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Pediatr Allergy Immunol. 2019 Sep 13. doi: 10.1111/pai.13124. [Epub ahead of print]

Perioperative anaphylaxis in children: Etiology, time sequence, and patterns of clinical reactivity.

Author information

1
Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK.
2
Faculty of Medicine, MSc Allergy, University of Southampton, Southampton, UK.
3
inVIVO Planetary Health, Group of the Worldwide Universities, West New York, NJ, USA.
4
Seattle Children's Hospital, Seattle, WA, USA.
5
Danish Anaesthesia Allergy Centre, Allergy Clinic Gentofte Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
6
Sheffield Children's NHS Foundation Trust, Sheffield, UK.
7
Benaroya Research Institute and The Immune Tolerance Network, Seattle, WA, USA.
8
Department of Paediatric Allergy, King's Health Partners, King's College London, London, UK.

Abstract

BACKGROUND:

Perioperative anaphylaxis (PA) in children is an uncommon but potentially life-threatening complication associated with anesthesia. Early identification and management of PA is essential to optimize clinical outcomes.

METHODS:

We performed a retrospective study of anesthesia records from pediatric patients with PA from centers in the United Kingdom, France, and the United States over a period of 10 years. Time sequence of clinical signs and physiological variables during PA were collected, along with results of allergy testing.

RESULTS:

Twenty-nine children with PA were included. Median age was 11 years. Based on the modified Ring and Messmer Grading Scale, severe reactions were seen in 25 (86%) members of this cohort, with 4 (14%) experiencing cardiac arrest. Life-threatening hypotension was the first clinical sign of PA in 59% of cases, followed by tachycardia and bronchospasm. In 16 (55%) cases, the initial signs of PA involved multiple organ systems. When the initial signs of PA were cardiovascular and/or respiratory, more epinephrine doses were administered. Average time from initial sign of PA to treatment with epinephrine was 6 minutes (SD: 6, range: 1-25). The causative allergen was identified in 15 patients.

CONCLUSION:

Severe hypotension is the most common presenting sign of PA in children. Initial cardiovascular and/or respiratory signs are associated with the need for increased epinephrine doses. Further studies should optimize the prediction, identification, and early management of PA in children.

KEYWORDS:

anaphylaxis; anesthesia; children; drug allergy; epinephrine; hypersensitivity; hypotension; perioperative; skin tests; tryptase

PMID:
31518461
DOI:
10.1111/pai.13124

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