Abstract Anaphylaxis is a systemic allergic reaction that involves the respiratory and/or cardiovascular systems. Less severe reactions may be defined as anaphylaxis if there is a high index of ...suspicion for allergic reaction in the setting of previously diagnosed allergy. The prevalence of anaphylaxis is rising at an alarming rate in Westernised societies. The true prevalence of anaphylaxis in childhood is not well documented, but studies from Australia suggest it may be as high as one in 170 among pre-school aged children. Intramuscular adrenaline remains the cornerstone of treatment for the acute episode. Maintaining a supine posture, oxygen and fluid support are important adjunct measures. Whether corticosteroids and antihistamines are beneficial remains inconclusive. Long-term management centres on risk minimisation through prevention of repeat episodes, education of patients/parents in the recognition and emergency treatment of allergic reactions, and optimal management of co-morbidities especially asthma. Identification and avoidance of the allergen trigger are fundamental to prevention. However, avoidance of food triggers is difficult and accidental exposures are common. Education of patients/parents on recognition and treatment of allergic reactions is, therefore, essential and should be supported by provision of an anaphylaxis action plan. An adrenaline auto-injector allows early treatment of anaphylaxis occurring in the community and represents an important aspect of long-term management. However, controversy remains as to who might benefit from carrying this device. Some authoritative bodies recommend selective provision to children identified as being at high risk of anaphylaxis or fatality from anaphylaxis. Whether or not an adrenaline auto-injector is provided, risk minimisation strategies should be implemented for all children with known allergy where ongoing exposure is likely (e.g. food, insect sting).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective. Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's ...Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing medications among children of Asian descent. We attempted to characterize the clinical and epidemiologic profile of NSAID reactions in this group of patients. Methods. A retrospective case series from a hospital-based pediatric drug allergy clinic was studied. A diagnosis of NSAID hypersensitivity was made with a modified oral provocation test. Atopy was evaluated clinically and tested with a standard panel of skin-prick tests. We excluded from analysis patients with any unprovoked episodes of urticaria and/or angioedema, patients <1 year of age, and patients who refused a diagnostic challenge test. Results. Between March 1, 2003, and February 28, 2004, 24 patients, including 14 male patients (58%) and 18 Chinese patients (75%), with a mean age of 7.4 years (range: 1.4-14.4 years), were diagnosed as having cross-reactive NSAID hypersensitivity. A family history consistent with NSAID hypersensitivity was elicited for 17% of patients. None of the patients reported any episodes of angioedema/urticaria unrelated to NSAIDs. The median cumulative reaction-eliciting dose was 7.1 mg/kg. Facial angioedema developed for all patients (100%) and generalized urticaria for 38% of challenged patients, irrespective of age. There was no circulatory compromise, but respiratory symptoms of tachypnea, wheezing, and/or cough were documented for 42% of patients. A cross-reactive hypersensitivity response to acetaminophen was documented for 46% of our patients through their history and for 25% through diagnostic challenge. Compared with patients with suspected adverse drug reactions to antibiotics, patients in the NSAID group were older (7.4 vs 4.8 years) and more likely to have a diagnosis of asthma (odds ratio: 7.5; 95% confidence interval: 3.1-19). Conclusions. Early presentations of facial angioedema and urticaria are key features of dose- and potency-dependent, cross-reactive reactions to NSAIDs in a subpopulation of young, Asian, atopic children. Significant overlap with acetaminophen hypersensitivity, especially among very young patients, for whom the use of a cyclooxygenase-2-specific medication may not be feasible, severely limits options for medical antipyretic treatment. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2005-0969; nonsteroidal antiinflammatory drug, children, urticaria, atopy, angioedema.
: Although extensively studied in adults, nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity in children, especially in young children, remains poorly defined. Pediatricians, prescribing ...antipyretics for children, rarely encounter significant problems, but the few epidemiologic studies performed show conflicting results. Although it is clear that some patients with acetylsalicylic acid (ASA)-sensitive asthma have their clinical onset of disease in childhood and bronchoconstriction after ASA challenge is seen in 0 to 22% of asthmatic children so challenged, ibuprofen at antipyretic doses may cause acute respiratory problems only in a very small number of mild to moderate asthmatics. The recently elucidated mechanism of action of acetaminophen may explain some occurrences of adverse reactions in patients with cross-reactive NSAID hypersensitivity on the basis of its inhibitory activity on the newly described enzyme, cyclooxygenase (COX)-3. This nonspecific sensitivity to inhibition of COX is most likely genetically determined and shows a remarkable association with atopic disease even in the very young age group and possibly an increased predilection in specific ethnic groups. This review summarizes state-of-the-art published data on NSAID hypersensitivity in preschool children.
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