Çocuklarda Anafilaktik Reaksiyonların Özellikleri: Çocuk Alerji Kliniği Bulguları

Abstract

ÖZET Amaç: Anafilaksi, hızla gelişen çoklu sistem tutulumu ile karakterize, şiddetli ve potansiyel olarak yaşamı tehdit edici bir aşırı duyarlılık reaksiyonudur. Anafilaksi öyküsü olan hastaların klinik özellikleri sistematik olarak değerlendirilerek, çocuklarda yaşamı tehdit eden bu durumun epidemiyolojisi ve klinik spektrumu hakkında değerli bilgiler edinebiliriz. Gereç ve Yöntemler: Ocak 2016- Aralık 2022 tarihleri arasında Çocuk Alerji Polikliniği' ne ‘anafilaktik şok, tanımlanmamış’ tanısı ile başvuran 0-18 yaş arası hastalar ile ilgili veriler geriye yönelik taranmış, anafilaksi öyküsü olan 186 hasta çalışmaya dahil edilmiştir. Hastaların tanı yaşı, cinsiyeti, alerji öyküsü, anafilaksiyi tetikleyen muhtemel alerjen öyküsü, anafilakside görülen klinik bulgular çalışma kapsamında değerlendirilmiştir. Bulgular: Hastaların %55,4'ü erkek, medyan yaş 5,0/yıl idi. Anafilaksi tetikleyicisi muhtemel alerjenler hastaların %41,9’unda besin, %40,3’ünde ilaç, %7,5’inde arı venomu, %10,2’sinde idiopatikti. Besinlerin içerisinde en sık kuruyemiş (%35,9), ilaçların içerisinde en sık antibiyotikler muhtemel alerjenlerdi. Hastaların %24,7’ sinde öncesinde bilinen alerji öyküleri vardı. Hastaların %85,5’inde solunum sistemi, %82,3’ünde deri-mukoza, %50’sinde gastrointestinal sistem ve %4,3’ünde kardiyovasküler sistem tutulumu gözlendi. Sonuçlar: Anafilaksi hastalarının klinik özelliklerinin değerlendirilmesi, çocuklarda bu karmaşık aşırı duyarlılık reaksiyonuna yönelik anlayışımızı ve klinik yaklaşımımızı geliştirmede büyük önem taşımaktadır. Bu sayede anafilaktik reaksiyonların tanısını, doğru yönetimini ve önlenmesini optimize etmeyi ve sonuçta çocuklar için daha iyi sağlık sonuçları ve daha iyi yaşam kalitesi hedeflenebilir.

Keywords

• Anafilaksi
• ilaç alerjisi
• adrenalin
• gıda kaynaklı anafilaksi

Characteristics of Anaphylactic Reactions in Children: Findings from a Pediatric Allergy Clinic

Abstract

Abstract Background/Aims: Anaphylaxis is a severe and potentially life-threatening hypersensitivity reaction characterized by rapidly developing multisystem involvement. By systematically evaluating the clinical features of anaphylaxis patients, we can obtain valuable information about the epidemiology and clinical spectrum of this life-threatening condition in children. Materials and Methods: Between January 2016 and December 2022, data regarding patients aged 0-18 years who presented to the Pediatric Allergy Clinic with the diagnosis of 'unspecified anaphylactic shock' were retrospectively screened, and a total of 186 patients with a history of anaphylaxis were included in the study. The patients' age at diagnosis, gender, allergy history, the potential allergen-causing anaphylaxis, and clinical manifestations during anaphylactic episodes were evaluated as part of the study. Results: Of the patients, 55.4% were male, and the median age was 5.0 years. The probable allergen triggering anaphylaxis was food in 41.9% of patients, drugs in 40.3%, bee venom in 7.5%, and idiopathic in 10.2%. Among food triggers, tree nuts were the most common (35.9%), while antibiotics were the most common probable allergens among drugs. 24.7% of the patients had a known allergy history. Respiratory system involvement was observed in 85.5% of the patients, skin-mucosa involvement was observed in 82.3%, gastrointestinal system involvement was observed in 50%, and cardiovascular system involvement was observed in 4.3%. Conclusion: Evaluating the clinical characteristics of anaphylaxis patients is of great importance in enhancing our understanding and clinical approach to this complex hypersensitivity reaction in children. This approach aims to optimize the diagnosis, proper management, and prevention of anaphylactic reactions, ultimately leading to better health outcomes and improved quality of life for children.

Keywords

• Anaphylaxis
• drug allergy
• adrenalin
• food-induced anaphylaxis

References

1. 1. Muraro A, Worm M, Alviani C, et al. EAACI guidelines: Anaphylaxis (2021 update). Allergy. 2022;77(2):357-377. 2. Greenhawt M, Gupta RS, Meadows JA, et al. Guiding Principles for the Recognition, Diagnosis, and Management of Infants with Anaphylaxis: An Expert Panel Consensus. J Allergy Clin Immunol Pract. 2019;7(4):1148-1156.e5.
2. 3. Turner PJ, Campbell DE, Motosue MS, Campbell RL. Global Trends in Anaphylaxis Epidemiology and Clinical Implications. J Allergy Clin Immunol Pract. 2020;8(4):1169-1176.
3. 4. Sampson HA, Muñoz-Furlong A, Campbell RL, et al. 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. J Allergy Clin Immunol. 2006;117(2):391-397.
4. 5. De Filippo M, Votto M, Albini M, et al. Pediatric Anaphylaxis: A 20-Year Retrospective Analysis. J Clin Med. 2022;11(18):5285.
5. 6. Tanno LK, Chalmers R, Bierrenbach AL, et al. Changing the history of anaphylaxis mortality statistics through the World Health Organization's International Classification of Diseases-11. J Allergy Clin Immunol. 2019;144(3):627-633.
6. 7. Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy. 2019;74(6):1063-1080.
7. 8. Cetinkaya F, Incioglu A, Birinci S, Karaman BE, Dokucu AI, Sheikh A. Hospital admissions for anaphylaxis in Istanbul, Turkey. Allergy. 2013;68(1):128-130.
8. 9. Lieberman JA, Gupta RS, Knibb RC, et al. The global burden of illness of peanut allergy: A comprehensive literature review. Allergy. 2021;76(5):1367-1384.

9. 10. Bahçeci Erdem S,Karaman S,Nacaroğlu H, et al. Risk Grup in Anaphylaxis: Infant Anaphylaxis. Astım Allerji İmmünoloji. 2016; 14(1): 30 - 35.
10. 11. Silva R, Gomes E, Cunha L, Falcão H. Anaphylaxis in children: a nine years retrospective study (2001-2009). Allergol Immunopathol (Madr). 2012;40(1):31-36.
11. 12. Gaspar Â, Santos N, Piedade S, et al. One-year survey of paediatric anaphylaxis in an allergy department [published correction appears in Eur Ann Allergy Clin Immunol. 2016 Jan;48(1):31]. Eur Ann Allergy Clin Immunol. 2015;47(6):197-205.
12. 13. Serbes M, Sasihuseyinoglu AS, Ozcan D, Ufuk Altıntas D. Clinical features of anaphylaxis in children. Allergy Asthma Proc. 2022;43(1):50-56.
13. 14. Jeong K, Ye YM, Kim SH, et al. A multicenter anaphylaxis registry in Korea: Clinical characteristics and acute treatment details from infants to older adults. World Allergy Organ J. 2020;13(8):100449.
14. 15. Su Y, Wen J, Zhang H, Zou Z, Cai Y, Zhang C. Clinical Characteristics of Anaphylaxis in Children Aged 0-16 Years in Xi'an, China. Int Arch Allergy Immunol. 2023;184(3):220-227.
15. 16. Dogru M, Bostanci I, Özmen S, Ginis T, Duman Senol H. The Features of Anaphylaxis Cases Followed in the Pediatric Allergy Clinic. J Curr Pediatr 2017;15:12-18.
16. 17. Cianferoni A, Muraro A. Food-induced anaphylaxis. Immunol Allergy Clin North Am. 2012;32(1):165-195.
17. 18. Jiang N, Xu W, Xiang L. Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence. World Allergy Organ J. 2021;14(11):100605.
18. 19. Fernandes RA, Regateiro F, Pereira C, et al. Anaphylaxis in a food allergy outpatient department: one-year review. Eur Ann Allergy Clin Immunol. 2018;50(2):81-88.
19. 20. Sicherer SH, Simons FER; SECTION ON ALLERGY AND IMMUNOLOGY. Epinephrine for First-aid Management of Anaphylaxis. Pediatrics. 2017;139(3):e20164006.
20. 21. Tuncel T, Sancaklı O, Bag O, Cetin HS, Özdoğru EE. Physicians' Approach to Anaphylaxis in Childhood. Pediatr Emerg Care. 2021;37(12):e1425-e1428.
21. 22. El-Sayed ZA, El-Owaidy R, Hussein SM, et al. Physicians' knowledge and practice concerning diagnosis and management of anaphylaxis: The situation in Egypt. Afr J Emerg Med. 2021;11(4):464-470.
22. 23. Arga M, Topal E, Yılmaz S, Erdemli PC, Bıçakcı K, Bakırtaş A. Healthcare workers` knowledge level regarding anaphylaxis and usage of epinephrine auto-injectors. Turk J Pediatr. 2021;63(3):372-383.
23. 24. Xing Y, Zhang H, Sun S, et al. Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data. Eur J Pediatr. 2018;177(1):145-154.
24. 25. Dhopeshwarkar N, Sheikh A, Doan R, et al. Drug-Induced Anaphylaxis Documented in Electronic Health Records. J Allergy Clin Immunol Pract. 2019;7(1):103-111.
25. 26. Atanaskovic-Markovic M, Gomes E, Cernadas JR, et al. Diagnosis and management of drug-induced anaphylaxis in children: An EAACI position paper. Pediatr Allergy Immunol. 2019;30(3):269-276.