Anaphylaxis after prick‐to‐prick test with fish

Skin prick testing is the diagnostic procedure for allergies and is considered to be safe. It is usually performed using the prick and the prick‐to‐prick method. Herein is described a pediatric case of anaphylaxis during prick‐to‐prick testing with raw fish in a patient who had consumed fish without any systemic allergic reactions beforehand, to illustrate that skin prick testing should be carefully planned and performed with caution in order to avoid potentially serious risks for the patient.     

Anaphylaxis induced by oral methylprednisolone in a 10‐year‐old boy

Corticosteroids are potent anti‐inflammatory and anti‐allergic agents used in the treatment of various inflammatory diseases, including allergic diseases. Allergic reactions caused by corticosteroids, however, have been reported. Among these, delayed reactions to topical steroids are more common, whereas immediate reactions to systemic steroids are rare. Herein, we report the case of a 10‐year old boy with methylprednisolone‐induced anaphylaxis, in which the patient had a positive oral challenge test result. Physicians should be aware of the possibility of anaphylaxis or other allergic hypersensitivity in response to corticosteroids.     

Pott's puffy tumor in a 12‐year‐old boy

Pott's puffy tumor (PPT) is a rare complication of sinusitis characterized by subperiosteal abscess and osteomyelitis of the frontal bone. Early diagnosis and treatment is vital before it causes intracranial complications such as subdural empyema or brain abscess. Herein we describe the case of a 12‐year‐old patient who developed preseptal cellulitis and PPT, and was successfully treated with abscess drainage, sinus surgery and long‐term antibiotic therapy.     

Mask face: Bilateral simultaneous facial palsy in an 11‐year‐old boy

Bilateral facial paralysis is an uncommon clinical entity especially in the pediatric age group and occurs frequently as a manifestation of systemic disease. The most important causes are trauma, infectious diseases, neurological diseases, metabolic, neoplastic, autoimmune diseases and idiopathic disease (Bell's palsy). We report a case of an 11‐year‐old boy presenting with bilateral simultaneous peripheral facial paralysis. All possible infectious causes were excluded and the patient was diagnosed as having Bell's palsy (idiopathic). The most important approach in these cases is to rule out a life‐threatening disease.     

Parental smoking and allergic sensitization in offspring defined by skin prick testing

Investigations of parental smoking during childhood and allergic sensitization have produced contradictory results, but this may be because of variations in the definition of allergy and other influences. We investigated associations of parental smoking with an objective measure of allergy, skin prick testing (SPT), and considered associations with maternal and paternal smoking, independently of each other. A stratified random sample, aged 22-74 yr, of 720 Swedish FinEsS-study members were skin prick tested for 15 allergens. Subjects with at least one positive SPT were defined as atopic. Data on childhood exposures, including parental smoking, were collected by structured interview. Logistic regression used atopy as the dependent variable. After adjustment, paternal smoking was statistically significantly associated with an increased risk and maternal smoking a non-statistically significant decreased risk in offspring, with odds ratios (and 95% confidence intervals) of 1.48 (1.04-2.10) and 0.73 (0.48-1.12), respectively. Analysis of families with a non-smoking mother produced an odds ratio for paternal smoking of 1.61 (1.09-2.37). The negative association between maternal smoking and atopy may not operate through passive smoke exposure and could conceal a significant increased risk associated with passive exposure to tobacco smoke in childhood.     

An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth

Evidence supporting the practice of skin‐to‐skin contact and breastfeeding soon after birth points to physiologic, social, and psychological benefits for both mother and baby. The 2009 revision of Step 4 of the WHO/UNICEF “Ten Steps to Successful Breastfeeding” elaborated on the practice of skin‐to‐skin contact between the mother and her newly born baby indicating that the practice should be “immediate” and “without separation” unless documented medically justifiable reasons for delayed contact or interruption exist. While in immediate, continuous, uninterrupted skin‐to‐skin contact with mother in the first hour after birth, babies progress through 9 instinctive, complex, distinct, and observable stages including self‐attachment and suckling. However, the most recent Cochrane review of early skin‐to‐skin contact cites inconsistencies in the practice; the authors found “inadequate evidence with respect to details … such as timing of initiation and dose.” This paper introduces a novel algorithm to analyse the practice of skin to skin in the first hour using two data sets and suggests opportunities for practice improvement. The algorithm considers the mother's Robson criteria, skin‐to‐skin experience, and Widström's 9 Stages. Using data from vaginal births in Japan and caesarean births in Australia, the algorithm utilizes data in a new way to highlight challenges to best practice. The use of a tool to analyse the implementation of skin‐to‐skin care in the first hour after birth illuminates the successes, barriers, and opportunities for improvement to achieving the standard of care for babies. Future application should involve more diverse facilities and Robson's classifications.     

Neurodevelopment in 1‐year‐old Japanese infants after congenital heart surgery

Background: The purpose of this study was to determine the prevalence of persistent neurodevelopmental sequelae in 1‐year‐old infants after open heart surgery for congenital heart disease, using the Bayley Scales of Infant Development second edition (BSID‐II). A secondary objective was to confirm the applicability and usefulness of the BSID‐II in Japanese infants. Methods: Thirty‐nine infants who underwent repair of a ventricular septal defect before 6 months of age and 108 normal Japanese infants at 1 year of age were assessed using the BSID‐II. Results: In normal infants, scores on the Mental Development Index and the Psychomotor Development Index components of the BSID‐II ranged from borderline retardation to very superior following a normal distribution similar to those obtained for US controls. No problems were encountered, either in translation or in following the instructions when the BSID‐II was used to evaluate the 1‐year‐old Japanese infants. On the other hand, the mean scores on the Mental Development Index and the Psychomotor Development Index were significantly lower in Japanese patients than in normal Japanese infants, particularly for gross motor development (P < 0.001). Linear regression analysis showed that a longer intensive care unit stay was associated with impaired cognitive development at 1 year of age (P= 0.03). Conclusions: Neurodevelopmental functions in 1‐year‐old infants with congenital heart disease were lower than those in normal infants, especially for gross motor function using the BSID‐II. One risk factor that correlated with neurodevelopmental sequelae was the length of intensive care unit stay.     

Acute aortic dissection mimicking acute abdomen in a 14‐year‐old boy

Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14‐year‐old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed.     

Anaphylactic reaction to lychee in a 12‐year‐old girl: Cross‐reactivity to latex?

There are very few case reports on allergic reactions to lychee in the literature – so far only in adults. We report on a 12-year-old girl who developed swelling of lips, pruritus, generalized urticaria and dyspnea 30 min after eating a raw lychee. A second event occurred after eating a piece of cake covered with a fruit cocktail. All other foods were well tolerated. In infancy the girl had suffered from atopic dermatitis, which disappeared in childhood; for the previous 2 yr she had presented with seasonal allergic rhinoconjunctivitis. Upon oral provocation, she developed restlessness, flush, generalized urticaria and inspiratory stridor 50 min after eating half a lychee. The diagnostic work up showed a clear positive skin prick test to raw lychee and specific immunoglobulin E (IgE) in serum to latex but not to lychee. In the cellular antigen stimulation test (CAST) carried out with lychee extracts in several concentrations, the same positive results could be found confirming an allergic reaction. Cross-reactivity of lychee to latex was shown by inhibition experiments using the UniCAP 100-system. In conclusion, it seems worthwhile considering the rare allergy to lychee in the case of unclear food-allergic reactions and lychee should be added to the list of foods cross-reacting with latex.