Anaphylaxis in Israel: Experience with 92 hospitalized children

Abstract

Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved.

Anafilaksijos Dažnis, Rizikos Veiksniai Ir Diagnostika

“…atvejų anafilaksijos priežastis lieka neaiški [12]. Maistas yra dažniausia anafilaksinės reakcijos priežastis vaikams, paaugliams ir jauniems suaugusiesiems [1,2,13,14,15]. Vabzdžių įgėlimai ir medikamentai dažniau pasitaiko vidutinio ir vyresnio amžiaus žmonėms [1,2].…”

Cutaneous and Systemic Mastocytosis in Children: A Risk Factor for Anaphylaxis?

“…Regarding hymenoptera allergy, additional studies reported a higher prevalence and more significant reactions in male patients with mastocytosis in both pediatric and adult populations [17,20,91,94]. In a pediatric study of venom-sensitive children, serum IgE and baseline serum tryptase were higher in children with a large local reaction compared to controls.…”

“…Symptoms, in decreasing frequency, are cutaneous, cardiovascular, respiratory, gastrointestinal, and neurologic. Although in both adults and children cutaneous reactions are most common, adults tend to experience more cardiovascular symptoms as opposed to respiratory and gastrointestinal symptoms in children (Table 1) [2,7,16,18,20,21]. In addition, infants may have less gastrointestinal symptoms than older children and more subtle symptoms such as drooling and pruritus [8].…”

“…The major triggers of anaphylaxis in adults are drugs, food, and venom [11••, 12, 27], respectively, whereas in children the major triggers are food, drugs, venom, and unknown causes (Table 2) [2,3,15,17,18,20,21,29]; interestingly, galactose-α-1,3 galactose sensitivity, and delayed anaphylaxis recently documented in children has not be reported in children with mastocytosis [30].…”

Epidemiology of anaphylaxis

“…Several studies worldwide mention food products as the main etiologic agent for anaphylaxis. [39][40][41][42][43][44][45] Food allergies are also related to a higher occurrence of anaphylaxis. 46 Besides food per se, there are other substances contained in food products, which can be hard to identify, and may be the real cause of allergic reaction, such as mites, [47][48][49] parasites (Anisakis simplex), 50 food additives, 51 and foods that cross-react with other already identified products.…”