Page 112 - Abstract Book KONIKA 18

Allergy Immunology

P-AI-019
COVID 19 and Systemic Lupus Erythematosus: A Case Series

M Riefky Kusdhany, R.A Myrna Alia, Edy Novery, Yusmala Helmy
Department of Child Health, Faculty of Medicine Universitas Sriwijaya/Dr. Mohammad Hoesin General Hospital,
Palembang, South Sumatera, Indonesia
Abstract
Background Systemic lupus erythematosus (SLE) causes immune dysregulation, such as the formation of
autoantibodies. These and the use of immunosuppressants in SLE patients may cause clinical worsening of
COVID-19. Objective To describe the clinical outcome of children with SLE and COVID-19 coinfection.
Cases Patient 1: 10.6 years old girl, newly diagnosed SLE. She had fever, cough and psychosis during
hospitalization. The SARS-CoV-2 PCR result was positive (CT: 14.45). The patient received favipiravir for
five days and methylprednisolone pulse. Cough and fever resolved in 2 days, psychosis improved in 10 days.
PCR result remained positive until 20 days. She was discharged after 32 days of hospitalization, then lost to
follow up. Patient 2: 13 years old boy, previously diagnosed with NPSLE for five months. He experienced
respiratory distress, fever and new rash (SLEDAI score 22). Chest X-Ray showed bilateral patchy infiltrate,
and the SARS-CoV-2 PCR test was positive (CT: 35.33). He was treated in ICU for nine days. We continued
the methylprednisolone pulse dose but postponed cyclophosphamide. All clinical problems were resolved,
and PCR result became negative within 15 days. Patient 3: 16 years old girl, previously diagnosed with
nephritis lupus for five months, complained of cough with positive SARS-CoV-2 PCR result (CT: 15.15).
We continued the routine administration of methylprednisolone and oral mycophenolic acid. Cough resolved
in 2 days, and PCR result became negative within 30 days.Conclusion From the three cases above, SLE and
immunosuppressant drugs do not appear to cause clinical deterioration in COVID-19.
Keywords: systemic lupus erythematous; COVID-19; immunosuppressants; outcomes

P-AI-020
Open Oral Food Challenge Test for Diagnosing Cow’s Milk Protein Allergy in
Children: A Case Series

Priyanti Kisworini, Nia Kurniati, Dina Muktiarti
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital,
Jakarta, Indonesia
Abstract
Background The gold standard of diagnosing cow’s milk protein allergy (CMPA) is double-blind placebo
controlled challenge, which is not routinely done. In clinical practice, open oral food challenge (OFC) test
is more frequently used. Objective To report of OFC test of cow’s milk allergy in outpatient clinic at Cipto
Mangunkusumo Hospital, from April to June 2021. Cases Four patients, age ranged from 4 months to 2 years
5 months old with diagnosis of CMPA underwent OFC for cow’s milk. The symptoms of CMPA were profuse
vomiting (case 1), frequent coughing mucus and vomiting (case 2), vomiting and diarrhoea (case 3), restless
and flushing (case 4). In case 1 OFC was used to determine tolerance while in cases 2-4 for diagnosis. The
OFC’s protocol was started with skin prick test followed by CM challenge. Standard formula was used,
started with 1 drop and increased gradually to the patient’s drinking ability in 3 hours. Case 1 passed the
test, case 2 experienced anaphylaxis, case 3 and 4 had diarrhoea and vomiting. We manage all the symptoms
appropriately. Conclusions The OFC should be used to diagnose CMPA or to determine the tolerance. It
should be done under doctor’s supervision in hospital with the preparation of anaphylaxis reaction.
Keywords: cow’s milk protein allergy; children; oral food challenge

64 KONIKA XVIII Abstract Book