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Pediatric anaphylaxis: triggers, clinical features, and treatment in a tertiary-care hospital
Wiparat Manuyakorn1, Suwat Benjaponpitak, Wasu Kamchaisatian
1Division of Pediatrics Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Anaphylaxis in Thai children is rising, with food and drugs as common triggers. Less epinephrine use was linked to severe or biphasic reactions, highlighting the need for better management strategies.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Clinical Epidemiology
Background:
- Anaphylaxis is a critical, potentially fatal condition with limited data on its characteristics in Asian pediatric populations.
- Understanding the specific triggers and clinical course of anaphylaxis in Thai children is crucial for effective public health interventions.
Purpose of the Study:
- To investigate the primary causes, clinical manifestations, treatment patterns, and overall outcomes of anaphylaxis among children in Thailand.
- To analyze trends in anaphylaxis incidence and identify factors associated with severe or biphasic reactions.
Main Methods:
- A retrospective review of medical records for pediatric patients diagnosed with anaphylaxis between 2004 and 2013 at Ramathibodi Hospital, Bangkok.
- Data analysis included incidence rates, trigger identification, treatment modalities, and outcomes such as biphasic or severe anaphylaxis.
Main Results:
- Anaphylaxis incidence increased significantly in Thai children from 2004-2013. Common triggers included food (34.92%), drugs (33.1%), and blood products (23.8%).
- Intramuscular epinephrine was underutilized in cases of biphasic (OR 0.08) and severe anaphylaxis (OR 9.36). No fatalities were reported.
- Associations were found between anaphylaxis triggers and atopic history, and between severe anaphylaxis and cardiovascular involvement.
Conclusions:
- The incidence of pediatric anaphylaxis is increasing in Thailand, often occurring without prior known trigger reactions.
- Underuse of intramuscular epinephrine correlates with biphasic and severe anaphylaxis, indicating a need for improved treatment protocols.
- Enhanced understanding of anaphylaxis patterns in children can lead to improved clinical management and patient outcomes.
Background:
Anaphylaxis is a life-threatening condition. There are limited data about its etiology and clinical characteristics in Asian children with anaphylaxis.
Objective:
To investigate triggers, presenting symptoms, treatment and clinical course of anaphylaxis in Thai children.
Method:
Medical record of children who were diagnosed with anaphylaxis between 2004 and 2013 at Ramathibodi Hospital, Bangkok, Thailand were reviewed.
Results:
One hundred-seventy two episodes of anaphylaxis occurred in 160 children (91 boys, 69 girls) aged 3 months to 18 years. Anaphylaxis increased from 2.7 cases/1000 pediatric admission to 4.51 cases/1000 pediatric admission between 2004-2008 and 2009-2013. The main causes were food (34.92%), drug (33.1%), blood components (23.8%), insect sting (9%), and unidentified causes (2.8%). Allergy to the triggers was known prior to anaphylaxis in 42 episodes (24.6%). Treatment consisted of epinephrine intramuscularly (93.8%), corticosteroids (92.5%), H₁antihistamines (96%), H₂antihistamines (50%), and β₂agonists nebulization (35.1%). Biphasic anaphylaxis occurred in 8.7% of the documented episodes and severe anaphylaxis in 34.3% of the documented episodes. Biphasic anaphylaxis and severe anaphylaxis were associated with fewer administrations of intramuscular epinephrine (OR 0.08 [95% CI 0.014-0.43]; p =0.01 and OR 9.36 [95% CI 2.5-34.7]; p <0.001 respectively). There were no fatality cases. There were associations between triggers of anaphylaxis and atopic histories, patients with severe anaphylaxis and cardiovascular involvement (p <0.01).
Conclusions:
The incidence of anaphylaxis in Thai children is increasing. Anaphylaxis in children commonly occurred without the histories of prior reaction to the causative agent. Less frequent treatment with intramuscular epinephrine was associated with biphasic and severe anaphylaxis. A better knowledge of patterns and causes of anaphylaxis might contribute to a better management.
