Çocuk Acil Servisinde Anafilaksi Hastalarının Klinik ve Tedavi Özelliklerinin Değerlendirilmesi

Abstract

Amaç: Anafilaksi bir alerjenle karşılaşıldıktan sonra aniden başlayan; ağır ve hayatı tehdit edebilen, çoklu sistemi etkileyen bir alerjik reaksiyondur. Anafilaksinin başarılı yönetimi; anafilaksinin hızlı tanınması ve epinefrin ile derhal tedavi edilmesini içerir. Acil servisler anafilaksi yönetiminde hayati rol oynar. Bu çalışmanın amacı üçüncü basamak bir eğitim araştırma hastanesinin çocuk acil polikliniğine anafilaksi nedeniyle başvuran hastaların demografik, klinik ve laboratuvar özelliklerini değerlendirmektir.

Gereç ve Yöntem: Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji ve Onkoloji Eğitim Araştırma Hastanesi Çocuk Acil Polikliniği’ne 5 yıllık sürede (2014-2019) ‘anafilaksi’ tanı kodu verilmiş hastaların klinik ve laboratuvar bilgilerine geriye dönük olarak dosya kayıtlarından ulaşıldı. Anafilaksi tetikleyicileri, epinefrin uygulamaları, epinefrin otoenjektör reçete edilme oranı, klinik bulgular, hastaneye yatış oranı ve hastanede/acilde kalış süresi değerlendirildi.

Bulgular: Çalışmaya alınan 40 hastanın 25’i (%62,5) erkek, ortalama yaşları 9,9±6,2 yıldı. Hastaların 33’ünde muhtemel bir alerjen ile temas öyküsü vardı. En sık muhtemel alerjen (13 hasta) besin idi. Hastaların tümüne epinefrin uygulanmıştı. Başvuru anında 36 hastada cilt-mukoza, 26 hastada solunum sistemi, 22 hastada gastrointestinal sistem ve 4 hastada kardiyovasküler sistem belirti ve bulguları vardı. Hastaların altısında besin, beşinde ilaç, ikisinde arı venom ve birinde inhalan (polen ve küf) alerji öyküsü vardı. Önceden anafilaksi öyküsü olan yedi hastanın epinefrin otoenjektörü vardı; beşi başvuru öncesinde otoenjektör ile epinefrin uygulamıştı. Hastaların hastanede kalış süresi ortalama 25,5 ± 5,9 saat olup hiçbir hastada bifazik reaksiyon gelişmemişti. 29 hastaya eve gönderilirken epinefrin otoenjektör reçete edilmişti.

Sonuç: Çocuklarda anafilaksinin en sık tetikleyicisi besinlerdir. Acil servislerde tedavinin ilk basamağında epinefrin uygulanması ve taburculukta epinefrin otoenjektör reçete edilmesi çok önemlidir.

Keywords

• çocuk
• acil
• anafilaksi

Evaluation of clinical and therapeutic characteristics of patients with anaphylaxis at the pediatric emergency department

Abstract

Aim: Anaphylaxis is a severe, life-threatening, and multisystemic allergic reaction that develops suddenly after exposure to an allergen. Successful management of anaphylaxis includes rapid recognition of anaphylaxis and immediate treatment with epinephrine. Emergency departments are vital in the management of anaphylaxis. The purpose of this study was to evaluate the demographic, clinical and laboratory characteristics of patients with anaphylaxis who presented to the pediatric emergency department of a tertiary training and research hospital.

Materials and Methods: Clinical and laboratory data of patients who presented to the Pediatric Emergency Department of Ankara Pediatrics, Hematology and Oncology Training and Research Hospital within a five-year period (2014-2019) were retrieved retrospectively via hospital records. Triggers of anaphylaxis, administration of epinephrine, prescription rate of epinephrine autoinjectors, clinical findings, hospitalization rates and length of hospital or emergency department stay were evaluated.

Results: Among the 40 patients enrolled, 25 (62.5%) were male, and the mean age was 9.9±6.2 years. 33 patients had probable exposure to an allergen. The most common (13 patients) probable allergen was foods. Epinephrine had been administered to all patients. At the time of presentation, 36 patients had cutaneous-mucosa, 26 had respiratory, 22 had gastrointestinal and four had cardiovascular involvement. History of allergy to foods, drugs, bee venom, and inhalants (pollen and mold) was present in six, five, two an one patient, respectively. Seven patients with previous history of anaphylaxis had epinephrine autoinjectors, five of whom had used their autoinjectors prior to presentation. Mean length of hospital stay was 25.5±5.9 hours, and no biphasic reactions were observed. 29 patients were prescribed an epinephrine autoinjector upon discharge.

Conclusion: Foods are the most common triggers of anaphylaxis in children. At emergency departments, it is very important to administer epinephrine as the first-line treatment and prescribe epinephrine autoinjector upon discharge.

Keywords

• Anaphylaxis
• Child
• Emergency

References

1. Lee J, Rodio B, Lavelle J, Lewis MO, English R, Hadley S ve ark. Improving Anaphylaxis Care: The Impact of a Clinical Pathway. Pediatrics 2018;141:e20171616.
2. Sicherer SH, Simons Fer; Section on allergy and immunology. Epinephrine for First-aid Management of Anaphylaxis. Pediatrics 2017;139:e20164006.
3. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A ve ark. Second symposium on the definition and management of anaphylaxis: summary report--second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med2006;47:373-80.
4. Fazıl Orhan, Ersoy Civelek, Ümit Murat Şahiner. Anafilaksi: Türk Ulusal Rehberi 2018;16 (Ek sayı): 1 Nisan 2018.
5. Selar DA, Lieberman PL. Anaphylaxis: underdiagnosed, underreported, and undertreated. Am J Med 2014;127:S1-5.
6. Choi B, Kim SH, Lee H. Missed Registration of Disease Codes for Pediatric Anaphylaxis at the Emergency Department. Emerg Med Int 2019;2019:4198630.
7. Huang F, Chawla K, Jarvinen KM, Nowak-Wegrzyn A. Anaphylaxis in a New York City pediatric emergency department: triggers, treatments, and outcomes. J Allergy Clin Immunol 2012;129:162-168.e1-3.
8. Sidhu N, Jones S, Perry T, Thompson T, Storm E, Melguizo Castro MS, Nick TG. Evaluation of Anaphylaxis Management in a Pediatric Emergency Department. Pediatr Emerg Care 2016;32:508-13.

9. Timoty E. Dribin, Richard M. Ruddy. Chapter 85 Allergic Emergencies. In: Shaw KH, Bachur RG (eds) Fleisher and Ludwig’s Textbook of Pediatric Emergency Medicine 8th ed. Wolters and Kluwer: Philadelphia 2016: 1440-60.
10. Wright CD, Longjohn M, Lieberman PL, Lieberman JA. An analysis of anaphylaxis cases at a single pediatric emergency department during a 1-year period. Ann Allergy Asthma Immunol 2017;118:461-4.
11. Cohen N, Capua T, Pivko D, Ben-Shoshan M, Benor S, Rimon A. Trends in the diagnosis and management of anaphylaxis in a tertiary care pediatric emergency department. Ann Allergy Asthma Immunol 2018;121:348-52.
12. Yunginger JW, Nelson DR, Squillace DL, Jones RT, Holley KE, Hyma BA ve ark. Laboratory investigation of deaths due to anaphylaxis. J Forensic Sci 1991;36:857-65.
13. Muraro A, Roberts G, Worm M, Bilo MB, Brockow K, Fernández Rivas M ve ark. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy 2014;69:1026-45.
14. Alqurashi W, Ellis AK. Do Corticosteroids Prevent Biphasic Anaphylaxis? J Allergy Clin Immunol Pract. 20175:1194-205.
15. Alvarez-Perea A, Ameiro B, Morales C, Zambrano G, Rodríguez A, Guzmán M ve ark. Anaphylaxis in the Pediatric Emergency Department: Analysis of 133 Cases After an Allergy Workup. J Allergy Clin Immunol Pract 2017;5:1256-63.