Significant predictive factors of the severity and outcomes of the first attack of acute angioedema in children

Abstract

BackgroundThe initial episode of angioedema in children can be potential life-threatening due to the lack of prompt identification and treatment. We aimed to analyze the factors predicting the severity and outcomes of the first attack of acute angioedema in children.MethodsThis was a retrospective study with 406 children (< 18 years) who presented in the emergency department (ED) with an initial episode of acute angioedema and who had subsequent follow-up visits in the out-patient department from January 2008 to December 2014. The severity of the acute angioedema was categorized as severe (requiring hospital admission), moderate (requiring a stay in the short-term pediatric observation unit [POU]), or mild (discharged directly from the ED). The associations among the disease severity, patient demographics and clinical presentation were analyzed.ResultIn total, 109 (26.8%) children had severe angioedema, and the majority of those children were male (65.1%). Most of the children were of preschool age (56.4%), and only 6.4% were adolescents. The co-occurrence of pyrexia or urticaria, etiologies of the angioedema related to medications or infections, the presence of respiratory symptoms, and a history of allergies (asthma, allergic rhinitis) were predictors of severe angioedema (all p < 0.05). Finally, the duration of angioedema was significantly shorter in children who had received short-term POU treatment (2.1 ± 1.1 days) than in those who discharged from ED directly (2.3 ± 1.4 days) and admitted to the hospital (3.5 ± 2.0 days) (p < 0.001).ConclusionThe co-occurrence of pyrexia or urticaria, etiologies related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predictors of severe angioedema. More importantly, short-term POU observation and prompt treatment might be benefit for patients who did not require hospital admission.

Pediatric urticaria in the Emergency Department: epidemiological characteristics and predictive factors for its persistence in children

“…In this study, we analyzed epidemiologic data of children with AU admitted to ED; also, we evaluated several significant factors that may predict the severity of an initial episode of AU in children and its progression to a chronic form. AU is a common cause of admission of children to the ED, and it is estimated to affect 15%-25% of people at some point in their life (4, 6), commonly adult females (7,8). In a register-based study, Ghazanfar et al (9) recently documented that women were more frequently diagnosed with urticaria than men, probably because men are less likely to seek medical attention than women.…”