1 - Serviço de Imunoalergologia, Hospital Dona Estefânia, Unidade Local de Saúde de São José, Dona Estefânia, Lisboa, Portugal.
2 - Centro Clínico Académico de Lisboa, Lisboa, Portugal.
3 - Serviço de Imunoalergologia do Hospital Central do Funchal - Dr. Nélio Mendonça, SESARAM, Funchal, Portugal.
4 - Comprehensive Health Research Center (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
- Póster em reunião internacional: EAACI Hybrid Congress, Valência, Espanha, junho de 2024
Resumo:
Introduction: Food-induced anaphylaxis (FIA) is a serious allergic reaction that requires immediate evaluation and treatment. This study aims to characterize pediatric FIA cases in an emergency room (ER) setting.
Methods: Retrospective study including pediatric patients from the ER, coded at discharge with the diagnosis of anaphylaxis, or those who received intramuscular adrenaline between 2018 and 2023. FIA diagnostic validation based on WAO Anaphylaxis Guidance 2020 and reviewed by two allergy specialists. We made a descriptive analysis from clinical records data.
Results: Among the 34 patients, 50% were female, aged (mean±SD) 9.51±1.03 years. Twenty-eight (82%) had a personal history of allergic diseases, and 11 (32%) had asthma; 20 (59%) had no prior history of food allergies. Of the 14 patients with a history of food allergies, 9 (65%) previously experienced FIA and carried adrenaline autoinjectors - 5 were foreign visitors, and four followed in our clinic. The most common allergens involved in the current episodes were nuts (43%), seafood (18%), and eggs (14%); all but one of the recurrent cases involved the same allergen as the previous FIA episode. All patients showed cutaneous and respiratory symptoms; 15 (44%) also had gastrointestinal and 5 (15%) cardiovascular symptoms. All but one received intramuscular adrenaline; of 9 carrying adrenaline autoinjectors, 4 used them pre-admission. There were no fatalities or hospitalizations, and discharge occurred after an average observation period of 10 hours. Twenty-two (65%) received adrenaline prescriptions. Except for foreigners, all but one were referred to an allergy department. Of the 12 patients who underwent a diagnostic work-up in our department, 11 had confirmed sensitization to the suspected allergen. Three of 19 patients under our care had another anaphylactic reaction within a year, two with the same allergen.
Conclusion: Allergic diseases and asthma were very common in the FIA group. The study highlights the difficulty in avoiding accidental food allergen exposure, especially for foreign visitors, who made up over half of recurrent FIA cases. While most were referred to allergy consultations, many were discharged without adrenaline prescriptions. Thus, reinforcement of education about food avoidance measures is needed to prevent further episodes, and all patients should be prescribed adrenaline and provided with a written action plan.
Palavras Chave: Anafilaxia, alergia alimentar, imunoalergologia pediátrica