To the Editor, Modern hectic lifestyles have created challenges for parents of allergic children, as treatment adherence and optimal disease control are closely tied to adequate caregiver supervision. Environmental allergen exposures in schools and outdoor environments are also difficult to control but impacts disease outcomes. 1 Improvements in disease symptoms are often reported during school vacations, 2 when children have more time at home under a caregiver's supervision. This study aimed to evaluate the impact of an 8-week (April to June 2020) COVID-19-induced nationwide lockdown in Singapore on allergic disease control in children. Universal masking and movement restrictions (closure of schools, workplaces, retail and entertainment facilities) were implemented. This presented a unique opportunity to evaluate the impact of increased caregiver supervision, school closures, reduction of outdoor exposures and increased indoor time on allergic diseases control. An anonymous self-administered questionnaire, hosted on a secure online portal (FormSG), was disseminated to the general public through several media platforms in the one month after nationwide lockdown measures were lifted. Parents of 0-to 18-year-old children, or adolescents themselves, with allergic disorders (eczema, asthma and allergic rhinitis (AR)) were invited to complete the questionnaire anonymously. Survey completion implied consent to participate. The study received ethics approval by the NHG Domain Specific Review Board, Singapore (Reference number 2020/00717). Data on demographics, caregiving arrangements, self-reported symptoms of allergic diseases and self-perceived reasons behind the changes in disease status were collected. Perceived treatment adherence was measured using a 10-point rating scale evaluating adherence before and during lockdown. Disease control was assessed through validated symptom scoring tools-the Patient-Oriented Eczema Measure (POEM) for eczema, 3 Asthma Control Test (ACT) for asthma 4 and Total Nasal Symptom Score (TNSS) for AR. 5 Data were analysed using SPSS Version 26.0 (IBM Corp). Pearson's chi-square test was used for categorical variables and Wilcoxon sign rank test for symptom score comparisons. Differences in medians between groups reporting different disease outcomes before and during lockdown were analysed with the Kruskal-Wallis test.A total of 173 parents/adolescents, 89 (51.4%) males and 84 (48.6%) females, aged 2 months to 18 years participated in this survey (Table S1). The majority of subjects (93.1%) received their

1. Lee SJ, Ha EK, Jee HM, et al. Prevalence and risk factors of urticaria with a focus on chronic urticaria in children. Allergy Asthma Immunol Res. 2017;9:212-219. 2. Jaakkola JJK, Knight TL. The role of exposure to phthalates from polyvinyl chloride products in the development of asthma and allergies: a systematic review and meta-analysis. Environ Health Perspect. 2008;116:845-853. 3. Tsai M-J, Kuo P-L, Ko Y-C. The association between phthalate exposure and asthma. Kaohsiung J Med Sci. 2012;28(7 Supplement):S28-S36. ACKNOWLEDGMENTSWe are grateful to our patient and her parents, as well as our unit's Day Therapy Centre staff (Hannah Thang, Isabel Sun, Linda Chow and Sandra Ligas) for providing their assistance in the monitoring of the patient during desensitization. CONFLICT OF INTERESTThe authors do not have any conflict of interests to declare. CLINICAL IMPLICATIONSSafe and effective desensitization with IM triptorelin acetate depot can be achieved with a standardized protocol.

Tofacitinib has an important role in pediatric rapidly progressive interstitial lung disease (ILD) associated with juvenile dermatomyositis (JDM), an otherwise potentially fatal condition. It may be useful in induction of remission and can be used safely to maintain remission. Serum ferritin and interleukin‐18 are useful markers for tracking activity and response of JDM‐associated ILD.