[How I explore... suspicion of insect venom allergy in children]

Suspicion of allergy to insect venoms following bites (mosquito, bee, wasp, …) is a frequent reason for consultation in pediatric allergology. Very often, these are local or locoregional reactions, which do not justify any other additional examinations. Biological analyses are performed when desensitization is recommended. Preventive measures should be explained to the patient and his/her parents. Symptomatic treatment with antihistamine, alcohol swabs and local corticosteroids is prescribed for local or locoregional reactions. If the child has a history of generalized anaphylactic reaction, an emergency kit containing an antihistamine and two auto-injectable epinephrine pens should be prescribed. Desensitization is indicated in case of a severe anaphylactic reaction.

[Food protein-induced enterocolitis syndrome (FPIES) : a poorly known type of food allergy]

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. Its pathophysiology is still poorly understood. FPIES mainly affects infant and young children, although cases have been reported in adults. Its symptomatology is restricted to gastrointestinal manifestations and the onset of allergic reaction subsequent to exposure is delayed. The most common culprit for children is cow's milk. Initial clinical presentation of FPIES is oftentimes acute, though it can also be chronic. Diagnosis relies on clinical criteria, which have been recently redefined and subject to international consensus. Through two clinical cases, this report aims to describe the characteristics of this emerging disease as well as delineate the treatment thereof.

[How I explore... a suspicion of paracetamol allergy in children]

Paracetamol (acetaminophen) is a molecule recognized worldwide for its anti-inflammatory and analgesic properties. While side effects are rare, some patients have allergic or non-allergic hypersensitivity to this molecule. Anamnesis helps to guide the diagnosis. The sensitivity and specificity of the specific IgE assay for paracetamol, skin tests and other in vitro challenge tests have been poorly studied. The oral provocation test remains the gold standard to confirm the diagnosis. In case of confirmed hypersensitivity to paracetamol, it is important to search for an alternative treatment. In this article, we describe a clinical case and its management.

[Hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations in children]

Hereditary hemorrhagic telangiectasia is a constitutional vascular dysplasia characterized by chronic epistaxis, mucocutaneous and visceral telangiectasias and arteriovenous malformations. Apart from family screenings, the disease is rarely diagnosed during the pediatric age given the late advent of typical clinical symptoms. Nevertheless, arteriovenous malformations are sometimes already present at a young age with significant morbidity risk. Therefore, it is important to establish an early diagnosis. We describe two pediatric cases of hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations with divergent clinical presentation.

Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C-ACT), and physician's rating

BACKGROUND

Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool.

AIM

To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist.

METHODS

Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT.

RESULTS

Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P < 0.0001). According to PA, 89% of patients with a C-ACT > 21 were controlled and 85% of patients with a C-ACT < 17 not controlled.

CONCLUSION

We observed discrepancies between the different tools applied to assess asthma control in children, and the impact of age and exacerbations. Cutoff point of 19 of C-ACT was not associated with the best performance compared to PA. Assessment of control should take into account symptoms and lung function as suggested by the latest GINA guidelines as well as exacerbation over a long period.