新加坡儿童过敏反应趋势：2015-2022 年。
Trends in Childhood Anaphylaxis in Singapore: 2015-2022.
机构信息
Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
出版信息
Clin Exp Allergy. 2024 Aug;54(8):585-595. doi: 10.1111/cea.14528. Epub 2024 Jun 26.
BACKGROUND
There has been limited data regarding the incidence of anaphylaxis in Asia. We aim to describe patterns in patient characteristics, triggers and clinical presentation of childhood anaphylaxis in Singapore.
METHODS
This was a retrospective review of emergency electronic medical records of children with anaphylaxis. Patients with the allergy-related diagnoses of anaphylaxis, angioedema, allergy and urticaria based on ICD-9 codes were screened. Cases fulfilling the World Allergy Organization criteria for anaphylaxis were included.
RESULTS
A total of 1188 cases of anaphylaxis were identified with a median age of 6.3 years. Extrapolating data from the study sites, from 2015 to 2022, the incidence rate of childhood anaphylaxis emergency visits in Singapore doubled from 18.9 to 38.8 per 100,000 person-years, with an incidence rate ratio (IRR) of 2.06 (95% confidence interval [CI] 1.70-2.49). In 2022, the incidence rate of food anaphylaxis was 30.1 per 100,000 person-years, IRR 2.39 (95% CI 1.90-3.01) and drug anaphylaxis was 4.6 per 100,000 person-years, IRR 1.89 (95% CI 1.11-3.25). The incidence rate in children aged 0-4 years quadrupled during the study period. Common triggers were egg (10.4%), peanut (9.3%), tree nut (8.8%), milk (8%), shellfish (7.8%) and non-steroidal anti-inflammatory drug (4.4%). The majority (88.6%) of patients were treated with intramuscular adrenaline. Total number of allergy-related visits did not increase over time between 2015 and 2019. Rates of severe anaphylaxis, namely anaphylactic shock and admission to high-dependency and intensive care, did not increase over time, with a mean incidence of 1.6, IRR 0.85 (95% CI 0.40-1.83) and 0.7, IRR 1.77 (95% CI 0.54-5.76) per 100,000 person-years, respectively.
CONCLUSION
While the number of emergency visits due to childhood anaphylaxis has increased, the number of cases of allergy-related visits, anaphylactic shock and anaphylaxis requiring high-dependency and intensive care did not rise.
背景
亚洲有关过敏反应发生率的数据有限。我们旨在描述新加坡儿童过敏反应患者特征、诱因和临床表现的模式。
方法
这是一项对儿童过敏反应急诊电子病历的回顾性研究。根据 ICD-9 编码，筛选出过敏反应、血管性水肿、过敏和荨麻疹相关诊断的过敏患者。符合过敏反应世界组织标准的病例被纳入。
结果
共发现 1188 例过敏反应，中位年龄为 6.3 岁。从研究地点推断，2015 年至 2022 年，新加坡儿童过敏反应急诊就诊的发生率从每 10 万人 18.9 例增加到 38.8 例，发病率比（IRR）为 2.06（95%置信区间 [CI] 1.70-2.49）。2022 年，食物过敏反应的发生率为每 10 万人 30.1 例，IRR 为 2.39（95%CI 1.90-3.01），药物过敏反应的发生率为每 10 万人 4.6 例，IRR 为 1.89（95%CI 1.11-3.25）。研究期间，0-4 岁儿童的发生率增加了四倍。常见的诱因是鸡蛋（10.4%）、花生（9.3%）、坚果（8.8%）、牛奶（8%）、贝类（7.8%）和非甾体抗炎药（4.4%）。大多数（88.6%）患者接受了肌肉内肾上腺素治疗。2015 年至 2019 年期间，与过敏相关的就诊次数并未随时间增加。严重过敏反应（即过敏性休克和入住高依赖和重症监护病房）的发生率并未随时间增加，平均发生率为 1.6%，发病率比（IRR）为 0.85（95%CI 0.40-1.83）和 0.7%，IRR 为 1.77（95%CI 0.54-5.76），每 10 万人中分别有 0.7 例。
结论
尽管因儿童过敏反应而就诊的人数有所增加，但与过敏相关的就诊次数、过敏性休克和需要高依赖和重症监护的过敏反应病例并未增加。
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