Anaphylaxis in children and adolescents: The European Anaphylaxis Registry
Anaphylaxis in children and adolescents: The European Anaphylaxis Registry
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DOI：
10.1016/j.jaci.2015.11.015
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发表时间：
2016-04-01
影响因子：
14.2
通讯作者：
Worm, Margitta
中科院分区：
文献类型：
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作者：
Grabenhenrich, Linus B.;Doelle, Sabine;Worm, Margitta
背景：儿童和青少年的过敏反应是一种潜在的危及生命的疾病。其不同的临床表现和在几乎任何情况下突然发生而没有警告的情况阻碍了全面的描述。目的：我们试图从诱因、症状、紧急治疗和长期管理等方面描述欧洲儿童和青少年的严重过敏反应。方法：欧洲过敏反应登记处记录了转诊到欧洲10个国家90个三级过敏中心中的1个进行深入诊断和咨询后的过敏反应细节，目的是对最严重的反应进行过抽样。结果：在2007年7月至2015年3月期间，1970名年龄在18岁以下的患者出现过敏反应。大多数事件发生在私人住宅(46%)和户外(19%)。三分之一的患者以前经历过过敏反应。食物是最常见的诱因(66%)，其次是昆虫毒液(19%)。前2年以牛奶和鸡蛋为主，学龄前儿童以榛子和腰果为主，各年龄段均以花生为主。从食物到昆虫毒液和药物引起的过敏反应一直持续到10岁，此后几乎没有变化。呕吐和咳嗽是生命最初十年的常见症状，主观症状(恶心、喉咙紧绷和头晕)在以后的生活中普遍存在。30%的患者接受了治疗，其中10%的患者使用肾上腺素自动注射器进行治疗。在专业急救中，肌肉内肾上腺素的比例从2011年的12%上升到2014年的25%。26例(1.3%)患者住进重症监护病房或出现IV级/致命性反应。结论：欧洲过敏反应登记处证实食物是儿童过敏反应的主要诱因，尤其是鸡蛋、牛奶和坚果。对昆虫毒液的反应更多地出现在年轻的成年期。重症监护病房入院和IV级/致命反应很少见。登记册将作为持续描述这一多种情况的系统基础。
Background: 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.