Risk Factors for Severe Anaphylaxis in Children

Olabarri, Mikel; Vázquez, Patricia; González-Posada, Aranzazu; Sanz, Núria; González‐Peris, Sebastià; Díez, Nuria; Vinuesa, Ana; Martínez-Indart, Lorea; Benito, Javier; Mintegi, Santiago

doi:10.1016/j.jpeds.2020.06.021

Cited by 21 publications

(26 citation statements)

References 25 publications

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“…Having cardiovascular symptoms such as hypotension and tachycardia may indicate severe anaphylaxis. 22 The present study revealed that cardiovascular symptoms found were more frequent in anaphylaxis from insect stings compared to other causes, P < .001, Figure 2. Anaphylaxis to insect stings has occurred in 3% of adults and can be fatal even on the first reaction.…”

Section: Discussionsupporting

confidence: 47%

Pediatric Anaphylaxis: Etiology and Predictive Factors in an Emergency Setting

Uppala

Phungoen

Mairiang

et al. 2021

Global Pediatric Health

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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.

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Section: Discussionsupporting

confidence: 47%

Pediatric Anaphylaxis: Etiology and Predictive Factors in an Emergency Setting

Uppala

Phungoen

Mairiang

et al. 2021

Global Pediatric Health

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“…Most guidelines recommend ‘immediately calling 911/112’ after adrenaline injection. However, given that biphasic reactions are rare (0.6%‐14.7%), that reactions requiring a second dose of adrenaline are infrequent (12%‐19%), 10 and the results of a cost‐effective analysis, new US recommendations during the COVID‐19 pandemic, suggest that patients experiencing anaphylaxis should watch and observe for the response to adrenaline 11 . If symptoms do not promptly resolve after adrenaline, EMS should be activated.…”

Section: Total N = 149 (100%) Adrenaline Used N = 71 (48%) Adrenaline Not Used N = 78 (52%) Pmentioning

confidence: 99%

Factors associated with the underuse of adrenaline in children with anaphylaxis

Pouessel

Antoine

Piérache

et al. 2021

Clin Experimental Allergy

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To the Editor, Intramuscular adrenaline injection is the first-line treatment of anaphylaxis. 1 More serious and even fatal or biphasic reactions may occur if there is a delay in administering it. 1 Adrenaline injection for anaphylaxis that occurs outside of a healthcare setting should be immediately followed by a call to emergency medical services (EMSs) ('911' in North America, '112' in Europe). 1 Before discharge from the emergency care unit (ECU), an adrenaline autoinjector (AAI) should be prescribed with clearly written instructions for its use and safety recommendations. 1 Despite international guidelines and education about the treatment of anaphylaxis, adrenaline is underused by caregivers and healthcare professionals. This study aimed to understand the factors associated with the underuse of adrenaline in children experiencing anaphylaxis. Preliminary results of this study focusing on the clinical outcome of the anaphylaxis manifestations have been previously reported. 2 All children (≤15 years) admitted for anaphylaxis (2015-2017) to one of 18 paediatric ECUs in the Nord-Pas-de-Calais region of France were prospectively included. Diagnosis of anaphylaxis was based on the criteria proposed by the National Institute of Allergy and Infectious Disease (NIAID)/Food Allergy and Anaphylaxis Network symposium. 3 All medical records were reviewed by an

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“…Meanwhile, Johnson & Johnson/Janssen COVID-19 vaccine, AstraZeneca severe acute respiratory syndrome coronavirus 2 adenovirus carrier vaccine, and several influenza vaccines (Fluarix quad and Flulaval Quad) contain polysorbate 80. 56,57 Although anaphylaxis after vaccination is rare in all age groups, this immediate-onset and life-threatening condition require adequate medical professionals and supplies to treat potential anaphylactic reactions during vaccination procedures.…”

Section: Vaccine-induced Anaphylaxismentioning

confidence: 99%

“…Current mRNA vaccines (Pfizer-BioNTech and Moderna COVID-19 vaccines) contain PEG components such as 2(PEG2000)-N,N-ditetradecylacetamide and PEG2000 dimyristoyl glycerol, respectively, which have been reported as the causes of COVID-19–induced anaphylaxis. Meanwhile, Johnson & Johnson/Janssen COVID-19 vaccine, AstraZeneca severe acute respiratory syndrome coronavirus 2 adenovirus carrier vaccine, and several influenza vaccines (Fluarix quad and Flulaval Quad) contain polysorbate 80 [ 56 , 57 ]. Although anaphylaxis after vaccination is rare in all age groups, this immediate-onset and life-threatening condition require adequate medical professionals and supplies to treat potential anaphylactic reactions during vaccination procedures.…”

Section: Common Types Of Anaphylaxismentioning

confidence: 99%

Recent update on the management of anaphylaxis

et al. 2021

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Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.

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Risk Factors for Severe Anaphylaxis in Children

Cited by 21 publications

References 25 publications

Pediatric Anaphylaxis: Etiology and Predictive Factors in an Emergency Setting

Pediatric Anaphylaxis: Etiology and Predictive Factors in an Emergency Setting

Factors associated with the underuse of adrenaline in children with anaphylaxis

Recent update on the management of anaphylaxis

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