Anaphylaxis in children Tanno, Luciana Kase; Demoly, Pascal; Marseglia, Gian Luigi
Pediatric allergy and immunology,
November 2020, 2020-11-00, 20201101, 2020-11, Letnik:
31, Številka:
S26
Journal Article
Recenzirano
Anaphylaxis in children is a potential acute life‐threatening systemic hypersensitivity reaction. Anaphylaxis fatality rate is estimated to be 0.65% to 2%. Food is the main anaphylaxis trigger in ...children, notably cow's milk, peanuts, and tree nuts. Mucocutaneous manifestations are observed in more than 90% of cases, but it is not essential for diagnosis. Deaths are rather secondary to the laryngeal edema, observed in 40%‐50% of cases. Personal history of asthma, allergy to particular foods such as peanuts and tree nuts, and adolescence are known risk factors for anaphylaxis and more severe reactions. Epinephrine (adrenaline) is the medication of choice for the first‐aid treatment of anaphylaxis. However, adrenaline auto‐injectors (AAIs) are commercially available in only 32% of world countries. There are still considerable unmet needs in the field of anaphylaxis in children. Therefore, the Montpellier WHO Collaborating Centre aims to start the global action plan applied to anaphylaxis.
The International Classification of Diseases (ICD) provides a common language for use worldwide as a diagnostic and classification tool for epidemiology, clinical purposes, and health management. The ...change in the hierarchy in ICD‐11 permitted the construction of the pioneer section addressed to allergic and hypersensitivity conditions (A/H), which may result in more accurate mortality and morbidity statistics, including more accurate accounting for mortality due to anaphylaxis, strengthen classification, terminology, and definitions. The ICD‐11 was presented and adopted by the 72nd World Health Assembly in May 2019, and the implementation is ongoing worldwide. The Montpellier World Health Organization (WHO) Collaborating Centre on Classification Scientific Support was designated in 2018 and is responsible for supporting the WHO through representing A/H in the international classifications and quality care of patients from the public health perspective.
Objective
Little is known regarding food anaphylaxis in infancy. We aimed to describe specificities of food anaphylaxis in infants (≤12 months) as compared to preschool children (1‐6 years).
Methods
...We conducted a retrospective study of all food anaphylaxis cases recorded by the Allergy Vigilance Network from 2002 to 2018, in preschool children focusing on infants.
Results
Of 1951 food anaphylaxis reactions, 61 (3%) occurred in infants and 386 (20%) in preschool children. Two infants had two anaphylaxis reactions; thus, we analyzed data among 59 infants (male: 51%; mean age: 6 months SD: 2.9); 31% had a history of atopic dermatitis, 11% of previous food allergy. The main food allergens were cow's milk (59%), hen's egg (20%), wheat (7%) and peanut (3%) in infants as compared with peanut (27%) and cashew (23%) in preschool children. Anaphylaxis occurred in 28/61 (46%) cases at the first cow's milk intake after breastfeeding discontinuation. Clinical manifestations were mainly mucocutaneous (79%), gastrointestinal (49%), respiratory (48%) and cardiovascular (21%); 25% of infants received adrenaline. Hives, hypotension and neurologic symptoms were more likely to be reported in infants than in preschool children (P = .02; P = .004; P = .002, respectively). Antihistamines and corticosteroids were more often prescribed in preschool children than in infants (P = .005; P = .025, respectively).
Conclusion
Our study found that in infants presenting with their first food allergy, in a setting with a high rate of infant formula use, the most predominant trigger was cow's milk. As compared to older preschool children, hives, hypotonia and hypotension were more likely to be reported in infants. We believe that this represents a distinct food anaphylaxis phenotype that can further support developing the clinical anaphylaxis criteria in infants.
Anaphylaxis in Brazil between 2011 and 2019 Tanno, Luciana Kase; Molinari, Nicolas; Annesi‐Maesano, Isabella ...
Clinical & experimental allergy/Clinical and experimental allergy,
September 2022, Letnik:
52, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Background
There is a lack of population‐based studies of anaphylaxis from low‐ and middle‐income countries. This hampers public health planning and investments and may influence availability of ...adrenaline auto‐injectors.
Objective
We conducted the first national population‐based study of anaphylaxis hospitalization in Brazil.
Methods
Descriptive study using routinely reported data to the Brazilian Hospital Information System for the years 2011–2019. Information available is coded based on the International Classification of Diseases (ICD)‐10 and covers main cause of hospitalization (primary cause) and any conditions contributing to it (secondary cause).
Results
Over 9 years, we identified 5716 admissions due to anaphylaxis for all causes. The average hospitalization rate related to anaphylaxis was 0.71/100,000 population per year, with a 2.4% (95% CI 1.9%, 2.9%) increase per annum over the study period. Admissions were more frequent among females (52.8%), except for cases due to insect sting. Most admissions occurred in adulthood, from 30 to 59 years (36.3%) but 13.8% in preschool children (0–4 years). There were more young children admitted for food‐related anaphylaxis, and more adults admitted for drug/iatrogenic‐related anaphylaxis. There were 334 cases (5.8% of admissions) of fatal anaphylaxis over the study period, with increased case fatality rate over time.
Conclusions and Clinical Relevance
This is the first study of anaphylaxis hospital admissions using nation‐wide data from a low‐ or middle‐income country. Hospital admissions and fatalities from anaphylaxis in Brazil appear to be increasing.
Data from the Brazilian Hospital Information System, which accounts for approximately 75%–80% of hospitalizations in Brazil, were analysed for 2011‐2019. A stepwise approach was used to identify hospitalizations for anaphylaxis, using ICD‐10 codes. This first study on anaphylaxis hospital admissions using Brazilian national data showed an average rate of 0.71 admissions per 100,000 population per year, with a 2.4% increase per annum between 2011 and 2019. More young children were admitted for food‐related anaphylaxis and more adults for drug‐related anaphylaxis. Fatal anaphylaxis occurred in 5.8% of admissions, and fatalities appeared to increase over time.
Correction added on 10 August 2022, after first online publication: The Graphical text was incorrect and has been updated in this version.
Drug hypersensitivity reactions (DHRs) are associated with high global morbidity and mortality. Cutaneous T cell–mediated reactions classically occur more than 6 hours after drug administration and ...include life‐threatening conditions such as toxic epidermal necrolysis, Stevens‐Johnson syndrome, and hypersensitivity syndrome. Over the last 20 years, significant advances have been made in our understanding of the pathogenesis of DHRs with the identification of human leukocyte antigens as predisposing factors. This has led to the development of pharmacogenetic screening tests, such as HLA‐B*57:01 in abacavir therapy, which has successfully reduced the incidence of abacavir hypersensitivity reactions. We have completed a PRISMA‐compliant systematic review to identify genetic associations that have been reported in DHRs. In total, 105 studies (5554 cases and 123 548 controls) have been included in the review reporting genetic associations with carbamazepine (n = 31), other aromatic antiepileptic drugs (n = 24), abacavir (n = 11), nevirapine (n = 14), trimethoprim‐sulfamethoxazole (n = 11), dapsone (n = 4), allopurinol (n = 10), and other drugs (n = 5). The most commonly reported genetic variants associated with DHRs are located in human leukocyte antigen genes and genes involved in drug metabolism pathways. Increasing our understanding of genetic variants that contribute to DHRs will allow us to improve diagnosis, develop new treatments, and predict and prevent DHRs in the future.
We review the history of the classification and coding changes for anaphylaxis and provide current and perspective information in the field. In 2012, an analysis of Brazilian data demonstrated ...undernotification of anaphylaxis-related deaths because of the difficulties of coding using the International Classification of Diseases, 10th Revision. This work triggered strategic international actions supported by the Joint Allergy Academies and the International Classification of Diseases World Health Organization (WHO) leadership to update the classification of allergic disorders for the International Classification of Diseases, 11th Revision (ICD-11), which resulted in construction of the pioneer “Allergic and hypersensitivity conditions” chapter. The usability of the new framework has been tested by evaluating the same data published in 2012 from the ICD-11 perspective. Coding accuracy was much improved, reaching 95% for definite anaphylaxis. As the results were provided to the WHO Mortality Reference Group, coding rules have been changed, allowing anaphylaxis to be recorded as an underlying cause of death in official mortality statistics. The mandatory use of ICD-11 from January 2022 for documenting cause of death could have 2 immediate consequences: (1) the reported number of anaphylaxis-related deaths might increase because of more appropriate coding and (2) the cross-sectional and longitudinal mortality data generated might ultimately lead to a better understanding of anaphylaxis epidemiology and improved health policies directed at reducing anaphylaxis-related mortality.
PDF
