Pediatric anaphylaxis at a university hospital including the rate of prescribing epinephrine autoinjectors

Jun Seak Gang; Hye-Sun Kim; Hyun Ho Bang; Tae Ho Kim; Hyun Jung Lee; Young Hwangbo; Joon Soo Park

doi:10.4168/aard.2017.5.3.135

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Gang, Kim, Bang, Kim, Lee, Hwangbo, and Park: Pediatric anaphylaxis at a university hospital including the rate of prescribing epinephrine autoinjectors

Original Article

Allergy Asthma Respir Dis 2017;5(3):135-140.

Published online: 5 May 2017

DOI: https://doi.org/10.4168/aard.2017.5.3.135

Pediatric anaphylaxis at a university hospital including the rate of prescribing epinephrine autoinjectors

Jun Seak Gang¹, Hye-Sun Kim¹, Hyun Ho Bang¹, Tae Ho Kim¹, Hyun Jung Lee², Young Hwangbo³, Joon Soo Park¹

¹Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

²Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

³Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea

Correspondence to: Joon Soo Park https://orcid.org/0000-0001-5813-6291 Department of Pediatrics, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea Tel: +82-41-570-2163, Fax: +82-41-572-4996, E-mail: pjstable@schmc.ac.kr

Received 3 September 201614 November 2016 Accepted 17 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Anaphylaxis is an acute, life-threatening systemic reaction which should be treated by epinephrine, and patients should be prescribed epinephrine autoinjector after the event. The purpose of this study was to investigate the clinical features of pediatric anaphylaxis, including the rate of using epinephrine at hospital and prescribing epinephrine autoinjector.

Methods

We performed a retrospective study of 68 anaphylactic patients at in-hospital, out-hospital, and Emergency Department of Soonchunhyang University Cheonan Hospital, Cheonan, Korea, who were under 15 years of age, from January 2013 through December 2014. We reviewed their clinical features, doctor's treatment methods, rate of follow-up and prescribing epinephrine autoinjectors.

Results

Causes of anaphylaxis were food (76.5%), drug (10.3%), and idiopathic (13.2%). The involved organs were the skin (86.8%), respiratory tract (80.9%), cardiovascular system (23.5%), and gastrointestinal tract (17.7%). Patients were treated with systemic steroids (91.2%), antihistamines (88.2%), and epinephrine (75.0%). Fifty-three patients (77.9%) revisited our pediatric allergy clinic and epinephrine autoinjectors were prescribed for 25 patients (36.8%).

Conclusion

Physicians should make an effort to use epinephrine as an initial treatment of anaphylaxis, to prescribe epinephrine autoinjectors, and to give proper information about disease.

Keywords: Anaphylaxis, Epinephrine, Management, Child

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Table 1.

Causes of anaphylaxis of subjects by age group (n=68)

Cause of anaphylaxis	0–2 Yr (n=28)	3–6 Yr (n=19)	7–15 Yr (n=21)	Total (n=68)	P-value ^II
Food	26 (92.9%)	14 (73.7%)	12 (57.1%)	52 (76.5%)	0.006
Dairy∗	8	3	0	11
Egg	7	2	0	9
Wheat	6	0	2	8
Nuts^†	0	2	2	4
Peanut	0	1	0	1
Sea foods^‡	0	3	3	6
Etc.^§	5	3	5	13
Drug	0 (0%)	1 (5.3%)	6 (28.6%)	7 (10.3%)
OTC	0	1	3	4
Antibiotics	0	0	1	1
NSAID	0	0	1	1
RCM	0	0	1	1
Idiopathic	2 (7.1%)	4 (21.1%)	3 (14.3%)	9 (13.2%)

OTC, over the counter drug-cold preparations; NSAID, nonsteroidal anti-inflammatory drug; RCM, radio contrast media.

^∗ Dairy: milk, cheese, baby milk powder, yogurt.

^† Nuts: walnut, almond, pine nut.

^‡ Sea foods: fish, shrimp, swimming crab, small octopus.

^§ Etc.: red bean, snack, chicken, fried potato, jelly, plant, cheese & egg, kiwi & egg, dried mango

^II Fisher exact test was used to compare the proportions of causes of anaphylaxis (food, drug, idiopathic) by age group.

Table 2.

Symptoms of patients when diagnosed with anaphylaxis by age group

Symptom	0–2 Yr (n=28)	3–6 Yr (n=19)	7–15 Yr (n=21)	Total (n=68)	P-value
Cutaneous	26 (92.9)	15 (78.9)	18 (85.7)	59 (86.8)	0.359
Respiratory	27 (96.4)	14 (73.7)	14 (66.7)	55 (80.9)	0.013
Cardiovascular	6 (21.4)	4 (21.1)	6 (28.5)	16 (23.5)	0.820
Gastrointestinal	6 (21.4)	2 (10.5)	4 (19.1)	12 (17.7)	0.665

Values are presented as number (%).

Table 3.

Treatment methods used to patients, revisit rate after anaphylaxis and prescribing rate of epinephrine autoinjector

Treatment method	0–2 Yr (n=28)	3–6 Yr (n=19)	7–15 Yr (n=21)	Total (n=68)	P-value
Epinephrine∗	22 (78.6)	10 (52.6)	19 (90.5)	51 (75.0)	0.019
Systemic steroid	26 (92.9)	16 (84.2)	20 (95.2)	62 (91.2)	0.487
Antihistamine	27 (96.4)	14 (73.7)	19 (90.5)	60 (88.2)	0.060
Revisit^†	26 (92.9)	16 (84.2)	11 (52.4)	53 (77.9)	0.003
Epinephrine autoinjector^‡	12 (42.9)	11 (57.9)	4 (19.1)	27 (39.7)	0.039

Values are presented as number (%).

^∗ Epinephrine: All patients of this category were injected epinephrine at hospital, no one used epinephrine autoinjector before arrival of hospital.

^† Revisit: patients who revisited the allergy clinic within 2 weeks after the onset of anaphylaxis.

^‡ Epinephrine autoinjector: patients who prescribed epinephrine autoinjector after anaphylaxis.

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