Characteristics and Treatment of Anaphylaxis in Children Visiting a Pediatric Emergency Department in Korea

Evaluation of the triggers and the treatment models of anaphylaxis in pediatric patients

OBJECTIVE

Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction. We aimed to evaluate the demographic and clinical characteristics of patients presenting with anaphylaxis, as well as triggers and risk factors, and to determine the rate of adrenaline auto-injector (AAI) usage.

METHODS

The study was planned in the pediatric allergy outpatient clinic over a 1-year period. The data of children diagnosed with anaphylaxis were evaluated retrospectively; demographic characteristics, causes of anaphylaxis, and treatment modalities were recorded in the created study form.

RESULTS

Eighty children (29 females) with a median age of 6.5 years (range: 1 month-17 years) were evaluated. The most common triggers were foods under 2 years of age (73%), and drugs (70%) above 2 years of age. Nearly half of the anaphylaxis episodes (n=41, 51.3%) occurred at home. Cutaneous and respiratory symptoms were the most commonly reported complaints (98.8%). The median age of the patients at the first attack with severe anaphylaxis (n=29, 36.3%) was significantly higher than the rest (p:0.007). The age at onset of the reaction (p:0.006) and occurrence of the reaction in hospital conditions (p<0.001) were determined to be significant risk factors for severe anaphylaxis. Most of them received antihistamines (95.7%) and corticosteroids (91.3%), while 78.3% received adrenaline. Only 9.5% of patients with recurrent episodes of anaphylaxis used AAIs.

CONCLUSION

Foods in infants and drugs in older children were the leading causative allergens of anaphylaxis. The most common clinical manifestations were respiratory and cutaneous symptoms. The older age at onset of the reaction and the occurrence of the reaction in hospital conditions were determined to be significant risk factors for severe anaphylaxis. It was determined that the frequency of AAI use was low among patients and their families.

L-asparaginase activity and anti-L-asparaginase antibody as biomarkers in estimating PEG-asp-related anaphylaxis risk in childhood acute lymphoblastic leukemia patients

BACKGROUND

L-Asparaginase (L-asp), the unconjugated form of polyethylene glycol-conjugated L-asparaginase (PEG-asp), regulates T cell stimulation, antibody production, and lysosomal protease activity to mediate PEG-asp-related anaphylaxis. This study aimed to investigate the relation of L-asp activity and anti-L-asp antibody with anaphylaxis risk and non-anaphylaxis adverse reaction risk in childhood acute lymphoblastic leukemia (ALL) patients who underwent PEG-asp contained therapy.

METHODS

In total, 170 childhood ALL patients underwent PEG-asp-contained treatment and their L-asp activity and anti-L-asp antibody were detected on the 7^th day after treatment initiation.

RESULTS

There were 27 (15.9%) patients who had PEG-asp-related adverse reaction: 17 (10.0%) patients experienced PEG-asp-related anaphylaxis and 14 (8.2%) patients experienced PEG- asp-related non-anaphylaxis adverse reaction. Moreover, L-asp activity was negatively related to anti-L-asp antibody in childhood ALL patients (P<0.001). Elevated L-asp activity was associated with the absence of PEG-asp-related anaphylaxis (P<0.001), PEG-asp-related non-anaphylaxis adverse reaction (P=0.004), and PEG-asp-related adverse reaction (P<0.001). However, the anti- L-asp antibody displayed opposite trend similar to L-asp activity. Receiver operating characteristic (ROC) curve analyses exhibited L-asp activity and anti-L-asp antibody exhibited superior predictive values in estimating PEG-asp-related anaphylaxis risk with area under curve (AUC) of 0.955 and 0.905, respectively compared to PEG-asp-related non-anaphylaxis adverse reaction risk with AUC of 0.730 and 0.675, respectively. Besides, patients with de novo disease, higher risk stratification, and allergic history showed trends linked with PEG-asp-related anaphylaxis risk.

CONCLUSION

The monitoring of L-asp activity and anti-L-asp antibody maybe useful for early estimation and prevention of PEG-asp-related anaphylaxis in childhood ALL management.

Anaphylaxis in Children and Adolescents: Greek Data Analysis from the European Anaphylaxis Registry (NORA)

The European Anaphylaxis Registry (NORA) was designed in order to create a comprehensive Anaphylaxis Registry regarding anaphylactic reactions characteristics and management in several European countries, including Greece. This study aims to analyze Greek data obtained in the NORA framework and describe anaphylaxis’ characteristics in this pediatric cohort. An online questionnaire was filled out by the Allergy Unit of the 2nd Pediatric Department of NKUA, regarding reported anaphylaxis characteristics. A total of 284 pediatric patients were analyzed. Patients were predominantly male. A previous, mild reaction (59.5%) to the same allergen was documented in 44.4% of patients. The most common system involved was skin and/or mucosa, followed by the respiratory system. Food was the most common eliciting factor (82.4%). First line treatment was most administered solely by a healthcare professional, followed by a lay person (38.7%). Auto injected adrenaline use by lay persons was third in frequency (29.2%). Most patients received post-reaction counseling and appropriate drug prescription. This study provides insight in anaphylactic cases’ characteristics and management in a Greek pediatric cohort. A low rate of adrenaline autoinjector administration was noted in lay people; however, drug prescription and counseling following the reaction could help increase correct acute anaphylaxis management in the future.

Pediatric Anaphylaxis: Etiology and Predictive Factors in an Emergency Setting

Anaphylaxis is a serious allergic life-threatening condition that needs immediate treatment to prevent unfavorable outcomes. The present study revealed that the prevalence of anaphylaxis in children increased with age and the adolescent group has the most frequent anaphylaxis events. Food-induced anaphylaxis was the most common cause of anaphylaxis in pediatric population. This etiology revealed a significant correlation with a known history of food allergy in the study population, P = .029. Anaphylaxis from insect stings associated with cardiovascular symptoms, P < .001 and inclined to be severe. Univariate analysis showed predicted probability of severe anaphylaxis increased with age with an odds ratio of 1.1. This finding strengthens and supports the view that physicians should be aware of severe anaphylaxis reactions in older age group when there is a documented history of insect sting. The overall pediatric anaphylaxis patients in the study population had favorable outcomes. The authors recommended at least 24 hours hospital observation in order to observe biphasic reaction in pediatric anaphylaxis especially in adolescent age group.

Association Between Allergen Sensitization and Anaphylaxis in Patients Visiting a Pediatric Emergency Department

Background and Objectives: Anaphylaxis, a severe allergic disease, can be triggered by various causes. This study investigated the association between allergic sensitization and anaphylactic symptoms and the severity of anaphylaxis in children. Patients and Methods: A retrospective review of 107 pediatric patients with anaphylaxis was performed between January 1, 2015, and December 31, 2017; 74 patients underwent allergen testing for specific immunoglobulin E. Allergic sensitizations and associations with anaphylactic symptoms and severity were investigated. Results: Overall, 64 (86.5%) patients were sensitized to food or inhalant allergens. In children under 2 years of age, 90.5% were sensitized to food (P = 0.001); in those over 6 years of age, 84.6% were sensitized to inhalant allergens (P = 0.001). Milk sensitization was significantly associated with severe anaphylaxis (P = 0.036). The following symptoms showed significant associations with certain allergen sensitizations: facial edema with food; wheezing with milk; dyspnea with mite, etc. Certain allergen sensitizations presenting as risk factors for anaphylactic symptoms: wheat (adjusted odds ratio [aOR] = 4.644, P = 0.044) and nuts (aOR=3.614, P = 0.041) for wheezing, nuts (aOR=5.201, P = 0.026) for dyspnea, and milk (aOR=4.712, P = 0.048) for vomiting. Conclusion: The allergen sensitization status differed according to the age of the children experiencing anaphylaxis. The severity, symptoms, and signs of anaphylaxis differed depending on the allergen sensitization status.