Castaño-Jaramillo Lina, Toledo-Salinas Carla, Mendoza David
Universidad CES, Facultad de Medicina, Medellin, Antioquia, Colombia.
Rev Alerg Mex. 2021 Jul-Sep;68(3):160-164. doi: 10.29262/ram.v68i3.904.
To clinically characterize the events of anaphylaxis in a third-level pediatric hospital.
1148 clinical records were reviewed. Eventually, the information of 35 events of anaphylaxis in 20 patients was analyzed; three of them had multiple episodes of anaphylaxis.
The median age for the anaphylactic episodes was 11 years (Interquartile range 10 years, Q1 = 5, Q3 = 15), predominantly in adolescents between the ages of 12 and 17 years, and there was a slight predominance in women. The most frequent clinical manifestations were cutaneous (86%), followed by respiratory (83%), cardiovascular (74%), and gastrointestinal (46%) alterations. Cardiac arrest was documented in three episodes; however, no anaphylaxis-related deaths were reported. The main triggers for anaphylaxis were food (34%), medications (29%), allergen-specific immunotherapy (14%), and latex (11%). In patients with perioperative anaphylaxis, the clinical behavior was severe. Epinephrine was administered in 27 out of the 35 events (77%), but only in 11 cases it was the first-line treatment. Systemic corticosteroids were the most frequently used treatment, followed by epinephrine and antihistamines.
The use of epinephrine, which is the mainstay of the treatment, is suboptimal; with a preferred use of second-line medications like corticosteroids. Clear protocols for the diagnosis and treatment of anaphylaxis, as well as continuous education of health personnel, are necessary.
对一家三级儿童医院的过敏反应事件进行临床特征分析。
回顾了1148份临床记录。最终，分析了20例患者中35起过敏反应事件的信息；其中3例有多次过敏反应发作。
过敏反应发作的中位年龄为11岁（四分位间距为10岁，Q1 = 5，Q3 = 15），主要发生在12至17岁的青少年中，女性略占优势。最常见的临床表现为皮肤症状（86%），其次是呼吸道症状（83%）、心血管症状（74%）和胃肠道症状（46%）。有3次发作记录到心脏骤停；然而，未报告与过敏反应相关的死亡病例。过敏反应的主要诱因是食物（34%）、药物（29%）、变应原特异性免疫治疗（14%）和乳胶（11%）。围手术期发生过敏反应的患者，临床症状严重。35起事件中有27起（77%）使用了肾上腺素，但只有11例将其作为一线治疗药物。全身用皮质类固醇是最常用的治疗药物，其次是肾上腺素和抗组胺药。
作为主要治疗药物的肾上腺素使用并不理想；更倾向于使用皮质类固醇等二线药物。需要制定明确的过敏反应诊断和治疗方案，以及对医护人员进行持续教育。
