Anaphylaxis in children and adolescents: The European Anaphylaxis Registry

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:137

Article

Grabenhenrich, Linus B.¹  Doelle, Sabine²  Moneret-Vautrin, Anne⁴  Koehli, Alice⁵  Lange, Lars⁶  Spindler, Thomas⁷  Rueff, Franziska⁸  Nemat, Katja⁹  Maris, Ioana¹⁰  Roumpedaki, Eirini¹¹  Scherer, Kathrin¹²  Ott, Hagen¹³  Reese, Thomas¹⁴  Mustakov, Tihomir¹⁵  Lang, Roland¹⁶  Fernandez-Rivas, Montserrat¹⁷  Kowalski, Marek L.¹⁸  Bilo, Maria B.¹⁹  Hourihane, Jonathan O'B.¹⁰  Papadopoulos, Nikolaos G.¹¹  Beyer, Kirsten^3,20  Muraro, Antonella²¹  Worm, Margitta² 

[1] Charite, Inst Social Med Epidemiol & Hlth Econ, Charitepl 1, D-10117 Berlin, Germany

[2] Charite, Dept Dermatol & Allergy, Charitepl 1, D-10117 Berlin, Germany

[3] Charite, Dept Pediat Pneumol & Immunol, Charitepl 1, D-10117 Berlin, Germany

[4] Univ Hosp Nancy, Allergy Vigilance Network, Nancy, France

[5] Univ Childrens Hosp Zurich, Div Allergol, Zurich, Switzerland

[6] St Marien Hosp, Dept Pediat, Bonn, Germany

[7] Lungenzentrum Sud West, Pediat Pneumol & Allergol, Wangen Im Allgau, Germany

[8] Univ Munich, Dept Dermatol & Allergol, Munich, Germany

[9] Kinderzentrum Dresden Friedrichstadt, Pediat Pneumol & Allergol, Dresden, Germany

[10] Natl Univ Ireland Univ Coll Cork, Dept Paediat & Child Hlth, Cork, Ireland

[11] Univ Athens, Dept Allergy, Athens, Greece

[12] Univ Basel Hosp, Dept Dermatol, CH-4031 Basel, Switzerland

[13] Childrens Hosp Bult, Pediat Dermatol & Allergol, Hannover, Germany

[14] Mathias Spital, Rheine Kinderklin, Rheine, Germany

[15] Med Univ Sofia, Univ Hosp Alexandrovska, Clin Ctr Allergol, Sofia, Bulgaria

[16] Paracelsus Med Privatuniv Salzburg, Dept Dermatol, Salzburg, Austria

[17] Hosp Clin San Carlos IdISSC, Dept Allergy, Madrid, Spain

[18] Med Univ Lodz, Dept Immunol Rheumatol & Allergy, Lodz, Poland

[19] Osped Riuniti, Univ Hosp, Allergy Unit, Dept Internal Med, Ancona, Italy

[20] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[21] Padua Gen Univ Hosp, Dept Mother & Child Hlth, Padua, Italy

关键词: Anaphylaxis;    arthropod venoms;    drug hypersensitivity;    epinephrine;    food hypersensitivity;    registries;   

DOI  :  10.1016/j.jaci.2015.11.015

来源: Elsevier

【 摘 要 】

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 long-term 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.

【 授权许可】

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