Pier Jennifer, Bingemann Theresa A
University of Rochester, Rochester, NY.
Department of Allergy, Immunology, and Rheumatology, Rochester Regional Health, Rochester, NY.
Pediatr Rev. 2020 Jun;41(6):283-292. doi: 10.1542/pir.2019-0056.
Urticaria and, to a lesser extent, angioedema are common occurrences in the pediatric population. There are multiple causes of acute and chronic urticaria and angioedema. Most causes are benign, although they can be worrisome for patients and their parents. An allergist should evaluate acute urticaria and/or angioedema if there are concerns of an external cause, such as foods or medications. Chronic urticaria and angioedema can severely affect quality of life and should be managed aggressively with antihistamines and immunomodulators if poorly controlled. Chronic symptoms are unlikely to be due to an external cause. Anaphylaxis is a more serious allergic condition characterized by a systemic reaction involving at least 2 organ systems. Anaphylaxis should be initially managed with intramuscular epinephrine. Patients who experience anaphylaxis should be evaluated by an allergist for possible causes; if found, avoidance of the inciting antigen is the best management. All patients should also be given an epinephrine autoinjector and an action plan. Foods are a common cause of anaphylaxis in the pediatric population. New evidence suggests that the introduction of highly allergic foods is safe in infancy and should not be delayed. In addition, the early introduction of foods such as peanuts may help prevent the development of food allergies.
荨麻疹，以及程度较轻的血管性水肿，在儿科人群中很常见。急性和慢性荨麻疹及血管性水肿有多种病因。大多数病因是良性的，尽管它们可能让患者及其父母感到担忧。如果担心是外部原因，如食物或药物引起的，过敏症专科医生应评估急性荨麻疹和/或血管性水肿。慢性荨麻疹和血管性水肿会严重影响生活质量，如果控制不佳，应积极使用抗组胺药和免疫调节剂进行治疗。慢性症状不太可能是由外部原因引起的。过敏反应是一种更严重的过敏状况，其特征是涉及至少两个器官系统的全身反应。过敏反应最初应使用肌肉注射肾上腺素进行治疗。经历过过敏反应的患者应由过敏症专科医生评估可能的病因；如果找到病因，避免接触诱发抗原是最佳治疗方法。所有患者还应配备肾上腺素自动注射器和行动计划。食物是儿科人群过敏反应的常见原因。新证据表明，在婴儿期引入高过敏性食物是安全的，不应延迟。此外，尽早引入如花生等食物可能有助于预防食物过敏的发生。
