Drug allergy evaluation in children with suspected mild antibiotic allergy

BackgroundAdverse antibiotic reactions caused by an immunological mechanism are known as allergic reactions. The percentage of reported antibiotic allergies is likely to differ from the one validated after a drug provocation test (DPT) with the culprit antibiotic. This study aimed to compare the percentage of children who were thought to be allergic to a certain antibiotic with those who have a true allergy, as confirmed by DPTs. We also validated Skin Prick Tests (SPTs) and Intradermal Tests (IDTs) by assessing their sensitivity and specificity, in diagnosing antibiotic allergies using DPT as the gold standard. Furthermore, we investigated epidemiological risk factors such as personal and family history of atopic disease and eosinophilia.MethodsChildren with a history of possible allergic reaction to an antibiotic underwent a diagnostic procedure that included: (1) Eosinophil blood count, (2) SPTs, (3) IDTs and (4) DPTs. The parameters were compared with Pearson's Chi-Square and Fisher's Exact Test. Several risk factors that were found significant in univariate analysis, such as personal and family history of atopic disease, and positive SPTs and IDTs were examined with multiple logistic regression analysis to see if they were related to a higher risk for a positive DPT.ResultsSemi-synthetic penicillin was the most common group of antibiotics thought to cause allergic reactions in this study. Overall, 123 children with a personal history of an adverse reaction to a certain antibiotic, were evaluated. In 87.8% of the cases, the symptoms had occurred several hours after administration of the culprit antibiotic. Both SPTs and IDTs had low sensitivity but high specificity. Moreover, they had a high positive predictive value (PPV). In contrast, eosinophilia was not recognized as a risk factor. Seventeen patients (13.8%) had a true antibiotic allergy, as confirmed by a positive DPT. A positive IDT was a strong predictor of a positive DPT, along with a positive personal and family history of atopy.ConclusionSPTs and IDTs are very reliable in confirming antibiotic allergy when found positive. A negative result of a SPT highly predicts a negative DPT. A positive IDT and a positive personal and family history of atopy were recognized as significant risk factors for antibiotic allergy

Adherence to the screening program for HBV infection in pregnant women delivering in Greece

BACKGROUND: Hepatitis B infection (HBV) is a major Public Health Problem. Perinatal transmission can be prevented with the identification of HBsAg(+) women and administration of immunoprophylaxis to their newborns. A national prevention programme for HBV with universal screening of pregnant women and vaccination of infants is in effect since 1998 in Greece. METHODS: To evaluate adherence to the national guidelines, all women delivering in Greece between 17–30/03/03 were included in the study. Trained health professionals completed a questionnaire on demographic data, prenatal or perinatal screening for HBsAg and the implementation of appropriate immunoprophylaxis. RESULTS: During the study period 3,760 women delivered. Prenatal screening for HBsAg was documented in 91.3%. Greek women were more likely to have had prenatal testing. HBsAg prevalence was 2.89% (95%CI 2.3–3.4%). Higher prevalence of HBV-infection was noted in immigrant women, especially those born in Albania (9.8%). Other risk factors associated with maternal HBsAg (+) included young maternal age and absence of prenatal testing. No prenatal or perinatal HBsAg testing was performed in 3.2% women. Delivering in public hospital and illiteracy were identifiable risk factors for never being tested. All newborns of identified HBsAg (+) mothers received appropriate immunoprophylaxis. CONCLUSION: The prevalence of HBsAg in Greek pregnant women is low and comparable to other European countries. However, immigrant women composing almost 20% of our childbearing population, have significant higher prevalence rates. There are still women who never get tested. Universal vaccination against HBV at birth and reinforcement of perinatal testing of all women not prenatally tested should be discussed with Public Health Authorities

Adherence to the screening program for HBV infection in pregnant women delivering in Greece

Background: Hepatitis B infection (HBV) is a major Public Health Problem. Perinatal transmission can be prevented with the identification of HBsAg(+) women and administration of immunoprophylaxis to their newborns. A national prevention programme for HBV with universal screening of pregnant women and vaccination of infants is in effect since 1998 in Greece. Methods: To evaluate adherence to the national guidelines, all women delivering in Greece between 17-30/03/03 were included in the study. Trained health professionals completed a questionnaire on demographic data, prenatal or perinatal screening for HBsAg and the implementation of appropriate immunoprophylaxis. Results: During the study period 3,760 women delivered. Prenatal screening for HBsAg was documented in 91.3%. Greek women were more likely to have had prenatal testing. HBsAg prevalence was 2.89% (95% CI 2.3 - 3.4%). Higher prevalence of HBV-infection was noted in immigrant women, especially those born in Albania (9.8%). Other risk factors associated with maternal HBsAg (+) included young maternal age and absence of prenatal testing. No prenatal or perinatal HBsAg testing was performed in 3.2% women. Delivering in public hospital and illiteracy were identifiable risk factors for never being tested. All newborns of identified HBsAg (+) mothers received appropriate immunoprophylaxis. Conclusion: The prevalence of HBsAg in Greek pregnant women is low and comparable to other European countries. However, immigrant women composing almost 20% of our childbearing population, have significant higher prevalence rates. There are still women who never get tested. Universal vaccination against HBV at birth and reinforcement of perinatal testing of all women not prenatally tested should be discussed with Public Health Authorities

Isolated right peroneal mononeuropathy after silent SARS-CoV-2 infection in a child: Case report and review of the literature

Introduction: Peroneal neuropathy is considered as the most common mononeuropathy of the lower extremities, albeit with limited medical documentation. Risk factors include local injuries or recurrent minor trauma, surgery, weight loss, habitual leg crossing, other prolonged postures, or application of inappropriately fitted orthopedic devices that lead to uninterrupted pressure at the fibular head, intoxication, bicycle riding, prolonged anesthesia, lengthy hospitalization, other underlying neuropathies, diabetes mellitus, exposure to cold and irradiation and infection by neurotropic viruses. Case Report: We present a 4-year-old non-immunocompromised boy with an isolated right foot drop. At presentation, he had a characteristic walking that resulted from the inability to bend his right foot upward at the ankle. The foot drop developed gradually over the last week and was not accompanied by other symptoms. A careful history and appropriate serologic and imaging studies ruled out common causes of peroneal neuropathy except for SARS-CoV-2. Indeed, a high titer of specific IgG antibodies to this new coronavirus was detected, despite no history of prior immunization. Conclusion: Peroneal neuropathy may represent one of the many neurological sequelae of infection with SARS-CoV-2; physicians should be aware of this. </jats:p

Adult Vaccinations Today&mdash;Innovations and Challenges for the Coming Years

Routine pediatric vaccinations have resulted in dramatic declines in the incidence and complications of several vaccine-preventable diseases (VPDs) over the past fifty years. At the same time, the prolongation of life expectancy and the large number of adults living with chronic medical conditions changed the demographic profile and, accordingly, the healthcare needs. The recognition of the burden and effects of several VPDs in adults and in particular risk groups and the comprehension of the age-dependent deterioration of immune responses have driven the extension of routine vaccination programs beyond adolescence. In addition, several VPDs emerged or re-emerged over the past decades, and new vaccines have been developed or are under clinical assessment. Currently, vaccination programs in many countries include vaccinations for adults, aiming to expand and strengthen protection throughout the lifespan and promote healthy aging. Moreover, there are needs for new or more effective vaccines against common or emerging pathogens and public health threats, including chronic diseases. This article reviews the current status of several adult vaccinations and discusses challenges for adult vaccinations, including new vaccines, emerging or re-emerging VPDs, and strategies to overcome low vaccination rates