응급실을 방문한 아나필락시스 환자의 임상 양상 및 에피네프린 사용의 나이대별 특성
Age group characteristics of clinical features and use of epinephrine in children with anaphylaxis who visited the emergency department
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Diagnosis of anaphylaxis depends on clinical manifestations and a high index of suspicion, and a misdiagnosis can lead to a preventable death. We aimed to investigate age group characteristics of clinical features and epinephrine use in children with anaphylaxis who visited the emergency department (ED). Methods: We performed a retrospective chart review of 138 children who visited a tertiary care hospital ED from January through December 2018, and were discharged with anaphylaxis as the diagnosis. Anaphylaxis was defined according to the National Institutes of Allergy and Infectious Disease criteria. The children were divided into 4 age groups; infants (< 1 year), preschoolers (1-5 years), schoolers (6-11 years), and adolescents (12-18 years). Clinical features and epinephrine use were compared among the age groups. Results: Of the 138 children with presumed anaphylaxis, 108 met the criteria. The most common cause was food (74%), followed by drugs (10.2%). Epinephrine was used in 82 children (75.9%). The infants and preschoolers reported less frequent cardiovascular symptoms (0%-3.6% vs. 26.5%, P = 0.020) and epinephrine use (33.3%-70.9% vs. 91.2%, P = 0.037) compared to the adolescents. The former 2 age groups reported food as triggers more frequent, and often reported foodassociated and respiratory or gastrointestinal symptoms. Conclusion: Infants and preschoolers with anaphylaxis may undergo less frequent cardiovascular symptoms and epinephrine use compared to adolescents. This feature prompts to increased epinephrine use in the former age groups even without ageadjusted hypotension.
Abstract
Purpose: Diagnosis of anaphylaxis depends on clinical manifestations and a high index of suspicion, and a misdiagnosis can lead to a preventable death. We aimed to investigate age group characteristics of clinical features and epinephrine use in children with anaphylaxis who visited the emergency department (ED). Methods: We performed a retrospective chart review of 138 children who visited a tertiary care hospital ED from January through December 2018, and were discharged with anaphylaxis as the diagnosis. Anaphylaxis was defined according to the National Institutes of Allergy and Infectious Disease criteria. The children were divided into 4 age groups; infants (< 1 year), preschoolers (1-5 years), schoolers (6-11 years), and adolescents (12-18 years). Clinical features and epinephrine use were compared among the age groups. Results: Of the 138 children with presumed anaphylaxis, 108 met the criteria. The most common cause was food (74%), followed by drugs (10.2%). Epinephrine was used in 82 children (75.9%). The infants and preschoolers reported less frequent cardiovascular symptoms (0%-3.6% vs. 26.5%, P = 0.020) and epinephrine use (33.3%-70.9% vs. 91.2%, P = 0.037) compared to the adolescents. The former 2 age groups reported food as triggers more frequent, and often reported foodassociated and respiratory or gastrointestinal symptoms. Conclusion: Infants and preschoolers with anaphylaxis may undergo less frequent cardiovascular symptoms and epinephrine use compared to adolescents. This feature prompts to increased epinephrine use in the former age groups even without ageadjusted hypotension.
참고문헌 (28)
- Sampson HA, "Second symposium on the definition and management of anaphylaxis: summary report. Second National Institute of Allergy and Infectious Disease", Food Allergy and Anaphylaxis Network symposium, 2006, pp.117, 391~397
- Anagnostou K, "Myths, facts and controversies in the diagnosis and management of anaphylaxis", Arch Dis Child, 104, pp.83~90 (2019)
- Simons FE, "World allergy organization guidelines for the assessment and management of anaphylaxis", World Allergy Organ J, 4, pp.13~37 (2011)
- Woo Sung Jung, "Missed Diagnosis of Anaphylaxis in Patients With Pediatric Urticaria in Emergency Department", Pediatric Emergency Care, pp.1~ (2020), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Hochstadter E, "Increasing visits for anaphylaxis and the benefits of early epinephrine administration: a 4-year study at a pediatric emergency department in Montreal, Canada", J Allergy Clin Immunol, 137, pp.1888-90.e4~ (2016)
- Fleming JT, "Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization", J Allergy Clin Immunol Pract, 3, pp.57~62 (2015)
- Rudders SA, "Agerelated differences in the clinical presentation of foodinduced anaphylaxis", J Pediatr, 158, pp.326~328 (2011)
- 김무정, "수원의 한 대학병원에서 10년간 경험한 아나필락시스 환자 분석", 천식 및 알레르기, 28(4), pp.298~304 (2008), 대한천식알레르기학회
- 박향미, "단일 의료기관에서 진단된 아나필락시스 환자의 임상적 특성", Allergy Asthma & Respiratory Disease, 22(3), pp.232~238 (2012), 대한 소아알레르기 호흡기학회
- 홍규락, "3차 의료기관 응급실에 내원한 아나필락시스 환자에 대한 임상적 및 통계적 고찰", 대한피부과학회지, 57(3), pp.126~135 (2019), 대한피부과학회
- American College of Surgeons, Committee on Trauma, "Advanced trauma life support for doctors, student course manual", American College of Surgeons, 195~ (2018)
- Lee JM, "Biphasic anaphylactic reactions in pediatrics", Pediatrics, 106, pp.762~766 (2000)
- American Academy of Pediatrics, American Heart Association, "Pediatric advanced life support: provider manual", American Heart Association, 134~ (2016)
- Campbell RL, "Emergency department diagnosis and treatment of anaphylaxis:a practice parameter", Ann Allergy Asthma Immunol, 113, pp.599~608 (2014)
- Jeong K, "A population-based epidemiological study of anaphylaxis using national big data in Korea: trends in age-specific prevalence and epinephrine use in 2010-2014", Allergy Asthma Clin Immunol, 14, pp.31~ (2018)
- Pumphrey R., "Anaphylaxis: can we tell who is at risk of a fatal reaction?", Curr Opin Allergy Clin Immunol, 4, pp.285~290 (2004)
- Liew WK, "Anaphylaxis fatalities and admissions in Australia", J Allergy Clin Immunol, 123, pp.434~442 (2009)
- 임대현, "소아청소년에서 아나필락시스의 역학", Clinical and Experimental Pediatrics, 51(4), pp.351~354 (2008), 대한소아청소년과학회
- Turner PJ, "Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012", J Allergy Clin Immunol, 135, pp.956-63.e1~ (2015)
- Pumphrey RS., "Lessons for management of anaphylaxis from a study of fatal reactions", Clin Exp Allergy, 30, pp.1144~1150 (2000)
- Prince BT, "Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities", J Asthma Allergy, 11, pp.143~151 (2018)
- Chooniedass R, "Epinephrine use for anaphylaxis: too seldom, too late: current practices and guidelines in health care", Ann Allergy Asthma Immunol, 119, pp.108~110 (2017)
- Tejedor Alonso MA, "Epidemiology of anaphylaxis", Clin Exp Allergy, 45, pp.1027~1039 (2015)
- Hemler JA, "Management of children with anaphylaxis in an urban emergency department", Ann Allergy Asthma Immunol, 118, pp.381~383 (2017)
- Ganapathy S, "Anaphylaxis in children: experience of 485 episodes in 1,272,482 patient attendances at a tertiary paediatric emergency department from 2007 to 2014", Ann Acad Med Singapore, 45, pp.542~548 (2016)
- 최유진, "Underuse of Epinephrine for Pediatric Anaphylaxis Victims in the Emergency Department: A Population-based Study", Allergy, Asthma & Immunology Research, 11(4), pp.529~537 (2019), 대한천식알레르기학회
- Sidhu N, "Evaluation of anaphylaxis management in a pediatric emergency department", Pediatr Emerg Care, 32, pp.508~513 (2016)
- Aun MV, "Adults and children with anaphylaxis in the emergency room: why it is not recognized?", Curr Opin Allergy Clin Immunol, 18, pp.377~381 (2018)