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BMC Pediatr. 2019 Nov 11;19(1):423. doi: 10.1186/s12887-019-1809-8.

Significant predictive factors of the severity and outcomes of the first attack of acute angioedema in children.

Syue YJ1, Li CJ2,3, Chen WL4, Lee TH4,5, Huang CC4,5, Yang MC5, Lin CM6,7,8, Wu MH2, Chou CC5,9,10, Chang CF5, Lin YR11,12,13.

Author information

1
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
2
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
3
Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung, Taiwan.
4
Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
5
Department of Emergency Medicine, Changhua Christian Hospital, 135 Nanshsiao Street, Changhua, 500, Taiwan.
6
Department of Neurology, Changhua Christian Hospital, Changhua City, Taiwan.
7
Department of Social Work and Child Welfare, Providence University, Taichung, Taiwan.
8
Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County, Taiwan.
9
School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
10
School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
11
Department of Emergency Medicine, Changhua Christian Hospital, 135 Nanshsiao Street, Changhua, 500, Taiwan. h6213.lac@gmail.com.
12
School of Medicine, Chung Shan Medical University, Taichung, Taiwan. h6213.lac@gmail.com.
13
School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. h6213.lac@gmail.com.

Abstract

BACKGROUND:

The initial episode of angioedema in children can be potential life-threatening due to the lack of prompt identification and treatment. We aimed to analyze the factors predicting the severity and outcomes of the first attack of acute angioedema in children.

METHODS:

This was a retrospective study with 406 children (< 18 years) who presented in the emergency department (ED) with an initial episode of acute angioedema and who had subsequent follow-up visits in the out-patient department from January 2008 to December 2014. The severity of the acute angioedema was categorized as severe (requiring hospital admission), moderate (requiring a stay in the short-term pediatric observation unit [POU]), or mild (discharged directly from the ED). The associations among the disease severity, patient demographics and clinical presentation were analyzed.

RESULT:

In total, 109 (26.8%) children had severe angioedema, and the majority of those children were male (65.1%). Most of the children were of preschool age (56.4%), and only 6.4% were adolescents. The co-occurrence of pyrexia or urticaria, etiologies of the angioedema related to medications or infections, the presence of respiratory symptoms, and a history of allergies (asthma, allergic rhinitis) were predictors of severe angioedema (all p < 0.05). Finally, the duration of angioedema was significantly shorter in children who had received short-term POU treatment (2.1 ± 1.1 days) than in those who discharged from ED directly (2.3 ± 1.4 days) and admitted to the hospital (3.5 ± 2.0 days) (p < 0.001).

CONCLUSION:

The co-occurrence of pyrexia or urticaria, etiologies related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predictors of severe angioedema. More importantly, short-term POU observation and prompt treatment might be benefit for patients who did not require hospital admission.

KEYWORDS:

Allergy; Angioedema; Children; Epinephrine; First attack; Urticaria

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