Severe anaphylaxis in children: Definitions, etiology, and preventive approaches

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Anaphylaxis is a generalized allergic reaction, and its severe course has a potential risk of fatal outcome. The course of each episode of anaphylaxis is the result of a complex interaction between the patient and some internal and external factors (concomitant diseases, profile and level of sensitization, features of allergen exposure, intercurrent infections, etc.). Currently, the clinical and biological features of severe anaphylaxis are not well characterized; however, arterial hypotension and/or loss of consciousness are usually observed in these patients, possibly without typical symptoms from the skin, whereas the outcome of the disease is associated with the possibility of timely emergency medical care. The lack of generally accepted reliable individual prognostic predictors for determining this group of patients is a serious problem. Very little data are available on subfatal/fatal anaphylaxis in pediatric patients, and approaches to it are often based on clinical experience in other age groups. This article presents a systematization of data in the context of severe and subfatal/fatal anaphylaxis in pediatrics to understand the etiology, risk factors, and markers of severe life-threatening allergic reactions in children and the possibilities of their prevention.

Full Text

Restricted Access

About the authors

Alexander N. Pampura

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University

Email: apampura1@mail.ru
ORCID iD: 0000-0001-5039-8473
SPIN-code: 9722-7961

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Natalia V. Esakova

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University

Author for correspondence.
Email: env007@rambler.ru
ORCID iD: 0000-0001-8792-2670
SPIN-code: 6924-9726

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

References

  1. Muraro A, Worm M, Alviani C, et al. EAACI guidelines: Anaphylaxis (2021 update). European academy of allergy and clinical immunology, food allergy, anaphylaxis guidelines group. Allergy. 2022;77(2):357–377. doi: 10.1111/all.15032
  2. Clinical recommendations. Anaphylactic shock. The Russian Association of Allergologists and Clinical Immunologists and the All-Russian Public Organization "Federation of Anesthesiologists and Resuscitators". 2020. 36 р. (In Russ).
  3. Turner PJ, Campbell DE, Motosue MS, Campbell RL. Global trends in anaphylaxis epidemiology and clinical implications. J Allergy Clin Immunol Pract. 2020;8(4):1169–1176. doi: 10.1016/j.jaip.2019.11.027
  4. Tejedor-Alonso MA, Moro-Moro M, Mugica-Garcia MV. Epidemiology of anaphylaxis: Contributions from the last 10 years. J Investig Allergol Clin Immunol. 2015;25(3):163–175.
  5. Alonso MA, Moro-Moro M, Mugica-García MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015;45(6):1027–1039. doi: 10.1111/cea.12418
  6. Perez-Codesido S, Rosado-Ingelmo A, Privitera-Torres M, et al. Incidence of fatal anaphylaxis: A systematic review of observational studies. Investig Allergol Clin Immunol. 2022;32(4):245–260. doi: 10.18176/jiaci.0693
  7. Ramsey NB, Guffey D, Anagnostou K, et al. Epidemiology of anaphylaxis in critically ill children in the United States and Canada. J Allergy Clin Immunol Pract. 2019;7(7):2241–2219. doi: 10.1016/j.jaip.2019.04.025
  8. Turner PJ, Campbell DE. Epidemiology of severe anaphylaxis: Can we use population-based data to understand anaphylaxis? Curr Opin Allergy Clin Immunol. 2016;16(5):441–450. doi: 10.1097/ACI.0000000000000305
  9. Ma L, Danoff TM, Borish L. Case fatality and population mortality associated with anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133(4):1075–1083. doi: 10.1016/j.jaci.2013.10.029
  10. Mehr S, Liew WK, Tey D, Tang ML. Clinical predictors for biphasic reactions in children presenting with anaphylaxis. Clin Exp Allergy. 2009;39(9):1390–1396. doi: 10.1111/j.1365-2222.2009.03276.x
  11. De Silva IL, Mehr SS, Tey D, Tang ML. Paediatric anaphylaxis: A 5-year retrospective review. Allergy. 2008;63(8):1071–1076. doi: 10.1111/j.1398-9995.2008.01719.x
  12. Pumphrey R. Anaphylaxis: Can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol. 2004;4(4):285–290. doi: 10.1097/01.all.0000136762.89313.0b
  13. Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144–1150. doi: 10.1046/j.1365-2222.2000.00864.x
  14. Francuzik W, Dölle S, Worm M. Risk factors and treatment of refractory anaphylaxis: A review of case reports. Exp Rev Clin Immunol. 2018;14(4):307–314. doi: 10.1080/1744666X.2018.1450140
  15. Jerschow E, Lin RY, Scaperotti M, McGinn AP. Fatal anaphylaxis in the United States, 1999–2010: Temporal patterns and demographic associations. J Allergy Clin Immunol. 2014;134(6):1318–1328. doi: 10.1016/j.jaci.2014.08.018
  16. Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to food. J Allergy Clin Immunol. 2001;107(1):191–193. doi: 10.1067/mai.2001.112031
  17. Esakova NV, Pampura AN. Food anaphylaxis in children: A retrospective analysis of 53 cases. Russian Journal of Allergy. 2013;(5):22–26. (In Russ).
  18. Esakova NV, Zakharova IN, Osmanov IM, et al. Anaphylaxis among children hospitalized with acute allergic reactions: A five-year retrospective analysis. Questions Children's Dietetics. 2022;20(4):21–30. (In Russ). doi: 10.20953/1727-5784-2022-4-21-30
  19. Ma L, Danoff TM, Borish L. Case fatality and population mortality associated with anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133(4):1075–1083. doi: 10.1016/j.jaci.2013.10.029
  20. Pouessel G, Turner PJ, Worm M, et al. Food-induced fatal anaphylaxis: From epidemiological data to general prevention strategies. Clin Exp Allergy. 2018;48(12):1584–1593. doi: 10.1111/cea.13287
  21. Pumphrey RS, Gowland MH. Further fatal allergic reactions to food in the United Kingdom, 1999–2006. J Allergy Clin Immunol. 2007;119(4):1018–1019. doi: 10.1016/j.jaci.2007.01.021
  22. Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992–2012. J Allergy Clin Immunol. 2015;135(4):956–963. doi: 10.1016/j.jaci.2014.10.021
  23. Esakova NV, Pampura AN. Features of food anaphylaxis in children that occurs with alternative routes of allergen intake. Pediatrics. Journal named after G.N. Speransky. 2021;100(2):57–63. (In Russ). doi: 10.24110/0031-403X-2021-100-2-57-63
  24. Turner PJ, Jerschow E, Umasunthar T, et al. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract. 2017;5(5):1169–1178. doi: 10.1016/j.jaip.2017.06.031
  25. Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol. 2009;123(2):434–442. doi: 10.1016/j.jaci.2008.10.049
  26. Li ZD, Liu WG, Zhao ZQ, et al. Analysis of 59 anaphylactic death cases. Fa Yi Xue Za Zhi. 2015;31(3):206–210.
  27. Shen Y, Li L, Grant J, et al. Anaphylactic deaths in Maryland (United States) and Shanghai (China): A review of forensic autopsy cases from 2004 to 2006. Forensic Sci Int. 2009;186(1-3):1–5. doi: 10.1016/j.forsciint.2008.12.007
  28. Yilmaz R, Yuksekbas O, Erkol Z, et al. Postmortem findings after anaphylactic reactions to drugs in Turkey. Am J Forensic Med Pathol. 2009;30(4):346–349. doi: 10.1097/PAF.0b013e3181c0e7bb
  29. Gurrieri C, Weingarten TN, Martin DP, et al. Allergic reactions during anesthesia at a large United States referral center. Anesth Analg. 2011;113(5):1202–1212. doi: 10.1213/ANE.0b013e31822d45ac
  30. Hitti EA, Zaitoun F, Harmouche E, et al. Acute allergic reactions in the emergency department: Characteristics and management practices. Eur J Emerg Med. 2015;22(4):253–259. doi: 10.1097/MEJ.0000000000000155
  31. Mullins RJ, Wainstein BK, Barnes EH, et al. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy. 2016;46(8):1099–1110. doi: 10.1111/cea.12748
  32. Bilò MB, Bonifazi F. The natural history and epidemiology of insect venom allergy: Clinical implications. Clin Exp Allergy. 2009;39(10):1467–1476. doi: 10.1111/j.1365-2222.2009.03324.x
  33. Greenberger PA, Rotskoff BD, Lifschultz B. Fatal anaphylaxis: Postmortem findings and associated comorbid diseases. Ann Allergy Asthma Immunol. 2007;98(3):252–257. doi: 10.1016/S1081-1206(10)60714-4
  34. Vetander M, Ly DH, Hаkansson N, et al. Recurrent reactions to food among children at paediatric emergency departments: Epidemiology of allergic disease. Clin Exp Allergy. 2014;44(1):113–120. doi: 10.1111/cea.12203
  35. Dribin TE, Michelson KA, Zhang Y, et al. Are children with a history of asthma more likely to have severe anaphylactic reactions? A retrospective cohort study. J Pediatr. 2020;(220):159–164.e2. doi: 10.1016/j.jpeds.2019.12.019
  36. Worm M, Francuzik W, Renaudin JM, et al. Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from the European anaphylaxis registry. Allergy. 2018;73(6):1322–1330. doi: 10.1111/all.13380
  37. Dorris S. Fatal food anaphylaxis: Registering a rare outcome. Ann Allergy Asthma Immunol. 2020;124(5):445–446. doi: 10.1016/j.anai.2020.02.001
  38. Anagnostou A, Sharma V, Herbert L, Turner PJ. Fatal food anaphylaxis: Distinguishing fact from fiction. J Allergy Clin Immunol Pract. 2022;10(1):11–17. doi: 10.1016/j.jaip.2021.10.008
  39. Mehr S, Turner PJ, Joshi P, et al. Safety and clinical predictors of reacting to extensively heated cow’s milk challenge in cow’s milk allergic children. Ann Allergy Asthma Immunol. 2014;113(4):425–429. doi: 10.1016/j.anai.2014.06.023
  40. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327(6):380–384. doi: 10.1056/NEJM199208063270603
  41. Esakova N, Treneva M, Okuneva T, Pampura AN. Food anaphylaxis: Reported cases in Russian federation children. Am J Public Health Res. 2015;3(5):187–191.
  42. Garib V, Trifonova D, Freidl R, et al. Milk Allergen Micro-Array (MAMA) for refined detection of cow’s-milk-specific IgE sensitization. Nutrients. 2023;15(10):2401. doi: 10.3390/nu15102401
  43. Shreffler WG, Beyer K, Chu TH, et al. Microarray immunoassay: Association of clinical history, in vitro IgE function, and heterogeneity of allergenic peanut epitopes. J Allergy Clin Immunol. 2004;113(4):776–782. doi: 10.1016/j.jaci.2003.12.588
  44. Mayer DE, Krauskopf A, Hemmer W, et al. Usefulness of post mortem determination of serum tryptase, histamine and diamine oxidase in the diagnosis of fatal anaphylaxis. Forensic Sci Int. 2011;212(1-3): 96–101. doi: 10.1016/j.forsciint.2011.05.020
  45. Schliemann S, Seyfarth F, Hipler UC, Elsner P. Impact of age and heterophilic interference on the basal serum tryptase, a risk indication for anaphylaxis in 1,092 dermatology patients. Acta Derm Venereol. 2012;92(5):484–489. doi: 10.2340/00015555-1245
  46. Osawa M, Satoh F, Horiuchi H, et al. Postmortem diagnosis of fatal anaphylaxis during intravenous administration of therapeutic and diagnostic agents: Evaluation of clinical laboratory parameters and immunohistochemistry in three cases. Leg Med. 2008;10(3):143–147. doi: 10.1016/j.legalmed.2007.10.002
  47. Vantur R, Rihar M, Koren A, et al. Chemokines during anaphylaxis: The importance of CCL2 and CCL2-dependent chemotactic activity for basophils. Clin Transl Allergy. 2020;10(1):63. doi: 10.1186/s13601-020-00367-2
  48. Wolters PJ, Pham CT, Muilenburg DJ, et al. Dipeptidyl peptidase I is essential for activation of mast cell chymases, but not tryptases, in mice. J Biol Chem. 2001;276(21):18551–18556. doi: 10.1074/jbc.M100223200
  49. Stone SF, Cotterell C, Isbister GK, et al. Elevated serum cytokines during human anaphylaxis: Identification of potential mediators of acute allergic reactions. J Allergy Clin Immunol. 2009;124(4):786–792.e4. doi: 10.1016/j.jaci.2009.07.055
  50. Polevshchikov AV, Nazarov PG. Immunology of acute phase proteins of inflammation and work of R.V. Petrov. Immunology. 2020;41(2):167–73. (In Russ). doi: 10.33029/0206-4952-2020-41-2-167-173
  51. Fukuda Y, Kawashima H, Saito K, et al. Effect of human plasma-type platelet-activating factor acetylhydrolase in two anaphylactic shock models. Eur J Pharmacol. 2000;390(1-2):203–207. doi: 10.1016/s0014-2999(99)00920-6
  52. Vadas P, Gold M, Perelman B, et al. Platelet-activating factor, PAF acetylhydrolase, and severe anaphylaxis. N Engl J Med. 2008;358(1):28–35. doi: 10.1056/NEJMoa070030
  53. Summers CW, Pumphrey S, Woods CN, et al. Factors predicting anaphylaxis to peanuts and tree nuts in patients referred to a specialist center. J Allergy Clin Immunol. 2008;121(3):632–638.e2. doi: 10.1016/j.jaci.2007.12.003
  54. Esakova NV, Saakyan EK, Kondratieva NS, et al. Platelet-activating factor-acetylhydrolase gene (PLA2G7) expression in children with a history of food anaphylaxis. J Allergy Therapy. 2015;6(2):211–215. doi: 10.4172/2155-6121.1000211

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright © Pharmarus Print Media, 2023



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies