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Pediatr Allergy Immunol. 2018 Dec 27. doi: 10.1111/pai.13015. [Epub ahead of print]

Anaphylaxis admissions in pediatric intensive care units: follow up and risk of recurrence.

Author information

1
Department of Pediatrics, Children's Hospital, F-59056, Roubaix, France.
2
CHU Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, F-59000, Lille, France.
3
CHU Lille, Pediatric Intensive Care Unit, F-59000, Lille, France.
4
Univ. Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, F-59000, Lille, France.
5
Department of Biostatistics, F-59000, Lille, France.

Abstract

BACKGROUND:

Data about the risk of anaphylaxis recurrence in children are lacking. We assessed anaphylaxis recurrence and medical follow-up in a cohort of children previously hospitalized in a French pediatric intensive care unit (PICU) for anaphylaxis.

METHODS:

We conducted a telephone survey of 166 children (≤18y) hospitalized from 2003 to 2013.

RESULTS:

In all, 106 (64%) completed the survey [boys, 59%; mean age (SD):15.3y (5.5)]. The main index triggers were drugs (45%) and foods (37%). The mean duration follow-up was of 7.7y (SD: 2.4). Thirty-eight (36%) children experienced 399 new allergic reactions during a follow-up period of 282 patient-years (incidence rate: 1.4/100 patients/year; 95% CI: 0.64-2.04). Twelve children experienced 19 anaphylaxis reactions including five requiring PICU admission (anaphylaxis recurrence rate: 0.20/100 patients/year; 95%CI non-calculable). Food was the trigger for 79% of recurrent reactions, drugs for 8%. The food trigger was previously known in 83%, the same as the index trigger in 69%. Overall, 1.5% of the recurrent reactions were treated with adrenaline injection and 8% an emergency hospital admission. Patients with recurrence had more likely a history of food allergy (p<10-4 ), asthma (p<0.005), atopic dermatitis (p<0.05) than those without. 31% of the 50 children with food allergy did not see an allergist, 23% had no adrenaline auto-injector, and 26% lacked a school individual healthcare plan.

CONCLUSIONS:

Following a PICU admission for anaphylaxis, recurrence is high in children with food allergy compared with drug allergy. Allergic comorbidities increase the risk. Medical follow-up has to be improved for these at-risk children. This article is protected by copyright. All rights reserved.

KEYWORDS:

anaphylaxis; child; drug; food allergy; intensive care unit; mortality

PMID:
30589462
DOI:
10.1111/pai.13015

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