Anaphylaxis in Children and Adolescents: Greek Data Analysis from the European Anaphylaxis Registry (NORA) (original) (raw)
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Anaphylaxis in children and adolescents: The European Anaphylaxis Registry
Journal of Allergy and Clinical Immunology, 2016
Background: Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description. Objective: We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and longterm management in European children and adolescents. Methods: The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. Results: Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food-to insect venom-and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/ fatal reactions. Conclusions: The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.
Anaphylaxis in children: A nine years retrospective study (2001–2009)
Allergologia et Immunopathologia, 2012
Background: Anaphylaxis is an acute multisystemic and potentially fatal reaction, resulting from the rapid release of inflammatory mediators. Its exact prevalence is unknown. In children, foods are the most significant triggers for IgE-mediated anaphylaxis. Objectives: To characterise the cases of anaphylaxis evaluated in an Allergy Division of a Central Paediatric Hospital. Material and methods: A review of all cases of anaphylaxis evaluated from 2001 to 2009. Anaphylaxis was defined according to Sampson's 2006 criteria. Results: Seventy-three children had anaphylactic reactions (47 male), of which 64% had history of atopy. Age at time of reaction ranged between 17 days and 15 years old (median: four years).
Anaphylaxis in Turkish children: a multi-centre, retrospective, case study
Clinical & Experimental Allergy, 2011
Background Anaphylaxis is a serious and potentially lethal systemic reaction affecting more than one organ or system. Objective We aimed to describe the demographic characteristics, clinical features, causes, settings, and administered therapy in Turkish children. Methods This retrospective, case note study included all children referred to the outpatient clinics of the Pediatric Allergy Departments of the participating study centres from 1 July 1999 to 30 June 2009 for investigation of anaphylaxis or who were seen by us at the moment of the reaction during the same period and who met the clinical criteria of anaphylaxis. Results Two hundred and twenty-four cases of anaphylaxis were reported in 137 children (88 boys, P = 0.0001). The mean ± SD age at the referral was 7.7 ± 4.2 years (range: 4 months-17 years). Ninety-eight episodes (43.8%) occurred at home. The symptoms were cutaneous in 222 (99.1%) episodes, respiratory in 217 (96.9%), neuro-psychiatric in 118 (52.7%), cardiovascular in 92 (41.1%), and gastrointestinal in 88 (39.3%). Biphasic reaction was reported in seven episodes (3.1%, 95% CI: 1.5-6.3). Death occurred in one case (0.4%, 95% CI: 0.08-2.4). Treatment was available in 158 episodes (70.5%). Of them, 148 (93.7%) received antihistamines, 132 (83.5%) corticosteroids, 51 (32.3%) epinephrine, and 17 (10.8%) beta-2-mimetics. The causative agents were foods in 86 (38.4%) episodes, hymenoptera venom in 84 (37.5%), drugs and medications in 47 (21.0%), and latex in 5 (2.2%). In two episodes (0.9%), the causative agent was unidentified. Allergy to the trigger was known prior to anaphylaxis in 116 (51.8%) episodes. An epinephrine autoinjector had been prescribed for 70 children (51.1%). Conclusions and Clinical Relevance Anaphylaxis was seen significantly more in boys. Most of the reactions occurred at home. Foods were the most frequent cause. Epinephrine, the first-line treatment of anaphylaxis, was administered in only a third of the children.
Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece
Allergologia et immunopathologia, 2024
Background: Anaphylaxis proportions of incidence are increasing globally. However, limited data are available regarding anaphylaxis in the pediatric population of Greece. Purpose: The aim of the study was to evaluate management of anaphylaxis in Greek pediatric departments. Methods: We performed a questionnaire-based study of children aged less than 16 years presenting with anaphylaxis in 10 national pediatric hospitals over a period of 2 years. Management of anaphylaxis was assessed prior to and after an informative intervention.
Epidemiological and Clinical Features of Anaphylaxis: Single Center Experience with 109 Children
Pediatric Allergy, Immunology, and Pulmonology, 2013
There has been increasing data on pediatric anaphylaxis. In this study, we aim to determine demographics and atopic status of patients, etiology, and clinical feature of anaphylaxis, its management and follow-up over the 9year period. We made a retrospective medical chart review of patients diagnosed as anaphylaxis in the Pediatric Allergy and Asthma Department of Gazi University Hospital between January 2003 and May 2012. Diagnosis of anaphylaxis was reviewed by 2 pediatric allergists and those compatible with the criteria according to the second symposium on the definition and management of anaphylaxis were included in the analysis. During the study period, 109 patients (66 male, 43 famale) were diagnosed with anaphylaxis. The median age was 72 months. Fourteen patients (12.8%) had more than one episode before diagnosis. Anaphylactic episode was severe in 28 patients (25.7%). Cutaneous symptoms were the most frequent symptoms (91.7%). Blood pressure measurement had been done in 47 patients (43.1%). Treatment of anaphylaxis included antihistamines in 105 patients (96.3%), corticosteroids in 101 patients (92.7%), and adrenaline in 50 patients (45.9%). The most common cause of anaphylaxis differed according to age groups: food in infants (85%), drugs in older children (43.8%). Sixty-six patients were prescribed autoinjector. In follow-up, 10 patients (9.2%) experienced a second episode of anaphylaxis. Nine of them had adrenaline autoinjector, 3 of them carried the autoinjector with them but only one patient used it. Major etiologic factors of anaphylaxis differed according to the age of children. There were inadequancies in management of anaphylaxis related to physicians, such as blood pressure measurement and acute treatment of anaphylaxis in medical centers and related to patients as uncompliances to carry and use adrenaline autoinjector.
Pediatric anaphylaxis: triggers, clinical features, and treatment in a tertiary-care hospital
Asian Pacific Journal of Allergy and Immunology, 2015
Background: Anaphylaxis is a life-threatening condition. There are limited data about its etiology and clinical characteristics in Asian children with anaphylaxis. Objective: To investigate triggers, presenting symptoms, treatment and clinical course of anaphylaxis in Thai children. Method: Medical record of children who were diagnosed with anaphylaxis between 2004 and 2013 at Ramathibodi Hospital, Bangkok, Thailand were reviewed. Results: One hundred-seventy two episodes of anaphylaxis occurred in 160 children (91 boys, 69 girls) aged 3 months to 18 years. Anaphylaxis increased from 2.7 cases/1000 pediatric admission to 4.51 cases/1000 pediatric admission between 2004-2008 and 2009-2013. The main causes were food (34.92%), drug (33.1%), blood components (23.8%), insect sting (9%), and unidentified causes (2.8%). Allergy to the triggers was known prior to anaphylaxis in 42 episodes (24.6%). Treatment consisted of epinephrine intramuscularly (93.8%), corticosteroids (92.5%), H 1 antihistamines (96%), H 2 antihistamines (50%), and β 2 agonists nebulization (35.1%). Biphasic anaphylaxis occurred in 8.7% of the documented episodes and severe anaphylaxis in 34.3% of the documented episodes. Biphasic anaphylaxis and severe anaphylaxis were associated with fewer administrations of intramuscular epinephrine (OR 0.08 [95%CI0.014-0.43]; p =0.01and OR 9.36 [95%CI2.5-34.7]; p <0.001 respectively). There were no fatality cases. There were associations between triggers of anaphylaxis and atopic histories, patients with severe anaphylaxis and cardiovascular involvement (p <0.01). Conclusions: The incidence of anaphylaxis in Thai children is increasing. Anaphylaxis in children commonly occurred without the histories of prior reaction to the causative agent. Less frequent treatment with intramuscular epinephrine was associated with biphasic and severe anaphylaxis. A better knowledge of patterns and causes of anaphylaxis might contribute to a better management.
Anaphylaxis in children: clinical and allergologic features
…, 1998
Objective. To evaluate the clinical and allergologic features of anaphylaxis in children referred to the allergology and immunology unit of A. Meyer Children's Hospital (Florence, Italy) from 1994 to 1996. Results. Ninety-five episodes of anaphylaxis occurred in 76 ...
Journal of investigational allergology & clinical immunology, 2015
To contrast the initial suspected etiology of anaphylaxis with the postworkup diagnosis in patients attended at the emergency department (ED) of a tertiary-level hospital in Spain and to investigate the incidence, causes, and management of anaphylaxis. We performed an observational study of patients aged more than 15 years who came to the ED with anaphylaxis between 2009 and 2010. All clinical records from the ED were reviewed. We recorded data on clinical management, the etiology proposed by the attending emergency physician, and the cause reported by the patient. The findings were compared with the diagnosis reached after the allergy workup. The incidence of anaphylaxis was 0.08%. The most common manifestation was skin-mucosal symptoms (98.3%). Anaphylaxis was diagnosed in the ED in only 44% of the cases, regardless of severity. Only 39.7% received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity. A total of 60...
Turkish Journal of Medical Sciences
Background/aim: Childhood anaphylaxis presents with a heterogeneous clinic. Elicitors and epidemiologic factors associated with anaphylaxis differ with age, geographic location and lifestyle. This study aimed to determine the clinical features and age-specific patterns of childhood anaphylaxis in a single referral center in Turkey. Materials and methods: We conducted a retrospective study of anaphylaxis in children aged between 0 and 18 years of age, attending an allergy department in a children's hospital. Results: A total of 95 children diagnosed with anaphylaxis were analyzed. Among all, 35.8% of the first anaphylaxis episodes occurred in infancy and 57.9% in preschool age. Foods were the most common culprits (57.9%) and followed by drugs (15.8%). Patients with foodinduced anaphylaxis were younger in age (p < 0.001). Food-related anaphylaxis was most common with cow's milk (36.4%) and followed by tree nuts (20%). Cow's milk played a significant role as a trigger in infancy, and tree nuts as a trigger in preschoolers and school-age children. Mucocutaneous manifestations were almost universally present (94.7%), followed by respiratory compromise (56.8%), with gastrointestinal (55.8%), cardiovascular (9.5%), and neurologic (4.2%) symptoms being less common. Respiratory and cardiovascular system-related symptoms were found more frequently in school-age children (p = 0.02 and p = 0.014, respectively). The severity of anaphylaxis was higher in school-age children (p = 0.015). Conclusion: Findings reveal that children diagnosed with anaphylaxis differ in terms of etiological and clinical findings according to age groups. This difference shows the dynamically changing clinic of anaphylaxis over time and the importance of evaluating childhood anaphylaxis according to age groups.