1 - Serviço de Imunoalergologia, Hospital Central do Funchal - Dr. Nélio Mendonça, SESARAM, Funchal, Portugal
2 - Serviço de Imunoalergologia, Hospital de Dona Estefânia, Unidade Local de Saúde de São José, Lisboa, Portugal.
3 - Centro Clínico Académico de Lisboa, Lisboa, Portugal
4 - Comprehensive Health Research Center (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Comunicação oral em reunião internacional – EAACI Hybrid Congress, Valência, Espanha, junho de 2024
Resumo:
Background: Anaphylaxis is the most severe clinical presentation of an allergic reaction that can be life-threatening. Its frequency has increased in recent years. We aim to characterize anaphylaxis in a pediatric population. Method: Retrospective analysis of paediatric patients discharged from the emergency room coded with the diagnosis of anaphylaxis, anaphylactic shock, or to whom intramuscular adrenaline was ad-ministered (2018–2023). Patients were selected according to WAO Anaphylaxis Guidance 2020.
Results: We analysed 37 patients, 51.4% female, mean age was9.4+3 years [min 5 months; max 18 years]. Most patients were admitted from the community (n = 36), 7 of which were through pre-hospital care. In 70.3% of patients, this was their first reaction. The median onset of symptoms was 10 minutes [5–30]. All patients had mucocutaneous involvement, followed by respiratory (97.3%), gastrointestinal (45.9%), and cardiovascular symptoms (13.5%). Most patients (64.9%) had a grade 3 reaction. Food was the most common trigger (78.4%), and cofactors were present in 7 patients. Intramuscular adrenaline was given to 97.3%. Seven self-administered adrenaline before arriving at the hospital, 4 of which had to repeat it. Five of the ten patients with previous anaphylaxis didn´t use their adrenaline injector. There was one biphasic reaction within 6 hours. Hospitalizations or deaths were not reported. Serum tryptase was determined in 7 patients and raised in 3. Upon discharge, there was a prescription of adrenaline in24 patients, and a referral to an allergist of 27 patients, only 17 to our department. The cause was identified in 12 cases, food allergy in 11, and drug allergy in 1 patient.
Conclusion: The diagnosis and management of anaphylaxis are challenging and crucial to prevent death. Most of our population received intramuscular adrenaline and was referred to an allergy department; two-thirds had an adrenaline autoinjector prescription, which highlights concern to avoid recurrence. Allergy referral is a crucial step-stone for anaphylaxis evaluation and further management. Serum tryptase was seldom requested, although its early measurement can play a spotlight in anaphylaxis management.
Palavras Chave: anafilaxia, imunoalergologia pediátrica, alergia alimentar