1 - Serviço de Imunoalergologia, Hospital de Dona Estefânia, Unidade Local de Saúde de São José, Lisboa, Portugal.
2 - Centro Clínico Académico de Lisboa, Lisboa, Portugal
3 - Serviço de Imunoalergologia, Hospital Central do Funchal - Dr. Nélio Mendonça, SESARAM, Funchal, Portugal.
4 - Comprehensive Health Research Center (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Póster em reunião internacional – EAACI Hybrid Congress, Valência, Espanha, junho de 2024
Resumo:
Background: Adrenaline is the first-line treatment for anaphylaxis, a potentially life-threatening hypersensitivity reaction. We aim to characterize the adrenaline use in our pediatric emergency service.
Methods: Retrospective study, including all pediatric patients to whom adrenaline was administered in our pediatric emergency room (2018-2023). We divided patients with (Group 1) or without (Group 2) anaphylaxis (World Allergy Organization Anaphylaxis Guidance 2020). Based on clinical records, descriptive and comparative analyses were performed.
Results: We included 71 patients, aged (mean±SD) 9.4±5.8 years old; 32 females (45%); 32 with and 39 without anaphylaxis. In Group 1, 26 (81%) had a history of allergic diseases. All had mucocutaneous symptoms associated with respiratory involvement in 31 (97%), gastrointestinal symptoms in 13 (41%), and cardiovascular symptoms in 4 (13%). Cofactors were present in 5 cases. There was a known trigger in 5 (16%) patients, likely in 21 (66%), and unknown in 6 (19%). Of the known and likely triggers, 24 (92%) were foods, 1 (4%) a physical factor, and 1 (4%) a drug. An adrenaline auto-injector was prescribed in 21 (66%) patients. Twenty-three were sent to allergology and an anaphylaxis cause was confirmed in 11 out of 13 (85%) that completed the diagnostic work-up. In Group 2, 22 (56%) patients had allergic diseases. The suspected triggers were foods in 13 (33%), drugs in 12 (31%), unknown in 12 (31%), and airborne allergens in 2 (5%). Fifteen (39%) patients had infectious symptoms. Eleven of the 25 patients with suspected food and drug allergies had simultaneously an infection. An adrenaline auto-injector was prescribed in 12 (31%) patients. Thirty-two patients were referred to allergology, 17 to our department. Food allergy was confirmed in only two patients. Comparing the two groups, the frequency of allergic diseases was higher in group 1 (p=0.015).
Conclusion: Allergic diseases were more common in the anaphylaxis group. In about half of the administered adrenaline injections, anaphylaxis diagnostic criteria were not present. Confounding factors could have led to a more aggressive approach, like infectious symptoms that mimicked a second organ involvement and relying on self-reported food or drug allergy. Anaphylaxis education can improve the management of these patients, and allergology has a central role in this matter and in the confirmation or exclusion of the suspected trigger.
Palavras Chave: anafilaxia, imunoalergologia pediátrica, alergia alimentar