Clinical factors associated with prehospital exacerbation of anaphylaxis in children.
BACKGROUND
The severity of anaphylaxis often varies with time. Because prehospital intervention and initial treatment at hospital are affected by changing symptoms, the aim of this study was to determine the clinical factors associated with prehospital remission and exacerbation in the course of anaphylaxis in children.


METHODS
Data from medical records on anaphylactic children who were treated for 3 years at Kobe Children's Primary Emergency Medical Center were retrospectively analyzed. Severity of symptoms was evaluated using Sampson's grade (S-G). Patients with increased S-G at the hospital visit from disease onset (worsened group) were compared with those with decreased S-G at the visit (improved group). Uni- and multivariate analyses were performed to identify clinical differences between the groups, with P<0.05 considered statistically significant.


RESULTS
Among 115 anaphylactic children who showed S-G changes from onset to hospital visit, 43 were assigned to the worsened group and 72 to the improved group. Univariate analysis showed no significant differences in age, sex, history of asthma, prehospital treatment, type of antigen, or period from symptom onset to hospital visit between the groups. However, the time from antigen exposure to symptom onset was significantly longer, and S-G at onset was significantly lower in the worsened group than in the improved group. Multivariate analysis identified time from antigen exposure to symptom onset (odds ratio: 3.89, P<0.01) and S-G at onset (odds ratio: 0.06, P<0.001) as independent predictors of exacerbation.


CONCLUSIONS
Anaphylactic children with slower and milder symptoms at onset are more likely to show deterioration.
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Takeshi
T
Ninchoji
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Sota
S
Iwatani
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Masahiro
M
Nishiyama
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Naohiro
N
Kamiyoshi
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Taku
T
Nakagawa
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Mariko
M
Taniguchi-Ikeda
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Naoya
N
Morisada
Kobe Children's Primary Emergency Medical Center, Kobe, Japan.
Kazuto
K
Ishibashi
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Kazumoto
K
Iijima
Kobe Children's Primary Emergency Medical Center, Kobe, Japan.
Akihito
A
Ishida
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan - ichim@med.kobe-u.ac.jp.
Ichiro
I
Morioka
D000293:Adolescent; D000707:Anaphylaxis / Q000276:immunology / Q000503:physiopathology* / Q000628:therapy; D000941:Antigens / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D000941:Antigens