Alqurashi Waleed, Stiell Ian, Chan Kevin, Neto Gina, Alsadoon Abdulaziz, Wells George
Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ann Allergy Asthma Immunol. 2015 Sep;115(3):217-223.e2. doi: 10.1016/j.anai.2015.05.013. Epub 2015 Jun 22.
Epidemiologic data regarding biphasic reactions in children with anaphylaxis are sparse.
To investigate the incidence and clinical predictors of biphasic reactions in children presenting to the emergency department (ED) with anaphylaxis.
A health records review of ED visits at 2 large Canadian academic pediatric EDs was conducted. All visits that satisfied anaphylaxis diagnostic criteria of the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network were included. Predictors of biphasic reaction were analyzed using univariate and multiple logistic regression analyses.
Of 1,749 ED records reviewed, 484 visits met the study inclusion criteria. Seventy-one patients (14.7%) developed biphasic reactions. The median age was 6 years (interquartile range 2.7-10.1) and 51 (71.8%) were boys. Forty-nine of the 71 (69%) delayed reactions involved respiratory and/or cardiovascular manifestations and 35 (49%) were treated with epinephrine. Five independent predictors for biphasic reactions were found: age 6 to 9 years (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.5-8.58), delay in presentation to the ED longer than 90 minutes after the onset of the initial reaction (OR 2.58, 95% CI 1.47-4.53), wide pulse pressure at triage (OR 2.92, 95% CI 1.69-5.04), treatment of the initial reaction with more than 1 dose of epinephrine (OR 2.7, 95% CI 1.12-6.55), and administration of inhaled β-agonists in the ED (OR 2.39, 95% CI 1.24-4.62).
Biphasic reactions seem to be associated with the severity of the initial anaphylactic reactions. We identified clinical predictors that could ultimately be used to identify patients who would benefit from prolonged ED monitoring and enable better utilization of ED resources.
关于过敏反应患儿双相反应的流行病学数据稀少。
调查因过敏反应前往急诊科（ED）就诊的儿童双相反应的发生率及临床预测因素。
对加拿大两所大型学术性儿科急诊科的就诊记录进行健康记录回顾。纳入所有符合美国国立过敏和传染病研究所及食物过敏和过敏反应网络过敏反应诊断标准的就诊病例。采用单因素和多因素逻辑回归分析双相反应的预测因素。
在审查的1749份ED记录中，484次就诊符合研究纳入标准。71例患者（14.7%）出现双相反应。中位年龄为6岁（四分位间距2.7 - 10.1），51例（71.8%）为男性。71例延迟反应中的49例（69%）涉及呼吸和/或心血管表现，35例（49%）接受了肾上腺素治疗。发现双相反应的5个独立预测因素：年龄6至9岁（比值比[OR] 3.60，95%置信区间[CI] 1.5 - 8.58）、初始反应发作后90分钟以上才到急诊科就诊（OR 2.58，95% CI 1.47 - 4.53）、分诊时脉压宽（OR 2.92，95% CI 1.69 - 5.04）、初始反应使用超过1剂肾上腺素治疗（OR 2.7，95% CI 1.12 - 6.55）以及在急诊科使用吸入性β受体激动剂（OR 2.39，95% CI 1.24 - 4.62）。
双相反应似乎与初始过敏反应的严重程度相关。我们确定了临床预测因素，这些因素最终可用于识别那些将从急诊科延长监测中获益的患者，并能更好地利用急诊科资源。
