Perran BORAN, Ayça KIYKIM, Ahmet ÖZEN, Elif KARAKOÇ AYDINER, Hatice Ezgi BARIŞ, Safa BARIŞ

Alerji öyküsü olan çocuklarda aşılama pratikleri

Amaç: Besin alerjisi olan çocuklarda, aile hekimleri aşılama uygulamaktan kaçınmakta ve çocukları hastanelere yönlendirmektedir. Bu çalışmada Çocuk Sağlığı İzlem Polikliniği’mize alerjisi olup, aşılama için yönlendirilen çocukları değerlendirmeyi hedefledik.Gereç ve Yöntemler: Son iki yılda aşı yapılması için yönlendirilen alerjik çocukların dosyaları geriye dönük incelendi. Demografik ve laboratuvar verilerle, aşı sonrası reaksiyonlar değerlendirildi.Bulgular: Alerjisi olan ya da alerji şüphesiyle yönlendirilen 122 çocuk saptandı. Çocukların 50’sinde (%43,5) yumurta, 42’sinde (%36,5) çoklu besinler, dokuzunda (%7,8) süt, yedisinde (%6,1) daha önceki aşılamalar, öyküde etmen olarak bildirildi. En sık bildirilen reaksiyon cilt döküntüsüydü (n=89, %86,4). Sadece dokuz çocukta anafilaksi yakınması vardı. Cilt testi ve kanda alerjen spesifik IgE ölçümü ile hastaların 66’sında yumurta beyazı (%54,1) ve 25’inde (%20,5) yumurta sarısına duyarlanma saptandı. Çocukların çoğu (n=87, 71,9%) tüm 12. ay aşıları için, 21 (%17,4) çocuk sadece kızamık-kabakulak-kızamıkçık aşısı için yönlendirilmişti. Ortanca gecikme süresi kızamık-kabakulak-kızamıkçık aşısı için 20 gündü (8,7-41,2). Bir çocukta aşılamadan birkaç saat sonra ortaya çıkan döküntü dışında, diğer çocuklarda reaksiyon izlenmedi.Çıkarımlar: Yumurta alerjisi, aile hekimlerinden yönlendirilen çocukların aşılamasında en yaygın engel olarak bulundu. Yumurta ile ciddi reaksiyon tanımlayan çocuklarda dahi aşılama sonrası reaksiyon izlenmemiştir. Ciddi reaksiyon olmadığı düşünüldüğünde, ulusal aşı takviminde gecikmelerin önlenmesi için, kızamık-kabakulak-kızamıkçık aşısının aile hekimlerince uygulanmasında sakınca gözlenmemiştir.

Immunization practices in children with a history of allergies

Aim: In the presence of food allergies, especially egg allergies, primaryphysicians in Turkey avoid vaccine administration and refer children to a hospital setting. We aimed to evaluate children who had allergies or suspected allergies and were referred to our Well Child Clinic in a university hospital for vaccination.Material and Methods: Charts of all children referred to our clinic dueto concerns for allergies in the last two years, were reviewed. Demographic data, laboratory evaluation and reactions after immunization were recorded.Results: A total of 122 children with or without a confirmed diagnosis of allergies were referred by primary physicians. In the history, 50 children(43.5%) had reactions with egg, 42 (36.5%) had reactions with multiplefoods, nine (7.8%) had reactions with milk and seven (6.1%) had reactions with a previous vaccination. The most common reaction was rash (n=89, 86.4%). Nine children reported anaphylaxis. Skin testing or serum allergen specific IgE measurement revealed that 66 (54.1%) children had sensitization to egg white and 25 (20.5%) had sensitization to egg yolk. Most children (n=87, 71.9%) were referred for all the 12th-month vaccines, and 21 children were referred only for the measles-mumps-rubella vaccine (n=21, 17.4%). The median delay time in the administration of the measles-mumps-rubella vaccine was 20.0 (interquartile range: 8.7-41.2) days. No reaction was observed except for one child reporting a slight rash several hours after vaccination.Conclusion: Egg allergy was the most common barrier of vaccine administration in children referred from family physicians. Given the absence of any reactions, we support the administration of the measles-mumps-rubella vaccine in primary care settings to prevent delays in national vaccine schedule.

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