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Open Access 01-01-2018 | Original Article

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

Authors: Yan Xing, Hua Zhang, Shusen Sun, Xiang Ma, Roy A. Pleasants, Huilin Tang, Hangci Zheng, Suodi Zhai, Tiansheng Wang

Published in: European Journal of Pediatrics | Issue 1/2018

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.

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Aun MV, Blanca M, Garro LS, Ribeiro MR, Kalil J, Motta AA, Castells M, Giavina-Bianchi P (2014) Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis. J Allergy Clin Immunol Pract 2(4):414–420. https://doi.org/10.1016/j.jaip.2014.03.014 CrossRefPubMed

Bock SA, Munoz-Furlong A, Sampson HA (2007) Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol 119(4):1016–1018. https://doi.org/10.1016/j.jaci.2006.12.622 CrossRefPubMed

Brown AF, McKinnon D, Chu K (2001) Emergency department anaphylaxis: a review of 142 patients in a single year. J Allergy Clin Immunol 108(5):861–866. https://doi.org/10.1067/mai.2001.119028 CrossRefPubMed

Campbell RL, Bellolio MF, Knutson BD, Bellamkonda VR, Fedko MG, Nestler DM, Hess EP (2015) Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract 3(1):76–80. https://doi.org/10.1016/j.jaip.2014.06.007 CrossRefPubMed

Cao HS, He PB, Yang LZ (2006) Analysis of 288 anaphylaxis cases induced by herb injections. Chin J Pharmacoepidemiol (15):26–27

Dona I, Blanca-Lopez N, Torres MJ, Garcia-Campos J, Garcia-Nunez I, Gomez F, Salas M, Rondon C, Canto MG, Blanca M (2012) Drug hypersensitivity reactions: response patterns, drug involved, and temporal variations in a large series of patients. J Investig Allergol Clin Immunol 22(5):363–371PubMed

ECC Committee, Subcommittees and Task Forces of the American Heart Association (2005) 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 112(24 Suppl):IV1–203. https://doi.org/10.1161/CIRCULATIONAHA.105.166550

Fleming JT, Clark S, Camargo CJ, Rudders SA (2015) Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract 3(1):57–62. https://doi.org/10.1016/j.jaip.2014.07.004 CrossRefPubMed

Gonzalez-Perez A, Aponte Z, Vidaurre CF, Rodriguez LA (2010) Anaphylaxis epidemiology in patients with and patients without asthma: a United Kingdom database review. J Allergy Clin Immunol 125(5):1098–1104. https://doi.org/10.1016/j.jaci.2010.02.009 CrossRefPubMed

10.

Grabenhenrich LB, Dolle S, Moneret-Vautrin A, Kohli A, Lange L, Spindler T, Rueff F, Nemat K, Maris I, Roumpedaki E, Scherer K, Ott H, Reese T, Mustakov T, Lang R, Fernandez-Rivas M, Kowalski ML, Bilo MB, Hourihane JO, Papadopoulos NG, Beyer K, Muraro A, Worm M (2016) Anaphylaxis in children and adolescents: the European Anaphylaxis Registry. J Allergy Clin Immunol 137(4):1128–1137. https://doi.org/10.1016/j.jaci.2015.11.015 CrossRefPubMed

11.

Hegenbarth MA (2008) Preparing for pediatric emergencies: drugs to consider. Pediatrics 121(2):433–443. https://doi.org/10.1542/peds.2007-3284 CrossRefPubMed

12.

Hoffer V, Scheuerman O, Marcus N, Levy Y, Segal N, Lagovsky I, Monselise Y, Garty BZ (2011) Anaphylaxis in Israel: experience with 92 hospitalized children. Pediatr Allergy Immunol 22(2):172–177. https://doi.org/10.1111/j.1399-3038.2010.00990.x CrossRefPubMed

13.

Hsin YC, Hsin YC, Huang JL, Yeh KW (2011) Clinical features of adult and pediatric anaphylaxis in Taiwan. Asian Pac J Allergy Immunol 29(4):307–312PubMed

14.

Jackson KD, Howie LD, Akinbami LJ (2013) Trends in allergic conditions among children: United States, 1997–2011. NCHS Data Brief 121:1–8

15.

Jares EJ, Baena-Cagnani CE, Sanchez-Borges M, Ensina LF, Arias-Cruz A, Gomez M, Cuello MN, Morfin-Maciel BM, De Falco A, Barayazarra S, Bernstein JA, Serrano C, Monsell S, Schuhl J, Cardona-Villa R (2015) Drug-induced anaphylaxis in Latin American countries. J Allergy Clin Immunol Pract 3(5):780–788. https://doi.org/10.1016/j.jaip.2015.05.012 CrossRefPubMed

16.

Jiang N, Yin J, Wen L, Li H (2016) Characteristics of anaphylaxis in 907 Chinese patients referred to a tertiary allergy center: a retrospective study of 1,952 episodes. Allergy Asthma Immunol Res 8(4):353–361. https://doi.org/10.4168/aair.2016.8.4.353 CrossRefPubMedPubMedCentral

17.

Lane RD, Bolte RG (2007) Pediatric anaphylaxis. Pediatr Emerg Care 23(1):49–56, 57-60. https://doi.org/10.1097/PEC.0b013e31802d4b87 CrossRefPubMed

18.

Lin RY, Curry A, Pesola GR, Knight RJ, Lee HS, Bakalchuk L, Tenenbaum C, Westfal RE (2000) Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Ann Emerg Med 36(5):462–468. https://doi.org/10.1016/S0196-0644(00)43749-2 CrossRefPubMed

19.

Manuyakorn W, Benjaponpitak S, Kamchaisatian W, Vilaiyuk S, Sasisakulporn C, Jotikasthira W (2015) Pediatric anaphylaxis: triggers, clinical features, and treatment in a tertiary-care hospital. Asian Pac J Allergy Immunol 33(4):281–288. 10.12932/AP0610.33.4.2015 PubMed

20.

Michelson KA, Monuteaux MC, Neuman MI (2016) Variation and trends in anaphylaxis Care in United States Children’s hospitals. Acad Emerg Med 23(5):623–627. https://doi.org/10.1111/acem.12922 CrossRefPubMed

21.

Muraro A, Roberts G, Worm M, Bilo MB, Brockow K, Fernandez RM, Santos AF, Zolkipli ZQ, Bellou A, Beyer K, Bindslev-Jensen C, Cardona V, Clark AT, Demoly P, Dubois AE, DunnGalvin A, Eigenmann P, Halken S, Harada L, Lack G, Jutel M, Niggemann B, Rueff F, Timmermans F, Vlieg-Boerstra BJ, Werfel T, Dhami S, Panesar S, Akdis CA, Sheikh A (2014) Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy 69(8):1026–1045. https://doi.org/10.1111/all.12437 CrossRefPubMed

22.

National Cooperative Group on Childhood Asthma (2013) Third nationwide survey of childhood asthma in urban areas of China. Chin J Pediatr 51(10):729–735

23.

Ribeiro-Vaz I, Marques J, Demoly P, Polonia J, Gomes ER (2013) Drug-induced anaphylaxis: a decade review of reporting to the Portuguese Pharmacovigilance Authority. Eur J Clin Pharmacol 69(3):673–681. https://doi.org/10.1007/s00228-012-1376-5 CrossRefPubMed

24.

Rudders SA, Banerji A, Clark S, Camargo CJ (2011) Age-related differences in the clinical presentation of food-induced anaphylaxis. J Pediatr 158(2):326–328. https://doi.org/10.1016/j.jpeds.2010.10.017 CrossRefPubMed

25.

Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NJ, Bock SA, Branum A, Brown SG, Camargo CJ, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AJ, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW (2006) Second symposium on the definition and management of anaphylaxis: summary report—second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 117(2):391–397. https://doi.org/10.1016/j.jaci.2005.12.1303 CrossRefPubMed

26.

Simons FE, Sheikh A (2013) Anaphylaxis: the acute episode and beyond. BMJ 346:f602. https://doi.org/10.1136/bmj.f602 CrossRefPubMed

27.

Simons FE, Roberts JR, Gu X, Simons KJ (1998) Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunol 101(1 Pt 1):33–37. https://doi.org/10.1016/S0091-6749(98)70190-3 CrossRefPubMed

28.

Soar J, Pumphrey R, Cant A, Clarke S, Corbett A, Dawson P, Ewan P, Foex B, Gabbott D, Griffiths M, Hall J, Harper N, Jewkes F, Maconochie I, Mitchell S, Nasser S, Nolan J, Rylance G, Sheikh A, Unsworth DJ, Warrell D (2008) Emergency treatment of anaphylactic reactions—guidelines for healthcare providers. Resuscitation 77(2):157–169. https://doi.org/10.1016/j.resuscitation.2008.02.001 CrossRefPubMed

29.

Sole D, Ivancevich JC, Borges MS, Coelho MA, Rosario NA, Ardusso L, Bernd LA (2012) Anaphylaxis in Latin American children and adolescents: the online Latin American survey on anaphylaxis (OLASA). Allergol Immunopathol (Madr) 40(6):331–335. https://doi.org/10.1016/j.aller.2011.09.008 CrossRef

30.

Tang R, Xu HY, Cao J, Chen S, Sun JL, Hu H, Li HC, Diao Y, Li Z (2015) Clinical characteristics of inpatients with anaphylaxis in China. Biomed Res Int 2015:429534. https://doi.org/10.1155/2015/429534 PubMedPubMedCentral

31.

Tinning K, Acworth J (2007) Make your best guess: an updated method for paediatric weight estimation in emergencies. Emergency Medicine Australasia 19(6):528–534. https://doi.org/10.1111/j.1742-6723.2007.01026.x CrossRefPubMed

32.

Wang T, Ma X, Xing Y, Sun S, Zhang H, Sturmer T, Wang B, Li X, Tang H, Jiao L, Zhai S (2017) Use of epinephrine in patients with drug-induced anaphylaxis: an analysis of the Beijing Pharmacovigilance Database. Int Arch Allergy Immunol 173(1):51–60. https://doi.org/10.1159/000475498 CrossRefPubMedPubMedCentral

33.

Wiener ES, Bajaj L (2005) Diagnosis and emergent management of anaphylaxis in children. Adv Pediatr Infect Dis 52:195–206

34.

Zhao Y, Sun S, Li X, Ma X, Tang H, Sun L, Zhai S, Wang T (2017) Drug-induced anaphylaxis in China: a 10 year retrospective analysis of the Beijing Pharmacovigilance Database. Int J Clin Pharm. https://doi.org/10.1007/s11096-017-0535-2

Title: Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data
Authors: Yan Xing
Hua Zhang
Shusen Sun
Xiang Ma
Roy A. Pleasants
Huilin Tang
Hangci Zheng
Suodi Zhai
Tiansheng Wang
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 1/2018
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-017-3048-z

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

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