Disparities in pediatric anaphylaxis triggers and management across Asia.
Asia
adrenaline
anaphylaxis
nuts
prospective
registry
shellfish
wheat
Journal
Allergy
ISSN: 1398-9995
Titre abrégé: Allergy
Pays: Denmark
ID NLM: 7804028
Informations de publication
Date de publication:
10 Mar 2024
10 Mar 2024
Historique:
revised:
04
02
2024
received:
03
11
2023
accepted:
21
02
2024
medline:
11
3
2024
pubmed:
11
3
2024
entrez:
11
3
2024
Statut:
aheadofprint
Résumé
The epidemiology and management of anaphylaxis are not well-reported in Asia. A regional pediatric anaphylaxis registry was established by the Asia-Pacific Research Network for Anaphylaxis (APRA), using standardized protocols for prospective data collection, to evaluate the triggers and management of anaphylaxis in the Asia-Pacific region. Pediatric patients below 18 years presenting with anaphylaxis across four Asian countries/cities (Thailand, Singapore, Hong Kong (HK), and Qingdao) were included. Allergen triggers, symptoms, anaphylaxis severity, and management were compared. Between 2019 and 2022, 721 anaphylaxis episodes in 689 patients from 16 centers were identified. The mean age at anaphylaxis presentation was 7.0 years (SD = 5.2) and 60% were male. Food was the most common trigger (62%), particularly eggs and cow's milk in children aged 3 years and below. In school-age children, nut anaphylaxis was most common in HK and Singapore, but was rare in the other countries, and wheat was the top allergen in Bangkok. Shellfish anaphylaxis was most common in children aged 7-17. Adrenaline was administered in 60% of cases, with 9% given adrenaline before hospital arrival. Adrenaline devices were prescribed in up to 82% of cases in Thailand but none in Qingdao. The APRA identified food as the main trigger of anaphylaxis in children, but causative allergens differed even across Asian countries. Fewer than two-thirds of cases received adrenaline treatment, pre-hospital adrenaline usage was low, and adrenaline device prescription remained suboptimal. The registry recognizes an unmet need to strengthen anaphylaxis care and research in Asia-Pacific.
Sections du résumé
BACKGROUND
BACKGROUND
The epidemiology and management of anaphylaxis are not well-reported in Asia.
METHODS
METHODS
A regional pediatric anaphylaxis registry was established by the Asia-Pacific Research Network for Anaphylaxis (APRA), using standardized protocols for prospective data collection, to evaluate the triggers and management of anaphylaxis in the Asia-Pacific region. Pediatric patients below 18 years presenting with anaphylaxis across four Asian countries/cities (Thailand, Singapore, Hong Kong (HK), and Qingdao) were included. Allergen triggers, symptoms, anaphylaxis severity, and management were compared.
RESULTS
RESULTS
Between 2019 and 2022, 721 anaphylaxis episodes in 689 patients from 16 centers were identified. The mean age at anaphylaxis presentation was 7.0 years (SD = 5.2) and 60% were male. Food was the most common trigger (62%), particularly eggs and cow's milk in children aged 3 years and below. In school-age children, nut anaphylaxis was most common in HK and Singapore, but was rare in the other countries, and wheat was the top allergen in Bangkok. Shellfish anaphylaxis was most common in children aged 7-17. Adrenaline was administered in 60% of cases, with 9% given adrenaline before hospital arrival. Adrenaline devices were prescribed in up to 82% of cases in Thailand but none in Qingdao.
CONCLUSIONS
CONCLUSIONS
The APRA identified food as the main trigger of anaphylaxis in children, but causative allergens differed even across Asian countries. Fewer than two-thirds of cases received adrenaline treatment, pre-hospital adrenaline usage was low, and adrenaline device prescription remained suboptimal. The registry recognizes an unmet need to strengthen anaphylaxis care and research in Asia-Pacific.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Références
Sampson HA, Muñoz-Furlong A, Campbell RL, et al. 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. 2006;117:391-397. doi:10.1016/j.jaci.2005.12.1303
Commins SP, Jerath MR, Cox K, Erickson LD, Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016;65(1):16-20. doi:10.1016/j.alit.2015.10.001
Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: a systematic review. Allergy. 2019;74:1063-1080. doi:10.1111/all.13732
Turner PJ, Campbell DE, Motosue MS, et al. Global trends in anaphylaxis epidemiology and clinical implications. J Allergy Clin Immunol Pract. 2020;8:1169-1176. doi:10.1016/j.jaip.2019.11.027
Tham EH, Leung ASY, Pacharn P, et al. Anaphylaxis - lessons learnt when east meets west. Pediatr Allergy Immunol. 2019;30:681-688. doi:10.1111/pai.13098
Grabenhenrich LB, Dolle S, Moneret-Vautrin A, et al. Anaphylaxis in children and adolescents: the European anaphylaxis registry. J Allergy Clin Immunol. 2016;137:1128-1137.e1. doi:10.1016/j.jaci.2015.11.015
Sánchez-Borges M, Ansotegui I, Cox L. World allergy organization grading system for systemic allergic reactions: it is time to speak the same language when it comes to allergic reactions. Curr Treat Options Allergy. 2019;6:388-395. doi:10.1007/s40521-019-00229-8
Fernández-Rivas M, Gómez García I, Gonzalo-Fernández A, et al. Development and validation of the food allergy severity score. Allergy. 2022;77:1545-1558, 1558. doi:10.1111/all.15165
Wang Y, Koplin JJ, Ho MHK, et al. Increasing hospital presentations for anaphylaxis in the pediatric population in Hong Kong. J Allergy Clin Immunol Pract 2018; 6: 1050-1052.e1052. 10.1016/j.jaip.2017.09.018
Lee AY, Enarson P, Clarke AE, et al. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities. J Asthma Allergy. 2017;10:1-7. doi:10.2147/jaa.S123053
Goh SH, Soh JY, Loh W, et al. Cause and clinical presentation of anaphylaxis in Singapore: from infancy to old age. Int Arch Allergy Immunol. 2018;175:91-98. doi:10.1159/000485127
Jeong K, Ye YM, Kim SH, et al. A multicenter anaphylaxis registry in Korea: clinical characteristics and acute treatment details from infants to older adults. World Allergy Organ J. 2020;13:100449. doi:10.1016/j.waojou.2020.100449
Jiang N, Xu W, Xiang L. Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence. World Allergy Organ J. 2021;14:100605. doi:10.1016/j.waojou.2021.100605
Sato S, Yanagida N, Ito K, et al. Current situation of anaphylaxis in Japan: Data from the anaphylaxis registry of training and teaching facilities certified by the Japanese Society of Allergology-secondary publication. Allergol Int. 2023;72:437-443. doi:10.1016/j.alit.2022.12.003
Goh DL, Lau YN, Chew FT, Shek L, Lee B. Pattern of food-induced anaphylaxis in children of an Asian community. Allergy. 1999;54:84-86. doi:10.1034/j.1398-9995.1999.00925.x
Ebisawa M, Ito K, Fujisawa T, Committee for Japanese Pediatric Guideline for Food Allergy, The Japanese Society of Pediatric Allergy and Clinical Immunology, Japanese Society of Allergology. Japanese guidelines for food allergy 2020. Allergol Int. 2020;69:370-386. doi:10.1016/j.alit.2020.03.004
Peters RL, Guarnieri I, Tang MLK, et al. The natural history of peanut and egg allergy in children up to age 6 years in the HealthNuts population-based longitudinal study. J Allergy Clin Immunol. 2022;150:657-665.e613. doi:10.1016/j.jaci.2022.04.008
Wood RA, Sicherer SH, Vickery BP, et al. The natural history of milk allergy in an observational cohort. J Allergy Clin Immunol. 2013;131:805-812. doi:10.1016/j.jaci.2012.10.060
Spolidoro GCI, Ali MM, Amera YT, et al. Prevalence estimates of eight big food allergies in Europe: updated systematic review and meta-analysis. Allergy. 2023;78:2361-2417. doi:10.1111/all.15801
Robinson LB, Arroyo AC, Faridi MK, Rudders SA, Camargo CA Jr. Trends in US hospitalizations for anaphylaxis among infants and toddlers: 2006 to 2015. Ann Allergy Asthma Immunol. 2021;126:168-174.e3. doi:10.1016/j.anai.2020.09.003
Dölle-Bierke S, Höfer V, Francuzik W, et al. Food-induced anaphylaxis: data from the European anaphylaxis registry. J Allergy Clin Immunol Pract. 2023;11:2069-2079.e7. doi:10.1016/j.jaip.2023.03.026
Wai CYY, Leung NYH, Leung ASY, et al. Comprehending the allergen repertoire of shrimp for precision molecular diagnosis of shrimp allergy. Allergy. 2022;77:3041-3051. doi:10.1111/all.15370
Tham EH, Lee AJ, Bever HV. Aeroallergen sensitization and allergic disease phenotypes in Asia. Asian Pac J Allergy Immunol. 2016;34:181-189. doi:10.12932/ap0770
Bee Wah L, Lynette Pei-Chi S, Irvin Francis AG, et al. Food allergy-lessons from Asia. World Allergy Organ J. 2008;1:129-133. doi:10.1097/WOX.0b013e31817b7431
Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122:984-991. doi:10.1016/j.jaci.2008.08.039
Tham EH, Lee BW, Chan YH, et al. Low food allergy prevalence despite delayed introduction of allergenic foods-data from the GUSTO cohort. J Allergy Clin Immunol Pract. 2018;6:466-475.e1. doi:10.1016/j.jaip.2017.06.001
Li J, Ogorodova LM, Mahesh PA, et al. Comparative study of food allergies in children from China, India, and Russia: the EuroPrevall-INCO surveys. J Allergy Clin Immunol Pract. 2020;8:1349-1358.e16. doi:10.1016/j.jaip.2019.11.042
Wong GW, Hui DS, Chan HH, et al. Prevalence of respiratory and atopic disorders in Chinese schoolchildren. Clin Exp Allergy. 2001;31:1225-1231. doi:10.1046/j.1365-2222.2001.01140.x
Fok AO, Wong GW. What have we learnt from ISAAC phase III in the Asia-Pacific rim? Curr Opin Allergy Clin Immunol. 2009;9:116-122. doi:10.1097/aci.0b013e3283292256
von Mutius E, Vercelli D. Farm living: effects on childhood asthma and allergy. Nat Rev Immunol. 2010;10:861-868.
Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259-1260. doi:10.1136/bmj.299.6710.1259
Hanski I, von Hertzen L, Fyhrquist N, Koskinen K, Torppa K, Laatikainen T, Karisola P, Auvinen P, Paulin L, Mäkelä MJ, Vartiainen E, Kosunen TU, Alenius H, Haahtela T Environmental biodiversity, human microbiota, and allergy are interrelated. Proc Natl Acad Sci 2012; 109: 8334-8339. doi:10.1073/pnas.1205624109
Panjari M, Koplin JJ, Dharmage SC, et al. Nut allergy prevalence and differences between Asian-born children and Australian-born children of Asian descent: a state-wide survey of children at primary school entry in Victoria, Australia. Clin Exp Allergy. 2016;46:602-609. doi:10.1111/cea.12699
Koplin JJ, Peters RL, Ponsonby AL, et al. Increased risk of peanut allergy in infants of Asian-born parents compared to those of Australian-born parents. Allergy. 2014;69:1639-1647. doi:10.1111/all.12487
Pumphrey RS. Fatal posture in anaphylactic shock. J Allergy Clin Immunol. 2003;112:451-452. doi:10.1067/mai.2003.1614
Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract. 2017;5:1169-1178. doi:10.1016/j.jaip.2017.06.031
Rudders SA, Banerji A, Clark S, Camargo CA Jr. Age-related differences in the clinical presentation of food-induced anaphylaxis. J Pediatr. 2011;158:326-328. doi:10.1016/j.jpeds.2010.10.017
Kerddonfak S, Manuyakorn W, Kamchaisatian W, Sasisakulporn C, Teawsomboonkit W, Benjaponpitak S. The stability and sterility of epinephrine prefilled syringe. Asian Pac J Allergy Immunol. 2010;28:53-57.
Kelly JR, Dalm GW. Stability of epinephrine in dental anesthetic solutions: implications for autoclave sterilization and elevated temperature storage. Mil Med. 1985;150:112-114.
Lee S, Hess EP, Lohse C, Gilani W, Chamberlain AM, Campbell RL. Trends, characteristics, and incidence of anaphylaxis in 2001-2010: a population-based study. J Allergy Clin Immunol. 2017;139:182-188.e2. doi:10.1016/j.jaci.2016.04.029
Clark S, Bock SA, Gaeta TJ, et al. Multicenter study of emergency department visits for food allergies. J Allergy Clin Immunol. 2004;113:347-352. doi:10.1016/j.jaci.2003.10.053
Fleischer DM, Perry TT, Atkins D, et al. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study. Pediatrics. 2012;130:e25-e32. doi:10.1542/peds.2011-1762