Keywords
Pediatrics
Epinephrine
How to Cite
Plaudit
Abstract
Objective: To clinically characterize the events of anaphylaxis in a third-level pediatric hospital.
Methods: 1148 clinical records were reviewed. Eventually, the information of 35 events of anaphylaxis in 20 patients was analyzed; three of them had multiple episodes of anaphylaxis.
Results: The median age for the anaphylactic episodes was 11 years (Interquartile range 10 years, Q1 = 5, Q3 = 15), predominantly in adolescents between the ages of 12 and 17 years, and there was a slight predominance in women. The most frequent clinical manifestations were cutaneous (86%), followed by respiratory (83%), cardiovascular (74%), and gastrointestinal (46%) alterations. Cardiac arrest was documented in three episodes; however, no anaphylaxis-related deaths were reported. The main triggers for anaphylaxis were food (34%), medications (29%), allergen-specific immunotherapy (14%), and latex (11%). In patients with perioperative anaphylaxis, the clinical behavior was severe. Epinephrine was administered in 27 out of the 35 events (77%), but only in 11 cases it was the first-line treatment. Systemic corticosteroids were the most frequently used treatment, followed by epinephrine and antihistamines.
Conclusions: The use of epinephrine, which is the mainstay of the treatment, is suboptimal; with a preferred use of second-line medications like corticosteroids. Clear protocols for the diagnosis and treatment of anaphylaxis, as well as continuous education of health personnel, are necessary.
References
Moore LE, Kemp AM, Kemp SF. Recognition, treatment, and prevention of anaphylaxis. Immunol Allergy Clin North Am. 2015;35(2):363-374. DOI: 10.1016/j.iac.2015.01.006
Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Khan DA, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. DOI: 10.1016/j.jaci.2020.01.017
Douglas DM, Sukenick E, Andrade WP, Brown JS. Biphasic systemic anaphylaxis: an inpatient and outpatient study. J Allergy Clin Immunol. 1994;93(6):977-985. DOI: 10.1016/s0091-6749(94)70044-3
Cardona V, Álvarez-Perea A, Ansotegui IJ, Arias-Cruz A, González-Díaz SN, Latour-Staffeld P, et al. Manejo de la anafilaxia en América Latina: situación actual. Rev Alerg Mex. 2017;64(2):171-177. DOI: 10.29262/ram.v64i2.250
Sampson HA, Muñoz-Furlong A, Bock SA, Schmitt C, Bass R, Chowdhury BA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol. 2005;115(3):584-591. DOI: 10.1016/j.jaci.2005.01.009
Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández-Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026-1045. DOI: 10.1111/all.12437
Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-397. DOI: 10.1016/j.jaci.2005.12.1303
Actualizaciones de la CIE-10 [Internet]. Organización Panamericana de la Salud/Organización Mundial de la Salud; 2013. Disponible en:https://www3.paho.org/hq/index.php?option=com_content&view=article&id=9178:2013-actualizaciones-cie-10&Itemid=40350&lang=es
Yu JE, Lin RY. The epidemiology of anaphylaxis. Clin Rev Allergy Immunol. 2018;54(3):366-374. DOI: 10.1007/s12016-015-8503-x
Motosue MS, Bellolio MF, van Houten HK, Shah ND, Campbell RL. Increasing emergency department visits for anaphylaxis, 2005-2014. J Allergy Clin Immunol Pract. 2017;5(1):171-175. DOI: 10.1016/j.jaip.2016.08.013
Campbell RL, Hagan JB, Manivannan V, Decker WW, Kanthala AR. Bellolio MF, et al. Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients. J Allergy Clin Immunol. 2012;129(3):748-752. DOI: 10.1016/j.jaci.2011.09.030
Samady W, Trainor J, Smith B, Gupta R. Food-induced anaphylaxis in infants and children. Ann Allergy Asthma Immunol. 2018;121(3):360-365. DOI: 10.1016/j.anai.2018.05.025
Simons FER. Anaphylaxis. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S161-S181. DOI: 10.1016/j.jaci.2009.12.981
Grabenhenrich LB, Dölle S, Moneret-Vautrin A, Köhli A, Lange L, Spindler T, et al. Anaphylaxis in children and adolescents: the European Anaphylaxis Registry. J Allergy Clin Immunol. 2016;137(4):1128-1137.e1. DOI: 10.1016/j.jaci.2015.11.015
Tejedor-Alonso MA, Moro-Moro M, Múgica-García MV. Epidemiology of anaphylaxis: contributions from the last 10 years. J Investig Allergol Clin Immunol. 2015;25(3):163-175; quiz follow 174-175. Disponible en: http://www.jiaci.org/issues/vol25issue3/1.pdf
Simons FER, Ardusso LR, Bilò MB, Cardona V, Ebisawa M, El-Gamal YM, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9. DOI: 10.1186/1939-4551-7-9
Wang J, Sampson HA. Food anaphylaxis. Clin Exp Allergy. 2007;37(5):651-660. DOI: 10.1111/j.1365-2222.2007.02682.x
Hompes S, Köhli A, Nemat K, Scherer K, Lange L, Rueff F, et al. Provoking allergens and treatment of anaphylaxis in children and adolescents--data from the anaphylaxis registry of German-speaking countries. Pediatr Allergy Immunol. 2011;22(6):568-574. DOI: 10.1111/j.1399-3038.2011.01154.x
Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract. 2017;5(5):1169-1178. DOI: 10.1016/j.jaip.2017.06.03
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