<b><i>Background:</i></b> Accurate use of adrenaline auto-injectors (AAIs) for anaphylaxis is critical to decrease mortality and morbidity. <b><i>Objective:</i></b> In this study, we aimed to assess user knowledge of AAIs and evaluate the factors that affect their correct use. <b><i>Methods:</i></b> The study involved caregivers of pediatric patients diagnosed with anaphylaxis who were trained with trainer injectors up to 24 months ago. The demographics of the caregivers, anaphylaxis history of the patients, usage of AAIs in the case of anaphylaxis, and the reasons for not using AAIs in anaphylaxis were evaluated. Users were asked to demonstrate the use of Penepin® with a trainer injector. <b><i>Results:</i></b> Fifty-nine caregivers were enrolled in the study. Forty-seven (79.7%) users stated that they always carry AAIs with them. Forty-one (69.5%) of the users demonstrated all steps of the use of AAIs. The time from the last AAI training was the most significant parameter affecting the ability to use AAIs correctly (OR 0.678, 95% CI 0.546–0.841, <i>p</i> &#x3c; 0.0001). AAI training every 6 months results in the proper usage of AAIs, with 96% probability. Thirty (50.8%) caregivers stated that anaphylactic reactions occurred in their children after the last AAI training. Of these, 16 (53.3%) users stated that they did not use an AAI for the anaphylactic reaction. The most common reason (50%) was not carrying an AAI on their person. <b><i>Conclusion:</i></b> Training users at least every 6 months is associated with the proper application of AAIs. Although regular training increases the frequency of AAI use in anaphylaxis, awareness of carrying AAIs is the most important factor for usage of AAI in anaphylaxis.

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Purpose: It has been well known that high serum immunoglobulin (Ig) E levels are associated with allergies, parasitic infections and some immune de ciencies; however, the potential effects and clinical implications of low IgE level on the human immune system are not well known. To determine the disorders accompanying very low IgE levels in children and adults.Methods: The patients whose IgE levels were determined between January 2015 and September 2020 were analyzed, and the ones with an IgE level <2.5 IU/mL were included in the study. Demographic data, immunoglobulin levels, auto-antibody results, and the diagnoses of the patients were noted from the electronic recording system of the hospital. Result: The IgE levels were measured in 34,809 patients (21,875 children, 12,934 adults), and 180 patients had IgE levels <2.5 IU/mL. Eighty patients were children (0.37%), 100 were adults (0.77%). There was a malignant disease in 45 (11 of them children) (25%), autoimmune diseases in 30 (4 of them children) (16.7%) and immunode ciency in 19 (16 of them children) (10.6%) of the patients. The most common reasons were other disases, immunode ciency and malignancy in children; and malignancy, autoimmune disorders and other diseases in the adults, in rank order. The IgE level did not show any correlation with the levels of other immunoglobulins. Conclusion: Although rare, a low IgE level has been shown to accompany malignancies, autoimmune disorders and immune de ciencies. Patients with very low IgE levels should be carefully monitored for systemic disorders.

Background/aim: Allergic Bronchopulmonary Aspergillus (ABPA) is a lung disease caused by hypersensitivity from Aspergillus fumigatus. Diagnostic criteria, staging systems and treatment methods for ABPA disease have been reported in studies evaluating populations, the majority of which are adult patients. Our study aimed to discuss the use of ABPA diagnostic criteria in children, the success of other alternative regimens to oral corticosteroids in the treatment of ABPA, and the changes that occur during treatment, in the light of the literature. Materials and methods:Between January 2017 and 2020, patients diagnosed with ABPA at the Dokuz Eylul University Child Allergy and Immunology clinic were identified; demographic characteristics, clinical and laboratory findings, diagnostic scores and stages, treatment protocols were analyzed retrospectively. Results:The mean age of patients diagnosed with ABPA was 14.33±1.96. At the time of ABPA diagnosis, the median Total IgE level was 1033 IU/mL (1004-6129), and the median AF specific IgE was 10.64 (2.59-49.70) kU/L. Bronchiectasis was detected in HRCT of 5 cases. We detected significant improvement in spirometric analysis with omalizumab treatment in our patient with steroid-related complications. Conclusion:Today, although risk factors have been investigated for ABPA, it has not been revealed clearly. Both diagnostic criteria and treatment regimens have been described in research studies, mostly adults. In pediatric patients; clarification of diagnosis and treatment algorithms is necessary to prevent irreversible lung tissue damage and possible drug side effects.

Objective A misdiagnosed “penicillin allergy” is a common problem in childhood. Recently, skipping skin tests (STs) and performing a direct oral challenge test (OCT) have become an increasingly common approach in children with suspected β-lactam (BL) allergy. In our study, we aimed to evaluate the safety and efficacy of OCT without using ST in children who had a history of hypersensitivity reactions with BL antibiotics. Materials and Methods We retrospectively evaluated direct OCT outcomes in children with both nonimmediate and immediate-type reaction history with BL antibiotics. STs were not performed before the challenge test. The patients were monitored for 4 hours after the challenge and continued using the drug in two divided doses for 3 days at home. Results In this study, 72 patients were included, with median age of 7 years (interquartile range: 4; min: 1 year to max: 16 years), and of these, 56% were male. Forty-five subjects (63%) reported immediate-type adverse reactions. The most common clinical manifestation was urticaria/angioedema (51%, n: 37) and maculopapular exanthema in 46% (n: 33) of patients, respectively. The most commonly suspected drug was 71% amoxicillin-clavulanate. A 3-day OCT without preceding ST was performed in all patients. Only three patients (4.2%) showed a positive response to the oral drug challenge test. None of these reactions observed was more severe than index reactions. Conclusion Performing OCT without STs is a safe and convenient method to exclude BL hypersensitivity in the pediatric age group.