Tarczoñ Izabela, Jedynak-Wąsowicz Urszula, Lis Grzegorz, Tomasik Tomasz, Brzyski Piotr, Cichocka-Jarosz Ewa
"Przyladek Zdrowia", Krakow, Poland.
Department of Paediatrics, Jagiellonian University Medical College, Krakow, Poland.
Postepy Dermatol Alergol. 2021 Oct;38(5):788-797. doi: 10.5114/ada.2020.95650. Epub 2020 Jun 26.
The number of anaphylaxis diagnoses in children is rising, being still based on the clinical picture.
To determine whether triggers of anaphylaxis influence its clinical characteristics in children and adolescents.
The study group included 114 children (5 months-17 years, mean age: 8.0 ±4.8 years), (66%: boys) with the episode of anaphylaxis up to 1 year back. Medical data were entered to the NORA Registry by means of a validated structured on-line questionnaire.
Three most frequent triggers of anaphylaxis were: insect venom (47.4%), food (35.1%), drugs (5.3%), with a predominance of food (egg white, cow's milk, nuts and peanuts) in the 0-6 years age group, while insect venom (bee predominance) in the 7-17 years age group ( = 0.016). Clinical manifestations differed between food vs. venom allergic reactions and presented as gastro-intestinal (GI) (61.4%) ( = 0.004), respiratory (RS) (93.9%) ( = 0.036), and cardiovascular (CVS) (74.6%) ( = 0.022) symptoms. Among objective symptoms, vomiting was the most common symptom in the 0-2 years age group (47.1%) ( = 0.006), while hypotension in those aged 7-12 years (40%) ( = 0.010). Severity of symptoms evaluated as Mueller's grade (IV - 74.5%) and as Ring and Messmer's grade (III - 65.8%), depended on the trigger ( = 0.028, = 0.029, respectively). Life-threatening symptoms occurred in 26 children (fall of the blood pressure - 22%, loss of consciousness - 4.4%).
The clinical manifestation of anaphylaxis in children is both trigger and age dependent, irrespective of the gender. A typical patient with food anaphylaxis was younger, presenting predominantly GI symptoms, while a typical patient with venom anaphylaxis was older, with mostly cardiovascular symptoms.
儿童过敏反应的诊断数量正在上升，目前仍基于临床表现。
确定过敏反应的触发因素是否会影响儿童和青少年的临床特征。
研究组包括114名儿童（年龄5个月至17岁，平均年龄：8.0±4.8岁），其中66%为男孩，他们在过去1年内有过过敏反应发作。通过经过验证的结构化在线问卷将医疗数据录入诺拉登记处。
过敏反应最常见的三种触发因素为：昆虫毒液（47.4%）、食物（35.1%）、药物（5.3%）。在0至6岁年龄组中，食物（蛋清、牛奶、坚果和花生）是主要触发因素，而在7至17岁年龄组中，昆虫毒液（主要是蜜蜂毒液）是主要触发因素（P = 0.016）。食物过敏反应和毒液过敏反应的临床表现有所不同，表现为胃肠道（GI）症状（61.4%）（P = 0.004）、呼吸道（RS）症状（93.9%）（P = 0.036）和心血管（CVS）症状（74.6%）（P = 0.022）。在客观症状中，呕吐是0至2岁年龄组最常见的症状（47.1%）（P = 0.006），而低血压是7至12岁年龄组最常见的症状（40%）（P = 0.010）。根据米勒分级（IV级 - 74.5%）和林格与梅斯默分级（III级 - 65.8%）评估的症状严重程度取决于触发因素（分别为P = 0.028和P = 0.029）。26名儿童出现了危及生命的症状（血压下降 - 22%，意识丧失 - 4.4%）。
儿童过敏反应的临床表现既取决于触发因素，也取决于年龄，与性别无关。典型的食物过敏患儿年龄较小，主要表现为胃肠道症状，而典型的毒液过敏患儿年龄较大，主要表现为心血管症状。
