BACKGROUND: There is limited literature in the management of chronic urticaria in children. Treatment algorithms are generally extrapolated from adult studies. OBJECTIVE: Utility of a weight and age-based algorithm for antihistamines in management of chronic spontaneous urticaria (CSU) in childhood. To document associated factors that predict for step of control of CSU and time taken to attain control of symptoms in children. METHODS: A workgroup comprising of allergists, nurses, and pharmacists convened to develop a stepwise treatment algorithm in management of children with CSU. Sequential patients presenting to the paediatric allergy service with CSU were included in this observational, prospective study. RESULTS: Ninety-eight patients were recruited from September 2012 to September 2013. Majority were male, Chinese with median age 4 years 7 months. A third of patients with CSU had a family history of acute urticaria. Ten point two percent had previously resolved CSU, 25.5% had associated angioedema, and 53.1% had a history of atopy. A total of 96.9% of patients achieved control of symptoms, of which 91.8% achieved control with cetirizine. Fifty percent of all the patients were controlled on step 2 or higher. Forty-seven point eight percent of those on step 2 or higher were between 2 to 6 years of age compared to 32.6% and 19.6% who were 6 years and older and lesser than 2 years of age respectively. Eighty percent of those with previously resolved CSU required an increase to step 2 and above to achieve chronic urticaria control. CONCLUSION: We propose a weight- and age-based titration algorithm for different antihistamines for CSU in children using a stepwise approach to achieve control. This algorithm may improve the management and safety profile for paediatric CSU patients and allow for review in a more systematic manner for physicians dealing with CSU in children.
Adult ; Angioedema ; Asian Continental Ancestry Group ; Cetirizine ; Child ; Histamine Antagonists ; Humans ; Hypersensitivity ; Male ; Pharmacists ; Prospective Studies ; Urticaria

BACKGROUND: Cyclooxygenase-2 (COX-2) inhibitors have been found to be safe alternatives in adults with cross-intolerant hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). However they are usually not prescribed in children and there is little information about their tolerance in the pediatric age group. OBJECTIVE: This study aims to evaluate the tolerance to etoricoxib in children with hypersensitivity to multiple antipyretics. METHODS: A retrospective case series of children diagnosed with hypersensitivity reactions to NSAIDs and/or paracetamol who underwent a drug provocation test (DPT) with etoricoxib. Information on atopy, family history of allergic diseases, and medication usage was collected. Outcomes of the DPTs and tolerance to etoricoxib were also evaluated. RESULTS: A total of 24 children, mean age 13.5 years, had a diagnosis of cross-intolerant hypersensitivity to NSAIDs and/or paracetamol. All except one patient successfully tolerated an oral challenge with etoricoxib. Of those who passed the DPT, the majority continued to use etoricoxib with no problems. It was found to be moderately effective in reducing fever and pain. CONCLUSION: Etoricoxib can be used as a safe alternative in older children with hypersensitivity to multiple antipyretics.
Acetaminophen ; Adult ; Anti-Inflammatory Agents, Non-Steroidal ; Antipyretics ; Child ; Cyclooxygenase 2 ; Diagnosis ; Drug Hypersensitivity ; Fever ; Humans ; Hypersensitivity ; Retrospective Studies

Background/Aims: Depression and anxiety are associated with poorer outcomes in patients with hepatocellular carcinoma (HCC). However, the prevalence of depression and anxiety in HCC are unclear. We aimed to establish the prevalence of depression and anxiety in patients with HCC. Methods: MEDLINE and Embase were searched and original articles reporting prevalence of anxiety or depression in patients with HCC were included. A generalized linear mixed model with Clopper-Pearson intervals was used to obtain the pooled prevalence of depression and anxiety in patients with HCC. Risk factors were analyzed via a fractional-logistic regression model. Results: Seventeen articles involving 64,247 patients with HCC were included. The pooled prevalence of depression and anxiety in patients with HCC was 24.04% (95% confidence interval [CI], 13.99–38.11%) and 22.20% (95% CI, 10.07–42.09%) respectively. Subgroup analysis determined that the prevalence of depression was lowest in studies where depression was diagnosed via clinician-administered scales (16.07%;95% CI, 4.42–44.20%) and highest in self-reported scales (30.03%; 95% CI, 17.19–47.01%). Depression in patients with HCC was lowest in the Americas (16.44%; 95% CI, 6.37–36.27%) and highest in South-East Asia (66.67%; 95% CI, 56.68–75.35%). Alcohol consumption, cirrhosis, and college education significantly increased risk of depression in patients with HCC. Conclusions One in four patients with HCC have depression, while one in five have anxiety. Further studies are required to validate these findings, as seen from the wide CIs in certain subgroup analyses. Screening strategies for depression and anxiety should also be developed for patients with HCC.

Occupational therapists have a significant role in driving rehabilitation by helping clients with disabilities to return to driving. To date, the services for driving rehabilitation are still limited in Malaysia. Furthermore, the current practice of driving rehabilitation in Malaysia is still underreported. Therefore, this study aims to assess occupational therapists’ challenges, attitudes, and skills towards driving rehabilitation, the sociodemographic differences, and associations between the developed constructs. A cross-sectional study was conducted from June to September 2020. A convenience sampling method was used to recruit 177 occupational therapists with at least one year of working experience in Malaysia. The questionnaire consists of three constructs: the challenges, attitudes, and skills related to driving rehabilitation. The content validity of the questionnaire was good (S-CVI/Ave= 0.992; S-CVI/UA= 0.950; modified kappa= 0.812 to 1.000). Based on the Exploratory Factor Analysis (EFA), three items had been deleted due to low communalities. The Cronbach’s alpha for all constructs was acceptable (Cronbach’s alpha > 0.7). Experience in practicing driving rehabilitation, workplace settings, and educational level had significant differences in at least one of the constructs. Age and years graduated had a significant positive correlation with skills. This questionnaire proved to be a tool with good content validity and reliability to assess occupational therapists’ challenges, attitudes, and skills related to driving rehabilitation. In the future, qualitative studies are recommended to better understand the occupational therapists towards driving rehabilitation, especially from their personal experience.