Novembre E, Cianferoni A, Bernardini R, Mugnaini L, Caffarelli C, Cavagni G, Giovane A, Vierucci A
Allergy and Clinical Immunology Unit, Department of Pediatrics, Florence, Italy.
Pediatrics. 1998 Apr;101(4):E8. doi: 10.1542/peds.101.4.e8.
Despite the importance of anaphylaxis, little information is available on its clinical features.
To evaluate the clinical and allergologic features of anaphylaxis in children referred to the allergology and immunology unit of A. Meyer Children's Hospital (Florence, Italy) from 1994 to 1996.
Ninety-five episodes of anaphylaxis occurred in 76 children (50 boys and 26 girls). Sixty-six children (87%) had only one episode of anaphylaxis, while 10 (13%) had two or more episodes. Sixty-two (82%) of the 76 patients had a personal history of atopic symptoms, although 14 (18%) did not. Sixty (79%) of the 76 children studied had at least one positive skin prick test to one or more of the common inhalant and/or food allergens. Children with venom-induced anaphylaxis usually had negative skin tests to the allergens tested. A younger age and eczema were more frequent among children with food-dependent anaphylaxis, whereas an older age together with urticaria-angioedema were common among those with exercise-induced anaphylaxis. The mean latent period (+/-SD) of the anaphylaxis episodes was 15.4 +/- 27.5 minutes. Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal and cardiovascular ones. The most frequent clinical manifestation in children with food anaphylaxis was gastrointestinal symptoms, whereas cardiovascular symptoms were rare. The most probable causative agents in the 95 episodes described were foods (57%), drugs (11%), hymenoptera venom (12%), exercise (9%), additives (1%), specific immunotherapy (1%), latex (1%), and vaccines (2%), but in 6 cases (6%) the agent was never determined. Among the foods, seafood and milk were the most frequently involved. As for location, 57% of the anaphylactic events occurred in the home (54/95), 12% outdoors (11/95); 5% in restaurants (5/95); 3% in the doctor's office (3/95); 3% in hospitals (3/95); 3% on football fields (3/95); 2% on the beach (2/95); 1% in the gym (1/95); 1% at school (1/95); and 1% in the operating room (1/95). In the remaining 12% of cases (11/95) the site remained unknown. Sixty-two percent of the patients (59/95) were treated in an emergency room or hospital, while 32% (30/95) were not (this information is lacking in 6% of the cases [6/95]). Patients were treated with corticosteroids in 72% of the cases (68/95), with antihistamines in 20% (19/95), with epinephrine in 18% (17/95), with beta2-agonists in 5% (5/95), and with oxygen in 4% (4/95).
In our area, foods, particularly seafood and milk, seem to be the most important etiologic factors triggering anaphylaxis. Food-induced anaphylaxis often occurs in younger children with a severe food allergy, whereas exercise-induced anaphylaxis occurs more often in older children with a history of urticaria-angioedema. The venom-induced variant usually presents itself in nonatopic subjects. Given the fact that most of the children had only one anaphylactic reaction, prevention is almost impossible. Epinephrine, although it is the first-choice treatment of anaphylaxis, often goes unused, even in hospitals and doctors' offices.
尽管过敏反应很重要，但关于其临床特征的信息却很少。
评估1994年至1996年转诊至意大利佛罗伦萨A. Meyer儿童医院过敏与免疫科的儿童过敏反应的临床和过敏学特征。
76名儿童（50名男孩和26名女孩）发生了95次过敏反应。66名儿童（87%）仅发生过一次过敏反应，而10名儿童（13%）发生过两次或更多次。76名患者中有62名（82%）有特应性症状的个人史，尽管14名（18%）没有。76名接受研究的儿童中有60名（79%）对一种或多种常见吸入性和/或食物过敏原的皮肤点刺试验至少有一项呈阳性。毒液诱发的过敏反应儿童对所检测的过敏原皮肤试验通常为阴性。食物依赖性过敏反应的儿童年龄较小且湿疹更为常见，而运动诱发的过敏反应儿童中年龄较大且伴有荨麻疹-血管性水肿较为常见。过敏反应发作的平均潜伏期（±标准差）为15.4±27.5分钟。皮肤和呼吸道表现起病较早且比胃肠道和心血管表现更为常见。食物过敏反应儿童中最常见的临床表现是胃肠道症状，而心血管症状很少见。所描述的95次发作中最可能的致病因素是食物（57%）、药物（11%）、膜翅目毒液（12%）、运动（9%）、添加剂（1%）、特异性免疫治疗（1%）、乳胶（1%）和疫苗（2%），但有6例（6%）病因从未确定。在食物中，海鲜和牛奶是最常涉及的。至于发生地点，57%的过敏事件发生在家中（54/95），12%发生在户外（11/95）；5%发生在餐馆（5/95）；3%发生在医生办公室（3/95）；3%发生在医院（3/95）；3%发生在足球场（3/95）；2%发生在海滩（2/95）；1%发生在健身房（1/95）；1%发生在学校（1/95）；1%发生在手术室（1/95）。其余12%的病例（11/95）地点不明。62%的患者（59/95）在急诊室或医院接受治疗，而32%（30/95）没有（6%的病例[6/95]缺乏此信息）。72%的病例（68/95）患者接受了皮质类固醇治疗，20%（19/95）接受了抗组胺药治疗，18%（17/95）接受了肾上腺素治疗，5%（5/95）接受了β2激动剂治疗，4%（4/95）接受了氧气治疗。
在我们地区，食物，尤其是海鲜和牛奶，似乎是引发过敏反应的最重要病因。食物诱发的过敏反应常发生于患有严重食物过敏的年幼儿童，而运动诱发的过敏反应更常发生于有荨麻疹-血管性水肿病史的年长儿童。毒液诱发型通常见于非特应性个体。鉴于大多数儿童仅发生过一次过敏反应，预防几乎是不可能的。肾上腺素尽管是过敏反应的首选治疗药物，但即使在医院和医生办公室也常常未被使用。
