Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey
Main Article Content
Keywords
acute treatment, anaphylaxis, children, epinephrine, long-term management
Abstract
Background: Anaphylaxis proportions of incidence are increasing globally. However, limited data are available regarding anaphylaxis in the pediatric population of Greece.
Purpose: The aim of the study was to evaluate management of anaphylaxis in Greek pediatric departments.
Methods: We performed a questionnaire-based study of children aged less than 16 years presenting with anaphylaxis in 10 national pediatric hospitals over a period of 2 years. Management of anaphylaxis was assessed prior to and after an informative intervention.
Results: In all, 127 cases of anaphylaxis were identified. Epinephrine was administered in almost half of all cases (51.2%), predominantly through intramuscular route (88.5%), while the majority of anaphylaxis patients were treated with antihistamines (92.9%) and corticosteroids (70.1%). Epinephrine was more likely administered by physicians if the elicitor was a drug (P < 0.003). Regarding long-term management, an epinephrine auto-injector was prescribed in 66.9% of patients. Follow-up information was available for most of the patients (92.9%), the majority of whom (76.3%) were referred to an allergist. More than half of these patients (63.6%) had a documented allergy follow-up, which identified a causative allergen in 53.3% of cases. No statistically significant differences were recorded prior to and after the intervention regarding management of anaphylaxis.
Conclusions: This nationwide study highlighted the necessity of further improvement in terms of anaphylaxis treatment and secondary prevention measures. This presupposes appropriate education and training of healthcare professionals, thus contributing to proper and comprehensive care of the pediatric population.
References
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3. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, et al. World Allergy Organization Anaphylaxis Guidance 2020. World Allergy Organ J. 2020 Oct 30;13(10):100472. 10.1016/j.waojou.2020.100472
4. Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy. 2019 Jun;74(6):1063–80. 10.1111/all.13732
5. Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL. National trends in emergency department visits and hospitalizations for food-induced anaphylaxis in US children. Pediatr Allergy Immunol. 2018 Aug;29(5):538–44. 10.1111/pai.12908
6. Conrado AB, Ierodiakonou D, Gowland MH, Boyle RB, Turner PJ. Food anaphylaxis in the United Kingdom: Analysis of national data, 1998–2018. Br Med J (BMJ). 2021 Feb 17;372:n251. 10.1136/bmj.n251
7. Nocerino R, Leone L, Cosenza L, Berni Canani R. Increasing rate of hospitalizations for food-induced anaphylaxis in Italian children: An analysis of the Italian Ministry of Health database. J Allergy Clin Immunol. 2015 Mar;135(3):833–5.e3. 10.1016/j.jaci.2014.12.1912
8. Pyrpyris N, Kritikou M, Aggelidis X, Manolaraki I, Makris M, Papadopoulos NG, Xepapadaki P. Anaphylaxis in children and adolescents: Greek data analysis from the European Anaphylaxis Registry (NORA). J Pers Med. 2022 Sep 30;12(10):1614. 10.3390/jpm12101614
9. Mullins RJ, Dear KB, Tang ML. Time trends in Australian hospital anaphylaxis admissions in 1998–1999 to 2011–2012. J Allergy Clin Immunol. 2015 Aug;136(2):367–75. 10.1016/j.jaci.2015.05.009
10. Tejedor Alonso MA, Moro Moro M, Múgica García MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015 Jun;45(6):1027–39. 10.1111/cea.12418
11. Michelson KA, Monuteaux MC, Neuman MI. Variation and trends in anaphylaxis care in United States children’s hospitals. Acad Emerg Med. 2016 May;23(5):623–7. 10.1111/acem.12922
12. Quoc QL, Bich TCT, Jang JH, Park HS. Recent update on the management of anaphylaxis. Clin Exp Emerg Med. 2021 Sep;8(3):160–72. 10.15441/ceem.21.121
13. Sclar DA, Lieberman PL. Anaphylaxis: Underdiagnosed, underreported, and undertreated. Am J Med. 2014 Jan;127(1 Suppl):S1–5. 10.1016/j.amjmed.2013.09.007
14. Dribin TE, Motosue MS, Campbell RL. Overview of allergy and anaphylaxis. Emerg Med Clin North Am. 2022 Feb;40(1):1–17. 10.1016/j.emc.2021.08.007
15. Shroba JA. Infant anaphylaxis: Diagnostic and treatment challenges. J Am Assoc Nurse Pract. 2020 Feb;32(2):176–83. 10.1097/JXX.0000000000000386
16. Australasian Society of Clinical Immunology and Allergy (ASCIA). Guidelines for the acute management of anaphylaxis. Accessed 19 April 2021.
17. Kim H, Fischer D. Anaphylaxis. All Asth Clin Immun. 2011;7(Suppl 1):S6. 10.1186/1710-1492-7-S1-S6
18. Fleming JT, Clark S, Camargo CA Jr, Rudders SA. Early treatment of food induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract. 2015 Jan–Feb;3(1):57–62. 10.1016/j.jaip.2014.07.004
19. Alqurashi W, Stiell I, Chan K, Neto G, Alsadoon A, Wells G. Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis. Ann Allergy Asthma Immunol. 2015 Sep;115(3):217–23.e2. 10.1016/j.anai.2015.05.013
20. Ellis AK. Priority role of epinephrine in anaphylaxis further underscored—The impact on biphasic anaphylaxis. Ann Allergy Asthma Immunol. 2015 Sep;115(3):165. 10.1016/j.anai.2015.06.024
21. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010 Feb;125 (Suppl 2):S161–81. 10.1016/j.jaci.2009.12.981
22. Simons FE. Anaphylaxis, killer allergy: Long-term management in the community. J Allergy Clin Immunol. 2006 Feb;117(2):367–77. 10.1016/j.jaci.2005.12.002
23. Fineman SM, Bowman SH, Campbell RL, Dowling P, O’Rourke D, Russell WC, et al. Addressing barriers to emergency anaphylaxis care: From emergency medical services to emergency department to outpatient follow-up. Ann Allergy Asthma Immunol. 2015 Oct;115(4):301–5. 10.1016/j.anai.2015.07.008
24. Russell WS, Farrar JR, Nowak R, Hays DP, Scmitz N, Wood J, et al. Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice. World J Emerg Med. 2013;4(2):98–106. 10.5847/wjem.j.issn.1920-8642.2013.02.003
25. Robinson M, Greenhawt M, Stukus DR. Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department. Ann Allergy Asthma Immunol. 2017 Aug;119(2):164–9. 10.1016/j.anai.2017.06.001
26. Sidhu N, Jones S, Perry T, Thompson T, Storm E, Melguizo Castro AS, et al. Evaluation of anaphylaxis management in a pediatric emergency department. Pediatr Emerg Care. 2016 Aug;32(8):508–13. 10.1097/PEC.0000000000000864
27. Simons FE, Ardusso LR, Bilo MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011 Feb;4(2):13–37. 10.1097/WOX.0b013e318211496c
28. Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet.1977 Feb 26;1(8009):466–9. 10.1016/S0140-6736(77)91953-5
29. Grabenhenrich LB, Dölle S, Ruëff F, Renaudin JM, Scherer K, Pföhler C, et al. Epinephrine in severe allergic reactions: The European anaphylaxis register. J Allergy Clin Immunol Pract. 2018 Nov–Dec;6(6):1898–906.e1. 10.1016/j.jaip.2018.02.026
30. Gaspar Â, Santos N, Faria E, Pereira AM, Gomes E, Câmara R, et al. Anaphylaxis in children and adolescents: The Portuguese Anaphylaxis Registry. Pediatr Allergy Immunol. 2021 Aug;32(6):1278–86. 10.1111/pai.13511
31. Rangkakulnuwat P, Sutham K, Lao-Araya M. Anaphylaxis: Ten-year retrospective study from a tertiary-care hospital in Asia. Asian Pac J Allergy Immunol. 2020 Mar;38(1):31–9.
32. Pouessel G, Antoine M, Pierache A, Dubos F, Lejeune S, Deschildre A. Pediatric Emergency Medicine Group. Factors associated with the underuse of adrenaline in children with anaphylaxis. Clin Exp Allergy. 2021 May 51(5):726–9. 10.1111/cea.13821
33. Prince BT, Mikhail I, Stukus DR. Underuse of epinephrine for the treatment of anaphylaxis: Missed opportunities. J Asthma Allergy. 2018 Jun 20;11:143–51. 10.2147/JAA.S159400
34. Anagnostou K, Turner PJ. Myths, facts and controversies in the diagnosis and management of anaphylaxis. Arch Dis Child. 2019 Jan;104(1):83–90. 10.1136/archdischild-2018-314867
35. Simon FE, Clark S, Camargo CA Jr. Anaphylaxis in the community: Learning from the survivors. J Allergy Clin Immunol. 2009 Aug;124(2):301–6. 10.1016/j.jaci.2009.03.050
36. Arroabarren E, Lasa EM, Olaciregui I, Sarasqueta C, Muñoz JA, Pérez-Yarza EG. Improving anaphylaxis management in a pediatric emergency department. Pediatr Allergy Immunol. 2011 Nov;22(7):708–14. 10.1111/j.1399-3038.2011.01181.x
37. Simons FE, Gu X, Simons KJ. Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. J Allergy Clin Immunol. 2001 Nov;108(5):871–3. 10.1067/mai.2001.119409
38. Campbell RL, Bellolio MF, Knutson BD, Bellamkonda VR, Fedko MG, Nestler DM, et al. Epinephrine in anaphylaxis: Higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol. 2015 Jan–Feb;3(1):76–80. 10.1016/j.jaip.2014.06.007
39. Simons FE, Roberts JR, Gu X, Simons KJ. Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunol.1998 Jan;101(Pt 1):33–7. 10.1016/S0091-6749(98)70190-3
40. Vera MJ, Tagaro IC. Anaphylaxis diagnosis and management in the emergency department of a tertiary hospital in the Philippines. Asia Pac Allergy. 2020 Jan 13;10(1):e1. 10.5415/apallergy.2020.10.e1
41. Jeong K, Ye YM, Kim SH, Kim KW, Kim JH, Kwon JW, et al. A multicenter anaphylaxis registry in Korea: Clinical characteristics and acute treatment details from infants to older adults. World Allergy Organ J. 2020 Aug 11;13(8):100449. 10.1016/j.waojou.2020.100449
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