Asia Pac Allergy.  2013 Apr;3(2):106-114. 10.5415/apallergy.2013.3.2.106.

Clinical evaluation of pediatric anaphylaxis and the necessity for multiple doses of epinephrine

Affiliations
  • 1Department of Pediatrics, Inagi Municipal Hospital, 1171 Omaru, Inagi, Tokyo 206-2801, Japan. nao2014272@yahoo.co.jp

Abstract

BACKGROUND
Epinephrine administered intramuscularly is the treatment of choice for anaphylaxis, and more than 1 dose is occasionally required.
OBJECTIVE
To determine clinical background of anaphylaxis for improving the treatment, management, and prognosis of anaphylaxis.
METHODS
Children who had satisfied the diagnostic criteria for anaphylaxis according to the National Institute of Allergy and Infectious Disease Food Allergy and Anaphylaxis Network were selected from our hospital from April 1, 2009 to March 31, 2012.
RESULTS
We analyzed 61 patients from the ages of 2 months to 14 years who satisfied the diagnostic criteria for anaphylaxis. Parents of 32 children (52.5%) reported that they had been administered single dose of epinephrine, and 3 children (4.9%) reported receiving multiple doses of epinephrine. The latter group experienced syncope more often (p = 0.049) than the former and suffered more often from comorbid allergic diseases (p = 0.043) that included either bronchial asthma, allergic rhinitis, or atopic dermatitis. Two (3.3%) children experienced biphasic reactions. Patients who experienced a biphasic reaction were more likely to have experienced syncope (p = 0.033), vomiting (p = 0.02), and administration of multiple doses of epinephrine (p = 0.0016).
CONCLUSION
Our findings lead us to recommend that children receiving more than 1 injection of epinephrine should be observed for 24 hours, because it seems that children with requiring more than 1 injection of epinephrine might be have biphasic reactions.

Keyword

Epinephrine; Children; Biphasic anaphylaxis; Anaphylaxis

MeSH Terms

Anaphylaxis*
Asthma
Child
Communicable Diseases
Dermatitis, Atopic
Epinephrine*
Food Hypersensitivity
Humans
Hypersensitivity
Parents
Prognosis
Rhinitis, Allergic
Syncope
Vomiting
Epinephrine
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