Anaphylaxis in children and adolescents: The European Anaphylaxis Registry

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• 作者：Linus B. Grabenhenrich ; MD ; MPH^a ; Sabine Dö ; lle ; PhD^b ; Anne Moneret-Vautrin ; MD^c ; Alice Kö ; hli ; MD^d ; Lars Lange ; MD^e ; Thomas Spindler ; MD^f ; Franziska Ruë ; ff ; MD^g ; Katja Nemat ; MD^h ; Ioana Maris ; MDⁱ ; Eirini Roumpedaki ; MD^j ; Kathrin Scherer ; MD^k ; Hagen Ott ; MD^l ; Thomas Reese ; MD^m ; Tihomir Mustakov ; MDⁿ ; Roland Lang ; PhD^o ; Montserrat Fernandez-Rivas ; MD^p ; Marek L. Kowalski ; MD ; PhD^q ; Maria B. Bilò ; MD^r ; Jonathan O'B. Hourihane ; MDⁱ ; Nikolaos G. Papadopoulos ; MD^j ; Kirsten Beyer ; MD^s ; ^t ; Antonella Muraro ; MD^u ; Margitta Worm ; MD^b ; ^{margitta.worm@charite.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Anaphylaxis ; arthropod venoms ; drug hypersensitivity ; epinephrine ; food hypersensitivity ; registries
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：137
• 期：4
• 页码：1128-1137.e1
• 全文大小：433 K

文摘

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.