Background:The first-line method in the diagnosis of patients who describe an immediate reaction after penicillin intake is skin tests(ST)with penicillin reagents. We aimed to determine the safety and diagnostic value of penicillin STs in the diagnosis of immediate reactions to penicillins. Methods:The study included patients with suspected immediate reaction to penicillin who were subjected to STs using a standard penicillin test kit (Diater;Madrid,Spain) and suspected penicillin and drug provocation tests(DPT) with suspected penicillin at our clinic Results:A total of 191 patients(53.9%males)with a median age of 6.83 years(inter-quartile range:4.2-12)were included in the study.The time from drug intake to the onset of reaction was ≤1 hour in 138(72.3%)patients and 1 to 6 hours in 53(27.7%)patients.Penicillin allergy was confirmed by diagnostic tests in 36(18.8%)of 191 patients.In multivariate logistic regression analysis, history of both urticaria and angioedema(odds ratio[OR]:27,683 95%confidence interval[CI]:3.143-243.837,p = 0.003) and anaphylaxis (OR:56.246, 95%CI:6.598-479.489, p <0.001) were main predictors of penicillin allergy diagnosis. While STs were positive in 23(63.8%)patients, 13(26.2%)patients had positive DPT results despite negative ST results. The negative predictive value(NPV)of STs was calculated 92.2% (155/168).None of our patients experienced immediate or delayed systemic/local reactions in relation to the STs. Conclusions:History of urticaria with and anaphylaxis were main predictors of true penicillin allergy in children with suspected immediate reactions.Skin tests with penicillin reagents are safe for use in children. Although STs have a high NPV, DPT is the gold standard for diagnosis. Drug provocation tests should be performed as the final step of the diagnostic evaluation of penicillin allergy in patients with negative STs

Background Guidelines as Global Initiative for Asthma(GINA) recommend disease control as the mainstay of asthma management. The performance of the tools assessing in asthma control is challenging in real-life. Methods Children and adolescents with asthma followed at a tertiary research hospital were enrolled in the study after evaluation of adherence to treatment. Asthma Control Test(ACT)/Pediatric Asthma Control Test(PACT), Pediatric Asthma Quality of Life Quesstionnaire(PAQLQ), fractional exhaled nitric oxide(FeNO) and lung function were evaluated. Patients were examined by asthma specialists blinded to the results of the tools and their control status were evaluated based on GINA. Results The median age(interquartile range,IQR) of the patients was 10.7(8.4-12.9) years, 57.9% were boys. Of 228 children, 84.2%, 9.6% and 6.1% had “well-controlled”, “partially-controlled” and “uncontrolled” asthma, respectively. The patients with “partially-controlled “ and “uncontrolled” asthma were grouped as “not well-controlled”. The cut-off levels were 22, 21 and 5.9 for PACT, ACT and PAQLQ for determining “well-controlled” asthma(p<0.001). With these cut-off values, ACT had the higher compatibility with GINA than PACT and PAQLQ(κ=0.221, 0.473 and 0.150, respectively, p<0.001). Correctly classified patients with PACT, ACT and PALQLQ based on GINA with these cut-off levels were 93(64.1%), 63(75.9%) and 139(62.9%), respectively. FeNO and lung function were unsuccessful at revealing control status according to GINA. Conclusion ACT is better than PACT at compatibility with GINA. Probably, it is because older children have a longer recall period than younger ones. It would be better to use these tools for each patient by comparing their own scores in real-life, instead of cut-off values.