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Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data.

ABSTRACT: We assessed the clinical features and treatment of pediatric patients with drug-induced anaphylaxis in clinical settings. Pediatric drug-induced anaphylaxis cases collected by the Beijing Pharmacovigilance Database from 2004 to 2014 were analyzed. A total of 91 cases were identified. Drug-induced anaphylaxis was primarily caused by antibiotics (53%). Children of 0-5 years were more likely to develop cyanosis symptoms than children of 13-17 years (OR?=?5.14, 95%CI [1.74, 15.20], P?=?0.002). Children of 13-17 years were more likely to develop hypotension than children of 6-12 years (OR?=?11.79, 95%CI [2.28, 60.87], P?=?0.002), and to manifest both neurological symptoms (OR?=?3.56, 95%CI [1.26, 10.08], P?=?0.015) and severe anaphylaxis than children of 0-5 years (OR?=?15.46, 95%CI [1.85, 129.33], P?=?0.002). Supratherapeutic doses of epinephrine were more likely with intravenous (IV) bolus (92%) in contrast to either intramuscular (IM) (36%, OR?=?19.25, 95%CI [1.77, 209.55], P?=?0.009) or subcutaneous (SC) injections (36%, OR?=?19.80, 95% CI [1.94, 201.63], P?=?0.005). Only 62 (68%) patients received epinephrine treatment as the first-line therapy. CONCLUSION:This study demonstrates that antibiotics were the most common cause of pediatric drug-induced anaphylaxis. Children may present with different anaphylactic signs/symptoms based on age groups. Epinephrine is under-utilized and provider education on the proper management of drug-induced anaphylaxis is warranted. What is Known: • The most common causes of anaphylaxis in children are allergies to foods. Drugs are the second most common cause of pediatric anaphylaxis. • IM epinephrine is the recommended initial treatment of anaphylaxis. What is New: • Drug-induced anaphylaxis in pediatric patients has age-related clinical features. • IV bolus epinephrine was overused and associated with supratherapeutic dosing.

SUBMITTER: Xing Y

PROVIDER: S-EPMC5748398 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data.

Xing Yan Y Zhang Hua H Sun Shusen S Ma Xiang X Pleasants Roy A RA Tang Huilin H Zheng Hangci H Zhai Suodi S Wang Tiansheng T

European journal of pediatrics 20171122 1

We assessed the clinical features and treatment of pediatric patients with drug-induced anaphylaxis in clinical settings. Pediatric drug-induced anaphylaxis cases collected by the Beijing Pharmacovigilance Database from 2004 to 2014 were analyzed. A total of 91 cases were identified. Drug-induced anaphylaxis was primarily caused by antibiotics (53%). Children of 0-5 years were more likely to develop cyanosis symptoms than children of 13-17 years (OR = 5.14, 95%CI [1.74, 15.20], P = 0.002). Child ...[more]

PMID: 29168013

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Project description:BackgroundWheat-dependent exercise-induced anaphylaxis (WDEIA) is a serious and potentially life-threatening form of wheat allergy. Further episodes can only be prevented by avoiding wheat ingestion or avoiding exercise after wheat intake. Anaphylaxis may recur in some patients post-diagnosis. This study aimed to analyze the clinical features and management/outcomes of WDEIA in China.MethodsWe retrospectively analyzed the clinical characteristics, and laboratory testing of 197 patients with WDEIA. After diagnosis, the patients were followed up as outpatients to evaluate dietary/exercise choice and clinical outcomes.ResultsAmong the 197 WDEIA patients (median age, 37 years), 53.8% were male and 28.4% had other allergic disorders. The median duration of anaphylaxis before diagnosis was 16 months. Significant delays in diagnosis (> 1 years) were recorded in 52.7% of the patients, which has not decreased by years (P = 0.064). Exercise (83.8%), alcohol (12.2%), and nonsteroidal anti-inflammatory drugs (7.1%) were the most common cofactors. The most common clinical features were urticaria (100%), loss of consciousness (82.7%), dyspnea (50.8%), and hypotension (47.2%). Of the 197 eligible patients, 155 responded (78.7%), and 124 (80.0%) of which had no anaphylaxis post-diagnosis. A wheat-free diet prevented future anaphylaxis in 91.7% of the patients, followed by the avoidance of wheat combined with exercise (87%) and reduced wheat intake combined with exercise avoidance (80.5%).ConclusionThe diagnosis of WDEIA is frequently delayed. Therefore, when patients present with unexplained anaphylaxis, the possibility of WDEIA should be considered. A wheat-free diet or avoiding wheat combined with exercise or reduced wheat combined with exercise avoidance helps to significantly reduce the onset of future anaphylaxis. However, approximately one-fifth of patients continue to experience anaphylaxis post-diagnosis. Thus, these patients must always carry epinephrine autoinjectors.

Dataset Information

Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data.

Publications

Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data.

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