Lin Yao, Li Yaqi, Ma Jingjing, Li Aijie, Liu Yang, Shi Lin
Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, People's Republic of China.
Int J Gen Med. 2021 Nov 16;14:8211-8216. doi: 10.2147/IJGM.S341398. eCollection 2021.
Aspirin remains a key component of the standard therapy for Kawasaki disease (KD) in children. Although it is well known that aspirin can cause hypersensitivity such as aspirin-induced urticaria (AIU), AIU in children with KD has not been described.
A retrospective case-control study was conducted to investigate AIU clinical features, biochemical parameters, treatment and outcomes in children with KD. Furthermore, biomarkers for predicting AIU were explored using the receiver operating characteristic (ROC) curve analysis.
We identified 46 AIU cases with 22 boys and 24 girls during April 2015-May 2019. Eighty-nine age-matched KD patients without AIU were randomly chosen as controls. The proportions of children with allergy history and aspirin doses administered in the 2 groups were found not to be significantly different. AIU group had substantially higher baseline C-reactive protein and NT-proBNP levels, and increased neutrophil percent. AIU appeared 6.0 (4.0, 8.0) days after aspirin treatment. Aspirin withdrawal and anti-allergic treatment were applied for AIU, and AIU disappeared in 1-3 days. Baseline NT-proBNP predicted AIU with an AUC of 0.70 (95% CI [0.60 to 0.79]) for sensitivity and specificity of 72.1% and 62.5%, respectively, for a cut-off value of 612.9 mg/L. The length of hospital stay for AIU patients was significantly greater compared with controls.
AIU in KD children is not related to gender or aspirin dose, and those with AIU have more severe inflammation at admission. Aspirin should be withdrawn for AIU management. Baseline NT-proBNP may serve as a valuable biomarker to predict AIU.
阿司匹林仍然是儿童川崎病（KD）标准治疗的关键组成部分。尽管众所周知阿司匹林可引起超敏反应，如阿司匹林诱发的荨麻疹（AIU），但KD患儿中的AIU尚未见报道。
进行一项回顾性病例对照研究，以调查KD患儿AIU的临床特征、生化参数、治疗及结局。此外，采用受试者工作特征（ROC）曲线分析探索预测AIU的生物标志物。
我们在2015年4月至2019年5月期间确定了46例AIU病例，其中男孩22例，女孩24例。随机选取89例年龄匹配的无AIU的KD患者作为对照。发现两组中有过敏史的儿童比例和给予的阿司匹林剂量无显著差异。AIU组的基线C反应蛋白和NT-proBNP水平显著更高，中性粒细胞百分比增加。AIU出现在阿司匹林治疗后6.0（4.0，8.0）天。对AIU采用停用阿司匹林及抗过敏治疗，AIU在1 - 3天内消失。基线NT-proBNP预测AIU的曲线下面积（AUC）为0.70（95%可信区间[0.60至0.79]），截断值为612.9 mg/L时，敏感性和特异性分别为72.1%和62.5%。与对照组相比，AIU患者的住院时间显著更长。
KD患儿的AIU与性别或阿司匹林剂量无关，且发生AIU的患儿入院时炎症更严重。对于AIU的处理应停用阿司匹林。基线NT-proBNP可作为预测AIU的有价值的生物标志物。
