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Clinical evaluation of pediatric anaphylaxis and the necessity for multiple doses of epinephrine

Naoyuki Inoue1, Asuka Yamamoto

  • 1Department of Pediatrics, Inagi Municipal Hospital, 1171 Omaru, Inagi, Tokyo 206-2801, Japan.

Asia Pacific Allergy
|May 14, 2013
PubMed

Insights

Children needing multiple epinephrine injections for anaphylaxis may experience biphasic reactions and syncope. Extended observation is recommended for these high-risk pediatric patients.

Area of Science:

  • Pediatric Allergy and Immunology
  • Emergency Medicine
  • Clinical Pediatrics

Background:

  • Intramuscular epinephrine is the primary treatment for anaphylaxis.
  • Occasional repeat dosing is necessary for severe or prolonged reactions.

Purpose of the Study:

  • To investigate the clinical characteristics of anaphylaxis in children.
  • To identify factors associated with severe anaphylaxis and biphasic reactions.
  • To improve the management and prognosis of pediatric anaphylaxis.

Main Methods:

  • Retrospective analysis of 61 pediatric patients diagnosed with anaphylaxis (April 2009-March 2012).
  • Criteria used: National Institute of Allergy and Infectious Diseases (NIAID) Food Allergy and Anaphylaxis Network guidelines.
  • Data collected on epinephrine dosage, symptoms, comorbidities, and reaction patterns.

Main Results:

  • 52.5% received one epinephrine dose; 4.9% received multiple doses.
  • Multiple epinephrine doses were associated with increased syncope (p=0.049) and comorbid allergic diseases (p=0.043).
  • Biphasic reactions occurred in 3.3% and were linked to syncope, vomiting, and multiple epinephrine doses (p=0.0016).

Conclusions:

  • Children requiring multiple epinephrine doses may be at higher risk for biphasic anaphylaxis.
  • Recommend 24-hour observation for pediatric patients receiving more than one epinephrine injection.
  • Findings aid in refining anaphylaxis management protocols for children.
Abstract

Keywords:
AnaphylaxisBiphasic anaphylaxisChildrenEpinephrine

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