Montreal Children's Hospital for suspected NSAID allergy were included in this study. After obtaining parental consent, a standardized questionnaire was filled out in order to collect data on demographics, clinical characteristics and management of the suspected Ibuprofen reaction. Table 1 displays the results of these questionnaires. The treating allergist then assessed the patient and decided if they were eligible to undergo a drug provocation test (DPT) (10% and 90% of the oral dose) to the culprit NSAID. As per guidelines set by the American Academy of Allergy, Asthma and Immunology (AAAAI), controlled oral provocation with the suspected allergen was used as it is considered to be the most conclusive way to confirm a diagnosis. 3 Children were observed

No abstract

No abstract

Purpose Upper lid eversion in adults from non-cicatricial causes is rare. We report a case of upper eyelid eversion secondary to epidemic keratoconjunctivitis (EKC). Observations A 37 year-old female presented with unilateral upper lid eversion. Known for left upper lid ptosis repair in childhood, the patient presented with seven-day history of severe bilateral conjunctivitis and eversion of her left upper lid three days prior. On exam, she had follicular conjunctivitis, punctate epithelial keratopathy with subepithelial infiltrates and membranes bilaterally, with an everted upper lid tarsus, and swollen and ulcerated palpebral conjunctiva. She received topical and oral prednisone to quickly reduce the inflammation, as well as moxifloxacin drops and lubrication. When the swelling subsided, the tarsus adopted a kinked and everted configuration, and was managed successfully with reversion, pressure patching, shielding and close follow-up. Conclusions and Importamce This is the first reported case of upper lid eversion secondary to EKC, likely due to sudden marked inflammation and edema of the posterior lamella caused by the adenoviral infection. This case was successfully managed with conservative therapy.

No abstract