FATAL AND NEAR-FATAL ANAPHYLACTIC REACTIONS TO FOOD IN CHILDREN AND ADOLESCENTS
FATAL AND NEAR-FATAL ANAPHYLACTIC REACTIONS TO FOOD IN CHILDREN AND ADOLESCENTS
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DOI：
10.1056/nejm199208063270603
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发表时间：
1992-08-06
影响因子：
158.5
通讯作者：
ROSEN, JP
中科院分区：
文献类型：
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作者：
SAMPSON, HA;MENDELSON, L;ROSEN, JP
背景与方法。儿童和青少年因食物发生致命或接近致命的过敏反应的报告很罕见。我们确定了6名因食物过敏反应死亡的儿童和青少年，以及7名险些死亡并需要插管的儿童和青少年。除1例外，所有病例都发生在14个月内的三个大都市地区之一。我们的调查包括查阅急救医疗报告、病历、事件目击者的证词，以及对家长（和一些患者）的访谈。
结果。在13名儿童和青少年（年龄范围为2至17岁）中，12人患有得到良好控制的哮喘。所有人都已知有食物过敏，但在不知情的情况下摄入了导致过敏反应的食物。过敏反应由花生（4名患者）、坚果（6名患者）、鸡蛋（1名患者）和牛奶（2名患者）引起，这些食物都包含在糖果、饼干和糕点等食物中。6名死亡患者在摄入过敏原后3至30分钟内出现症状，但只有2人在第一小时内接受了肾上腺素治疗。所有幸存患者在摄入过敏原后5分钟内出现症状，除1人外，所有人都在30分钟内接受了肾上腺素治疗。7名患者的过敏反应过程迅速进展且为单相型；3名为双相型，有一个相对无症状的间隔期；3名为迁延型，需要插管3至21天。
结论。儿童和青少年会发生危险的食物过敏反应。未能认识到这些反应的严重性以及未能及时给予肾上腺素会增加致命结果的风险。
Background and Methods. Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients).Results. Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days.Conclusions. Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.