You're in:

Anaphylaxis in children: A nine years retrospective study (2001–2009)

Silva, R.; Gomes, E.; Cunha, L.; Falcão, H.

Published in Allergol Immunopathol (Madr). 2012;40:31-6. - vol.40 núm 01

English: [ Abstract | Full text | PDF ]

Abstract

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). Food was the most frequently identified cause (n=57), followed by drugs (n=8), hymenoptera venom (n=2), and cold (n=1). In five cases there was no identifiable cause. Among foods, cow's milk was the culprit agent in 27 children. The most severe reaction was a cardiorespiratory arrest. The most frequent symptoms were respiratory and cutaneous in 51 cases. Hypotension was present in nine cases. There were no fatalities. Most acute reactions were treated with corticosteroids and/or antihistamines. Adrenaline was used in only about one quarter of children.

Conclusions

The most important causes of anaphylaxis in our study were foods, and the most common symptoms were respiratory and cutaneous. The prevalence of anaphylaxis was higher in males and, in two thirds of patients there was a history of atopy. Despite being the primary and most important treatment for anaphylaxis, adrenaline is still used in only a minority of these cases.

Key words: Adrenaline. Anaphylaxis. Children. Systemic allergic reaction.

Introduction

Background Anaphylaxis is an acute multisystemic and potentially fatal reaction, resulting from the rapid release of inflammatory mediators by mast cells and basophils, and occurs when a susceptible person is exposed to a certain agent. The severity of the reaction can vary from mild to life threatening and can be rapidly progressive.¹^,² The earliest description on record of a fatal allergic reaction is related to Menes, a first dynasty pharaoh, who died in 2621BC, presumably from an anaphylactic shock caused by a bee sting.³ Its name comes from the Greek: a (against) and phylaxis (immunity, protection), and was proposed in 1902 by Portier and Richet.⁴ According to the latest nomenclature proposed by the World Allergy Organization, it can be classified as: allergic (immunological reaction involving IgE, IgG or immune complexes) and non-allergic (where the mechanisms involved are not immune) (Table 1).⁵ Although it may appear that IgE-mediated anaphylaxis occurs upon a first exposure to a food, drug, or insect sting, there must have been a prior, and probably unwitting, sensitisation from a previous exposure.¹ The patient, however, may not remember an uneventful sting or be aware of “hidden” allergens in foods. Table 1. Types anaphylaxis. Examples Allergic Foods Milk, egg, peanut, fish, shrimp, cereals Drugs ...

Bibliography

1. Mcgrath KG. Anaphylaxis. En: Grammer L.C., Greenberger P.A., editors. Patterson's allergic diseases. 7th ed. Lippincott Williams & Wilkins; 2009. 197-219.

2. Ogawa Y, Grant JA. Mediators of anaphylaxis. Immunol Allergy Clin North Am. 2007; 27:249-60.

Pubmed

3. Ring J. History of anaphylaxis. Allergy Clin Immunol Int. 2003; 15:144-8.

4. Portier P, Richet C. De l’action anaphylactic de certains venins. C R Soc Biol Paris. 1902; 54:170-2.

5. Johansson SGO, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et-al. A revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of World Allergy Organization. J Allergy Clin Immunol. 2004; 113:832-6.

Pubmed

6. Sampson HA, Munoz-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; 117:391-7.

Pubmed

7. Lieberman P, Camargo CA, Bohlke K, Jick H, Miller RL, Sheikh A, et-al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006; 97:596-602.

Pubmed

8. Sheikh A, Hippisley-Cox J, Newton J, Fenty J. Trends in national incidence, lifetime prevalence and adrenaline prescribing for anaphylaxis in England. J R Soc Med. 2008; 101:139-43.

Pubmed

9. Simons FE. Anaphylaxis: recent advances in assessment and treatment. J Allergy Clin Immunol. 2009; 124:625-36.

Pubmed

10. Sampson HA, Munoz-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; 115:584-91.

Pubmed

11. Kobrynski LJ. Anaphylaxis. Clin Pediatr Emerg Med. 2007; 8:110-6.

12. Kemp SF. The post-anaphylaxis dilemma: how long is long enough to observe a patient after resolution of symptoms?. Curr Allergy Asthma Rep. 2008; 8:45-8.

Pubmed

13. Tse Y, Rylance G. Emergency management of anaphylaxis in children and young people: new guidance from the Resuscitation Council (UK). Arch Dis Child Educ Pract Ed. 2009; 94:97-101.

Pubmed

14. Lin RY, Anderson AS, Shah SN, Nurruzzaman F. Increasing anaphylaxis hospitalizations in the first 2 decades of life: New York State, 1990–2006. Ann Allergy Asthma Immunol. 2008; 101:387-93.

Pubmed

15. De Silva IL, Mehr SS, Tey D, Tang MLK. Paediatric anaphylaxis: a 5 year retrospective review. Allergy. 2008; 63:1071-6.

Pubmed

16. Hoffer V, Scheuerman O, Marcus N, Levy Y, Segal N, Lagovsky I, et-al. Anaphylaxis in Israel: experience with 92 hospitalized children. Pediatr Allergy Immunol. 2011; 22:172-7.

Pubmed

17. Mehl A, Wahn U, Niggemann B. Anaphylactic reactions in children – a questionnaire-based survey in Germany. Allergy. 2005; 60:1440-5.

Pubmed

18. Novembre E, Cianferoni A, Bernardini R, Mugnaini L, Caffarelli C, Cavagni G, et-al. Anaphylaxis in children: clinical and allergologic features. Pediatrics. 1998; 101:E8.

Pubmed

19. Barzegar S, Rosita A, Pourpak Z, Bemanian M, Shokouhi R, Mansouri M, et-al. Common causes of anaphylaxis in children: the first report of anaphylaxis registry in Iran. World Allergy Organ J. 2010; 3:9-13.

20. Simons FER, Peterson S, Black CD. Epinephrine dispensing for the out-of-hospital treatment of anaphylaxis in infants and children: a population-based study. Ann Allergy Asthma Immunol. 2001; 86:622-6.

Pubmed

21. Lieberman P. Anaphylaxis and anaphylactoid reactions. En: Middleton E., Adkinson N.F., Yunginger J.W., Busse W.W., Bachner B.S., Holgate S.T., Simons F.E.R., editors. Allergy: principles and practice. 6th ed. St Louis, Missouri: Mosby-Year Book, Inc; 2003. 1497-522.

22. Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol. 2006; 97:39-43.

Pubmed

23. Lieberman P. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2008; 8:316-20.

Pubmed

24. Ben-Shoshan M, Clarke AE. Anaphylaxis: past, present and future. Allergy. 2011; 66:1-14.

Pubmed

25. Moneret-Vautrin DA. Idiopathic anaphylaxis. Eur Ann Allergy Clin Immunol. 2004; 36:13-9.

Pubmed

26. Simons FER, Sampson HA. Anaphylaxis epidemic: fact or fiction?. J Allergy Clin Immunol. 2008; 122:1166-8.

Pubmed

27. Walker DM. Update on epinephrine (adrenaline) for pediatric emergencies. Curr Opin Pediatr. 2009; 21:313-9.

Pubmed

28. Liberman DB, Teach SJ. Management of anaphylaxis in children. Pediatr Emerg Care. 2008; 24:861-6.

Pubmed

29. Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et-al. EAACI task force on anaphylaxis in children. The management of anaphylaxis in childhood: position paper of the European Academy of Allergology and Clinical Immunology. Allergy. 2007; 62:857-71.

Pubmed

30. Ott H, Lehmann S, Wurpts G, Merk HF, Viardot-Helmer A, Rietschel E, et-al. Anaphylaxis in childhood and adolescence. Hautarzt. 2007; 58:1032-40.

Pubmed

31. Soar J, Pumphrey R, Cant A, Clarke S, Corbett A, Dawson P, et-al. Emergency treatment of anaphylactic reactions – guidelines for healthcare providers. Resuscitation. 2008; 77:157-69.

Pubmed

32. Sheikh A, Shehata YA, Brown SG, Simons FE. Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. Cochrane Database Syst Rev. 2008; 157-69. Oct 8;(4):CD006312

33. Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005; 95:217-26.

Pubmed

34. Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy. 2010; 65:933-45.

Pubmed

35. Ferreira MB, Alves RR. Are general practitioners alert to anaphylaxis diagnosis and treatment?. Eur Ann Allergy Clin Immunol. 2006; 38:83-6.

Pubmed

36. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010; 125(2 (Suppl 2)):S161-181.

Pubmed

37. Cantani A. Hidden presence of cow's milk proteins in foods. J Investig Allergol Clin Immunol. 1999; 9:141-5.

Pubmed

38. Freeman TM. Clinical practice. Hypersensitivity to hymenoptera stings. N Engl J Med. 2004; 351:1978-84.

Pubmed

39. Golden DBK. Insect sting allergy and venom immunotherapy: a model and a mystery. J Allergy Clin Immunol. 2005; 115:439-47.

Pubmed

40. Burks AW, Laubach S, Jones SM. Oral tolerance, food allergy, and immunotherapy: implications for future treatment. J Allergy Clin Immunol. 2008; 121:1344-50.

Pubmed

41. Longo G, Barbi E, Berti I, Meneghetti R, Pittalis A, Ronfani L, et-al. Specific oral tolerance induction in children with very severe cow's milk-induced reactions. J Allergy Clin Immunol. 2008; 121:343-7.

Pubmed

42. Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy. 2007; 62:1261-9.

Pubmed

43. Celik W, Pichler WJ, Adkinson NF. Drug allergy. En: Adkinson N.F., Bochner B.S., Busse W.W., Holgate S.T., Lemanske R.F., Simons F.E.R., editors. Middleton's allergy: principles and practice. 7th ed. St Louis: Mosby, Inc; 2009. 1205-26.

44. Castells MC, Tennant NM, Sloane DE, Hsu FI, Barrett NA, Hong DI, et-al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol. 2008; 122:574-80.

Pubmed

Silva, R.^a; Gomes, E.^b; Cunha, L.^b; Falcão, H.^b

^aAllergy Division, Hospital S. João EPE, Porto, Portugal

^bAllergy Division, Centro Hospitalar do Porto, EPE, Hospital Maria Pia, Porto, Portugal