Dibek Misirlioglu Emine, Vezir Emine, Toyran Müge, Capanoglu Murat, Guvenir Hakan, Civelek Ersoy, Kocabas Can Naci
Allergy Asthma Proc. 2017 Jan 1;38(1):38-43. doi: 10.2500/aap.2017.38.4009.
Anaphylaxis is increasingly reported in infancy. Diagnosis and management of anaphylaxis is difficult, and data are limited in infants. The aim of the present study was to determine the clinical course and management strategies used for anaphylaxis in infancy.
Patients attending to our clinic and who had anaphylaxis under 2 years old were evaluated. Sixty-three patients were enrolled for the study. The mean ± standard deviation age was 10.6 ± 6.1 months (median, 11 months).
Anaphylaxis occurred at home in 48 infants (76.2%). Food was the most common causative agent (n = 52 [82.5%]), with cow's milk (n = 21 [40.4%]) and egg white (n = 13 [25%]) being the most frequent. Medication was the other causative agent (n = 9 [14.3%]), with antibiotics being the most frequent (n = 6 [66.7%]). The clinical manifestations were cutaneous (95.2%) and respiratory symptoms (79.4%). The median time lapse between contact and onset of symptoms was 10 minutes (5-15 minutes) (median, interquartile range [IQR] 25-75%). The total duration of symptoms was 2 hours (0.5-3 hours) (median, IQR 25-75%). Six patients had mild (9.5%), 40 moderate (63.5%), and 17 severe (27%) symptoms. A biphasic course was noticed in two infants (3.2%), with a symptom-free interval between a minimum of 30 minutes and a maximum of 4 hours. Forty-three (68.3%) received H1 antihistamines, 31 received corticosteroids (49.2%), and 23 received adrenaline (36.5%). Only one patient needed intensive care.
This study provided detailed clinical information in the diagnosis of anaphylaxis in infants. Diagnosing and managing anaphylaxis are difficult in infancy. Arrangements for definition of symptoms should be made in the new anaphylaxis guidelines.
婴儿期过敏反应的报告日益增多。过敏反应的诊断和管理具有挑战性，且婴儿相关数据有限。本研究旨在确定婴儿期过敏反应的临床过程及管理策略。
对在我们诊所就诊且2岁以下发生过敏反应的患者进行评估。63例患者纳入本研究。平均年龄±标准差为10.6±6.1个月（中位数，11个月）。
48例婴儿（76.2%）在家中发生过敏反应。食物是最常见的致病因素（n = 52 [82.5%]），其中牛奶（n = 21 [40.4%]）和蛋清（n = 13 [25%]）最为常见。药物是另一个致病因素（n = 9 [14.3%]），其中抗生素最为常见（n = 6 [66.7%]）。临床表现为皮肤症状（95.2%）和呼吸道症状（79.4%）。接触过敏原至症状发作的中位时间为10分钟（5 - 15分钟）（中位数，四分位间距[IQR] 25 - 75%）。症状总持续时间为2小时（0.5 - 3小时）（中位数，IQR 25 - 75%）。6例患者症状轻微（9.5%），40例中度（63.5%），17例严重（27%）。2例婴儿（3.2%）出现双相病程，无症状间隔最短30分钟，最长4小时。43例（68.3%）接受了H1抗组胺药治疗，31例接受了皮质类固醇治疗（49.2%），23例接受了肾上腺素治疗（36.5%）。仅1例患者需要重症监护。
本研究为婴儿期过敏反应的诊断提供了详细的临床信息。婴儿期过敏反应的诊断和管理具有挑战性。新的过敏反应指南应制定症状定义的相关安排。
