Fuzak Julia K, Trainor Jennifer
Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO 80045, USA.
Pediatr Emerg Care. 2013 Feb;29(2):131-5. doi: 10.1097/PEC.0b013e31828058cd.
Failure to promptly recognize and treat anaphylaxis can result in death. Understanding the incidence, etiology, and management is imperative. A previous pediatric study identified latex as the most common anaphylaxis allergen. We aim to describe the incidence, etiology, and management of anaphylaxis prelatex and postlatex-precaution implementation.
Retrospective review of inpatient and emergency department (ED) records of pediatric anaphylaxis patients seen at 1 institution between 1986 and 1990 or 2002 and 2006 was performed. Patients with 2 systemic symptoms (gastrointestinal, respiratory, hypotension/syncope, oropharyngeal, altered mental status) or 1 systemic symptom plus 1 cutaneous symptom (urticaria, edema, or flushing) were included.
Fifty-three episodes were included from 1986 to 1990. A total of 117 episodes were included from 2002 to 2006. Approximately 80% of cases presented to the ED. From 1986 to 1990, we noted 30.5 cases per 100,000 ED visits versus 38 cases per 100,000 ED visits from 2002 to 2006. Food allergens were most common in both groups (43%). Latex accounted for only 1.9% of cases in 1986 to 1990 versus 1.7% postlatex precautions. Prehospital epinephrine use was poor. Patients in 2002 to 2006 were more likely to receive steroids, H2-blockers, epinephrine autoinjectors, and allergist referrals but less likely to receive epinephrine.
The etiology of pediatric anaphylaxis has not significantly changed over time but seems to differ across regions because latex was not a significant allergen at this institution in either period. The incidence of anaphylaxis has increased slightly. Anaphylaxis remains underdiagnosed and undertreated. Improved education of patients/caregivers and health care providers is needed.
未能及时识别和治疗过敏反应可能导致死亡。了解其发病率、病因及管理方法至关重要。此前一项儿科研究表明，乳胶是最常见的过敏反应过敏原。我们旨在描述在实施乳胶预防措施之前和之后过敏反应的发病率、病因及管理情况。
对1986年至1990年或2002年至2006年期间在1家机构就诊的儿科过敏反应患者的住院和急诊科记录进行回顾性分析。纳入有2种全身症状（胃肠道、呼吸、低血压/晕厥、口咽、精神状态改变）或1种全身症状加1种皮肤症状（荨麻疹、水肿或潮红）的患者。
1986年至1990年纳入53例病例。2002年至2006年共纳入117例病例。约80%的病例在急诊科就诊。1986年至1990年，每100,000次急诊科就诊中有30.5例病例，而2002年至2006年为每100,000次急诊科就诊中有38例病例。两组中食物过敏原最为常见（43%）。1986年至1990年乳胶仅占病例的1.9%，实施乳胶预防措施后为1.7%。院前使用肾上腺素的情况较差。2002年至2006年的患者更有可能接受类固醇、H2受体阻滞剂、肾上腺素自动注射器及过敏症专科医生转诊，但接受肾上腺素的可能性较小。
儿科过敏反应的病因随时间推移未发生显著变化，但似乎因地区而异，因为在该机构两个时期乳胶都不是主要过敏原。过敏反应的发病率略有上升。过敏反应仍未得到充分诊断和治疗。需要加强对患者/护理人员及医疗保健提供者的教育。
