Linus B Grabenhenrich1, Sabine Dölle2, Anne Moneret-Vautrin3, Alice Köhli4, Lars Lange5, Thomas Spindler6, Franziska Ruëff7, Katja Nemat8, Ioana Maris9, Eirini Roumpedaki10, Kathrin Scherer11, Hagen Ott12, Thomas Reese13, Tihomir Mustakov14, Roland Lang15, Montserrat Fernandez-Rivas16, Marek L Kowalski17, Maria B Bilò18, Jonathan O'B Hourihane9, Nikolaos G Papadopoulos10, Kirsten Beyer19, Antonella Muraro20, Margitta Worm21. 1. Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany. 2. Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany. 3. Allergy Vigilance Network, University Hospital Nancy, Nancy, France. 4. Division of Allergology, University Children's Hospital Zurich, Zurich, Switzerland. 5. Department of Pediatrics, St Marien-Hospital, Bonn, Germany. 6. Pediatric Pneumology and Allergology, Lungenzentrum Süd-West, Wangen, Germany. 7. Department of Dermatology and Allergology, Ludwig-Maximilian-Universität, Munich, Germany. 8. Pediatric Pneumology and Allergology, Kinderzentrum Dresden-Friedrichstadt, Dresden, Germany. 9. Department of Paediatrics and Child Health, University College Cork, Cork, Ireland. 10. Allergy Department, University of Athens, Athens, Greece. 11. Department of Dermatology, University Hospital Basel, Basel, Switzerland. 12. Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany. 13. Rheine Kinderklinik, Mathias-Spital, Rheine, Germany. 14. Clinical Centre of Allergology, University Hospital Alexandrovska/Medical University Sofia, Sofia, Bulgaria. 15. Department of Dermatology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria. 16. Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain. 17. Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland. 18. Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy. 19. Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Icahn School of Medicine at Mount Sinai, New York, NY. 20. Department of Mother and Child Health, Padua General University Hospital, Padua, Italy. 21. Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: margitta.worm@charite.de.
Abstract
BACKGROUND: Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description. OBJECTIVE: We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents. METHODS: The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. RESULTS: Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom- and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions. CONCLUSIONS: The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.
BACKGROUND: Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description. OBJECTIVE: We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents. METHODS: The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. RESULTS: Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom- and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions. CONCLUSIONS: The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.
Authors: Carlos Gamazo; Carmen D'Amelio; Gabriel Gastaminza; Marta Ferrer; Juan M Irache Journal: Hum Vaccin Immunother Date: 2017-10-03 Impact factor: 3.452
Authors: Mayte Suárez-Fariñas; Maria Suprun; Helena L Chang; Gustavo Gimenez; Galina Grishina; Robert Getts; Kari Nadeau; Robert A Wood; Hugh A Sampson Journal: J Allergy Clin Immunol Date: 2018-12-07 Impact factor: 10.793