Clinical Features of Patients with Anaphylaxis at a Single Hospital

Hyang Mi Park; Jin Chul Noh; Jong Hyun Park; Youn Kyoung Won; Se Hee Hwang; Jae Yoon Kim; You Young Kim; Eui-Jung Roh; Eun Hee Chung

doi:10.7581/pard.2012.22.3.232

Journal List > Pediatr Allergy Respir Dis > v.22(3) > 1033179

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Park, Noh, Park, Won, Hwang, Kim, Kim, Roh, and Chung: Clinical Features of Patients with Anaphylaxis at a Single Hospital

Abstract

Pediatr Allergy Respir Dis 2012;22(3):232-238.

Published online: 20 January 2012

DOI: https://doi.org/10.7581/pard.2012.22.3.232

Clinical Features of Patients with Anaphylaxis at a Single Hospital

Hyang Mi Park, MD¹, Jin Chul Noh, MD¹, Jong Hyun Park, MD¹, Youn Kyoung Won, MD¹, Se Hee Hwang, MD¹, Jae Yoon Kim, MD¹, You Young Kim, MD², Eui-Jung Roh, MD³, Eun Hee Chung, MD^1,

¹Department of Pediatrics, Seoul, Korea

²Department of Internal Medicine, National Medical Center, Seoul, Korea

³Department of Pediatrics, Sun General Hospital, Daejeon, Korea

책임저자:정은희, 서울특별시 중구 을지로 245 국립중앙의료원 소아청소년과 Tel: 02)2260-7301 Fax: 02)2260-7306 E-mail: ehchung@nmc.or.kr

Received 15 February 2012 Revised 8 March 2012 Accepted 7 June 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The studies concerning the clinical features of patients with anaphylaxis, who meet the newly established diagnostic criteria, are reported in Korea, but comparative studies regarding the clinical features of children and adult patients with anaphylaxis are lacking. The purpose of this study is to compare the clinical features of the children and adults with anaphylaxis, who meet the new diagnostic criteria at a single hospital.

Methods

We reviewed the medical records of patients who were diagnosed with anaphylaxis, anaphylactic shock, urticaria, and angioedema, including inpatients, outpatients and emergency room visited patients, at the National Medical Center from July, 2005 to August, 2011. The clinical characteristics of children and adults, who met the new diagnostic criteria for anaphylaxis, were analyzed.

Results

We identified 91 patients with anaphylaxis. Sixteen were children and 75 were adults. The sex ratio (male:female) and the mean age were 1:1.7 and 9.6 years among children, respectively, and 1:2.3 and 42.3 years, respectively, among adults. The most common cause of anaphylaxis based on clinical history was foods in 15 children (93.7%) and 35 adults (46.7%). Twelve children (75%) and 36 adults (48%) were rediagnosed with anaphylaxis. Patients with cardiovascular symptoms and severe severity were 1 (6.3%) and 1 (6.3%), respectively, among children, and 28 (37.3 %) and 23 (30.3%), respectively, among adults.

Conclusion

We rediagnosed some cases of anaphylaxis, using the new diagnostic criteria and most of the cases were diagnosed initially as urticaria or angioedema. The adults had more severe and more cardiovascular symptoms than children. In the future, a nationwide, multiinstitutional research will be necessary for the prevalence and the clinical features of anaphylaxis by the new diagnostic criteria in Korea.

Keywords: Anaphylaxis, Children, Adult

References

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Fig. 1.

Causes of anaphylaxis based on clinical history.

Table 1.

Demographic Characteristics of Patients with Anaphylaxis

Characteristic	Children (n=16)	Adult (n=75)	P-value
Sex (male: female)	1: 1.7	1: 2.3
Mean age (yr)	9.6 (74 day-18 yr)	42.3 (19 yr-74 yr)
History of allergic diseases	9 (56.3)	31 (41.3)	0.275
Atopic dermatitis	4 (25.0)	0 (0)
Allergic rhinitis	2 (12.5)	6 (8.0)	0.564
Asthma	1 (6.3)	5 (6.7)	0.951
Drug allergy	1 (6.3)	7 (9.3)	0.693
Food allergy	1 (6.3)	13 (17.3)	0.265
Past history of anaphylaxis	3 (18.8)	10 (13.3)	0.574

Values are presented as mean (range) or number (%).

Table 2.

The Initial Diagnosis before Using the New Diagnostic Criteria for Anaphylaxis

Initial diagnosis	Children (n=16)	Adult (n=75)	P-value
Urticaria	12 (75.0)	24 (32.0)	0.001
Angioedema	0 (0)	10 (13.3)
Anaphylaxis	4 (25.0)	39 (52.0)	0.050
Drug side effect	0 (0)	1 (1.3)
Skin eruption	0 (0)	1 (1.3)

Values are presented as number (%).

Table 3.

Clinical Manifestations, Symptom Severity and Clinical Progression of Patients with Anaphylaxis

	Children (n=16)	Adult (n=75)	P-value
Clinical manifestations
Skin	16 (100)	69 (92.0)	0.242
Respiratory	10 (62.5)	58 (77.3)	0.215
Gastrointestinal	10 (62.5)	29 (38.7)	0.080
Cardiovascular	1 (6.3)	28 (37.3)	0.015
Symptom severity
Moderate	15 (93.7)	52 (69.3)	0.044
Severe	1 (6.3)	23 (30.3)	0.044
Clinical progression
Uniphasic	11 (68.7)	62 (82.7)	0.205
Biphasic	2 (12.5)	3 (4.0)	0.176
Protracted	3 (18.8)	10 (13.3)	0.574

Values are presented as number (%).

Table 4.

Observation Time and Hospital Utilization Pattern of Anaphylactic Patients

Observation time & hospital utilization pattern	Children (n=16)	Adult (n=75)	P -value
Emergency room (hr)	14 (87.5)	68 (90.7)	0.700
<8	11 (68.7)	60 (80.0)	0.324
8 ≥	3 (18.7)	8 (10.7)	0.368
Outpatient clinic	0 (0)	3 (4.0)
Admission to general ward	2 (12.5)	4 (5.3)	0.294

Values are presented as number (%).

Table 5.

Treatment of Anaphylactic Patients

Treatment	Children (n=16)	Adult (n=75)	P-value
Medications
Epinephrine	5 (31.3)	30 (40.0)	0.514
Dopamine	0 (0)	1 (1.3)
Antihistamines	14 (87.5)	63 (84.0)	0.725
Corticosteroids	8 (50.0)	58 (77.3)	0.026
Bronchodilator	4 (25.0)	0 (0)
Intravenous fluid	10 (62.5)	67 (89.3)	0.007
Oxygen therapy	3 (18.7)	18 (24.0)	0.651

Values are presented as number (%).

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