Margitta Worm, Ewa Cichocka-Jarosz, Franziska Ruëff, Thomas Spindler, Alice Köhli, Johannes Trück, Lars Lange, Karin Hartmann, Thomas Hawranek, Katja Nemat, Claudia Pföhler, Maria Beatrice Bilò, Dominique Sabouraud-Leclerc, Nicola Wagner, Nikolaos Papadopoulos, Susanne Hämmerling, Luis Felipe Ensina, Sabine Dölle-Bierke, Veronika Höfer
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Abstract
Background: Hymenoptera venom is one of the most frequent causes of anaphylaxis. Studies from adults indicate the clinical profiles and risk factors of Hymenoptera venom induced anaphylaxis (VIA). Much less is known about pediatric VIA.
Objective: To better understand elicitor and age related factors determining pediatric VIA by analyzing data from the anaphylaxis registry.
Methods: We selected pediatric VIA, pediatric food induced anaphylaxis (FIA) and adult VIA cohorts from the anaphylaxis registry and performed a comparative data analysis regarding elicitors, symptoms and management.
Results: 725 pediatric VIA, 3,149 pediatric FIA and 5,534 adult VIA were identified. In pediatric VIA, boys were more frequently affected, atopy was not increased and the onset of the reaction after exposure was fast (≤ 30 min; 91%) when compared to pediatric FIA. Symptoms in pediatric VIA were age dependent, and although respiratory symptoms occurred besides skin symptoms most frequent in both, pediatric VIA and FIA, cardiovascular symptoms were more frequently reported in pediatric VIA than pediatric FIA. The analysis of pediatric versus adult VIA reveled clear differences of the frequency of involved organ systems (skin: 93/78%, respiratory: 77/64%, and cardiovascular: 61/85%). Among both, the pediatric and adult VIA, the rates of adrenaline application by a professional were low (29/31%) but the hospitalization rates were higher in children than in adults (61%/42%). Venom immunotherapy (VIT) was initiated frequently regardless of age (78% each).
Conclusion: Pediatric VIA is more frequent in boys, symptoms are age dependent and often hospitalization is required. Adrenaline should be applied according the current guidelines. VIT is an important treatment option in pediatric VIA and should be considered in severely affected children.
背景：膜翅目昆虫毒液是导致过敏性休克的最常见原因之一。成人研究表明了膜翅目昆虫毒液诱发过敏性休克（VIA）的临床特征和风险因素。但对小儿 VIA 的了解却很少：目的：通过分析过敏性休克登记数据，更好地了解决定小儿 VIA 的诱发因素和年龄相关因素：我们从过敏性休克登记处选取了小儿 VIA、小儿食物诱发过敏性休克（FIA）和成人 VIA 队列，并对诱发因素、症状和管理进行了数据对比分析：结果：共发现 725 例小儿 VIA、3149 例小儿 FIA 和 5534 例成人 VIA。在小儿 VIA 中，与小儿 FIA 相比，男孩发病率更高，而过敏性体质的儿童发病率并不增加，并且在接触后反应很快（≤ 30 分钟；91%）。小儿 VIA 的症状与年龄有关，虽然呼吸道症状是小儿 VIA 和 FIA 中除皮肤症状外最常见的症状，但小儿 VIA 比小儿 FIA 更常出现心血管症状。对小儿和成人 VIA 的分析显示，受累器官系统的频率存在明显差异（皮肤：93/78%；呼吸系统：77/64%；心血管系统：61/85%）。在儿童和成人 VIA 中，由专业人员使用肾上腺素的比例较低（29/31%），但儿童的住院率高于成人（61/42%）。毒液免疫疗法（VIT）的使用频率与年龄无关（各占 78%）：结论：小儿 VIA 多见于男孩，症状与年龄有关，通常需要住院治疗。应根据现行指南使用肾上腺素。VIT 是治疗小儿 VIA 的重要选择，严重患儿应考虑使用 VIT。
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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