RESEARCH – June 2016

Anaphylaxis cases in Children’s Clinic of Tartu University Hospital during the years 2005–2014

Authors: Maire Vasar, Anneli Larionova, Kaja Julge , Mari Kivivare, Tiia Voor

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Background and aims. Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction which needs correct and prompt diagnosing and rapid treatment. Our aim was to assess the clinical features, causes, risk factors and 5-year trends of anaphylaxis cases among paediatric patients who were treated at the Children’s Clinic of Tartu University Hospital during 2005–2014.

Methods. A retrospective medical chart review was performed of all anaphylaxis (ICD-10 codes T78.0 – T78.2), angioneurotic oedema (T78.3) and insect sting (T63.4) cases. Out of all 508 patients, 93 met at least two clinical criteria of anaphylaxis: acute onset of systemic hypersensitivity reaction and involvement of the skin and mucosal tissue or both, as well as presence of respiratory symtoms.

Results. Anaphylaxis was significantly more frequent in boys (male/female = 2.9, p < 0.0001). Foods (58%) and hymenoptera venom sting (26%) were the most common causative agents in our study. Food anaphylaxis was significantly more frequent among the under 6-year-old age group (30 children of 42 (71%) vs. 8 children of 19 (42%) vs. 14 children of 30 (47%), p = 0,04). Food anaphylaxis was most often induced by fish and shrimps (35%), followed by nuts (28%). Children with atopic dermatitis were 41 times more likely (28 children of 54 (51,9%) vs. 1 child of 39 (2,6%), OR 41; 95% CI: 5,2–320), p < 0,0001) to develop food anaphylaxis compared to those who did not have atopic dermatitis. Although the number of patients with anaphylaxis doubled in the last five years (30 vs. 63, p = 0.001), there is no statistical difference in epinephrine usage (20 %) or in the prescribing of adrenalin auto-injectors (18 of 30 (60 %) vs. 38 of 63 (60%), p = 1.0).

Conclusions. The number of patients with anaphylaxis doubled during the second 5-year period. Anaphylaxis occurred most frequently in boys. Most of the reactions were due to food. Children with anaphylaxis had more often atopic dermatitis. Like in many other countries, adrenaline as the first-line treatment of anaphylaxis is underused in Estonia. There is a clear need for continuing the education of medical staff as well as patients and parents concerning anaphylaxis.