First of all, it is important to distinguish children who get sick frequently from healthy children who have natural infections. Healthy children under the age of 5 with a normal immune system may experience upper respiratory tract infection (URTI) 4-9 times a year. This frequency increases up to 12 times a year in people living in crowded environments such as nurseries. However, if there are certain characteristics in children with recurrent infections, further examination should be performed in these patients. These are:
Lack of complete recovery with appropriate antibiotic treatments
Need for prolonged antibiotic treatments
Infections progress more severely than expected
Infection becomes chronic
However, there may be some factors that predispose some children to frequent illnesses.
Immune system is not fully developed: Infections may be more common at young ages due to the development of some protective antibodies in the immune system with age
Inappropriate environmental factors: Crowded home environment, at home Exposure to smoking, inappropriate health and nutrition conditions, frequent contact with sick children in nursery and school environments, having siblings of school age
Allergic diseases
Anatomical defects of the upper and lower respiratory tracts
Gastroesophageal reflux
It is important to investigate the presence of such factors in children who are frequently ill. But what is really vital is to understand whether a child who gets sick frequently has immunodeficiency. Primary immunodeficiencies are diseases with different clinical and immunological features that occur as a result of genetic errors in any component of the immune system. Early diagnosis of these diseases is lifesaving. For the early diagnosis of these diseases, 10 warning signs for primary immunodeficiency diseases were published by the Jeffrey Modell Foundation in 1993, by taking expert opinions. These are:
1. 4 or more ear infections in a year
2. 2 or more sinus infections in a year
3. 2 or more pneumonias in one year
4. 2 or more deep tissue infections, infection with opportunistic microorganisms
5. 2 a y or longer use of antibiotics
6. Need for intravenous antibiotic use to cure infection
7. Recurrent skin, deep tissue or organ abscesses
8. Long-lasting fungal infection in the mouth or skin
9. Growth and development retardation
10. Family history of immunodeficiency
Patients with these characteristics should be examined for immunodeficiency.
If we look at allergic diseases that predispose to infections; Asthma and allergic rhinitis are common respiratory allergic diseases in childhood. There are different patterns of relationships between infections and allergic diseases. The first of these; It is the "protective" feature of infections against allergic diseases. For this purpose, the "Hygiene hypothesis" has also been put forward. According to this hypothesis; In the last century, the shrinking of the family structure, the improvement in domestic comfort, and the increase in personal hygiene standards have reduced cross-infections among younger members of the family. This may cause allergic diseases to become common. Frequent infections that have decreased during childhood may be protective against allergic diseases that may develop in the future. Another relationship model is that infections increase the risk of allergic diseases that may develop in the future (Provocative relationship). There is an increased risk of allergic diseases, especially asthma, especially after Rhinovirus and Respiratory Syncytial Virus infections during infancy. Another type of relationship, although not directly related to infection, is the relationship between the intestinal microbiome and allergic diseases (microbiome hypothesis), which has been investigated in recent years. These studies have shown that there is a relationship between bacterial diversity and density in the intestine and allergic diseases in the future.
The relationship between infection and allergy has been investigated in people with allergic diseases, especially asthmatics. These studies have shown that allergic individuals have many immunological abnormalities and dysfunctions in both the innate immune system and the acquired immune system. It is especially important that there is a deterioration in the Interferon response against viral infections. Often Although there is an increase in viral infections, it has also been shown that there is an increase in susceptibility to infections, especially of bacterial pathogens of the respiratory tract. In addition to increased sensitivity to microbial pathogens in the immune system, allergic patients experience deterioration in the respiratory tract epithelium due to chronic inflammation. Accordingly, it becomes easier for infectious agents to pass into the sub-epithelial tissues. In this case, it is one of the important factors in the increase of infections.
Allergic rhinitis; It is an immunoglobulin E-mediated inflammatory disease of the nose, characterized by recurrent runny nose, congestion, postnasal drip, sneezing, and itching in the nose. Children with allergic rhinitis may have a cough, especially when going to bed at night and when they wake up in the morning. Similar findings may occur in upper respiratory tract infections. These two conditions can be confused and these patients are often given antibiotic treatments. Children with frequently recurring such complaints, whose complaints last longer than 1-2 weeks, and who have a family history of allergic diseases should be evaluated by a pediatric allergist for allergic rhinitis. With correct diagnosis and treatment of allergic rhinitis, unnecessary antibiotic use will be prevented.
Recurrent viral respiratory infections are common in children, especially in autumn and winter. These infections are mostly upper respiratory tract infections. In some children, respiratory infections that begin with cough, runny nose and congestion can lead to wheezing, shortness of breath and rapid breathing. Steam treatments are given to these patients. Further examination should be performed in patients with recurring such diseases.
For the reasons explained above, children with allergic diseases are more prone to respiratory infections. Flu; It is an infectious respiratory disease mostly caused by viruses of the Influenza genus. While it can heal without causing any complications in healthy people, it can cause serious complications, including death, in the elderly and those with chronic diseases such as asthma. Flu; worsening of existing diseases such as bacterial pneumonia, dehydration, sinus diseases, ear infections and asthma It may lead to complications such as bleeding. Respiratory infections such as influenza last longer and are more serious in children with allergic diseases. In asthmatics, flu can cause deterioration in respiratory functions, worsening of asthma symptoms, deterioration in asthma control and asthma attacks. In addition, school absenteeism in children causes workforce loss in their parents.
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