Anaphylaxis in Children

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Abstract
The articles prior to January 2008 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here Lori Kagy, MD; Michael S Blaiss, MD Anaphylaxis is an immediate IgE-mediated hypersensitivity reaction, which is unexpected and potentially fatal. It results from the release of potent pharmacologie mediators from tissue mast cells and peripheral blood basophils. These mediators lead to the clinical manifestations of anaphylaxis, which may involve many organ systems (usually the cutaneous, respiratory, gastrointestinal, and cardiovascular systems). The term anaphylaxis was coined in 1902 by two French researchers, Paul Portier and Charles Richet. They noted that injection of a previously tolerated sea anemone antigen in a dog produced a fatal reaction as opposed to the anticipated prophylaxis.1 They termed this phenomenon anaphylaxis Greek: ana = backward; phylaxis = protection). Anaphylaxis in children and adolescents is a medical emergency that requires immediate attention. If medical attention is delayed, death may occur as a result of airway obstruction or irreversible vascular collapse. One of the first such fatalities was described as early as 2641 BC, when, according to hieroglyphics, King Menés of Egypt was stung by a wasp or hornet and died. Several factors have been associated with an increased risk of anaphylaxis.2-4 In certain cases where avoidance of an anaphylactic agent is not possible, other measures of prevention are available. Venom immunotherapy should be offered to all patients with documented Hymenoptera anaphylaxis.30 It has been shown to be effective in the prevention of anaphylaxis in more than 95% of patients who were re-stung by insects. Penicillin skin testing can be used to determine whether IgE sensitivity to penicillin exists. Desensitization protocols are available for patients who show positive skin tests to penicillin and who must be given penicillin or one of its derivatives. 1. Portier P, Richer C. De l'action anaphylactique de certaines venins. Compi Rend Soc Bid. 1902:54:170. 2. Kagy L, Blaiss M, Lieberman P Clinical profile of 380 cases of anaphylaxis. Ann Allergy Aiifima fmmunol. 1998;80:81. 3. Weiszer I. Allergie emergencies. In: Patterson R, ed. Allergic Diseases: Diagnosis and Management, Philadelphia: J. B. Lippincott; 1985:418. 4. Marquardt DL, Wasserman SI. Anaphylaxis. In: Middleton E Jr, Reed CE, Ellis EF, Adkinson NFJr, Yunginger JW Busse WW, eds, Aíergy, Principies and Practice. St. Louisr C. V Mosby; 1993:1525. 5. Kaliner M, Sigler R, Summers R, Shelhamer J- Effects of infused histamine: analysis of the effects of H-I and H-2 histamine receptor antagonists on cardiovascular and pulmonary responses. } Allergy CIm Immunol. 1981:68:365-371. 6. Kemp SF, Lockey RF, Wolf BL, Lieberman P. Anaphylaxis: a review of 266 cases. Ardi Intern Med. 1995(155:1749-1754. 7. Siegel SC, Heimlich EM. Anaphylaxis. Pedían CIm North Am. 1962;9:29. 8. Delange C, Mullick FG, !very NS. Myocaidial lesions in anaphylaxis. Arch PoAoI lab MfA 1973;95:185. 9. Bochner BS, Lichtenstein LM. Anaphylaxis. N Engl] Mei 1991;324:1785. 10. Boston Collaborative Drug Surveillance Program. Drug-induced anaphylaxis. JAMA. 1973:224:61}. 1 1 . Levine BB. Antigenicify and crossresctivicy of penicillins and cephaiospíirúií. J In/ectDis. 1973;128i5364. 12. Setcipane GA, Boyd OK. Prevalence of bee sting allergy in 4992 boy scouts. ACM AOer&i. 1970;25:286-291. 13. Hoffman D. Allergy to biting insects. Clin Rev Allergy. 1987:5:177-190. 14. Grabenstein JD, Smith LJ. Incidence of anaphylactic self treatment in an outpatient population. Ann Ailergy. 1989;63:164-188. 15. HOSI A1 Halken S. A prospective study of cow milk allergy m Danish infants during the first 3 years of life. Allergy. 1990:45:587.596. 16. Holen E, Elsayed S. Characterization of four major allergens of hen egg-white by 1EF/SDS-PAGE combined with electrophoretic transfer and IgE immunoautoradiography. Im Arch Aafrgy Appi Jmmuno!. 1990;91:136-14l. 17. Anet ], Back JF, Baker RS, et al. Allergens in the white and yolk of hen's egg. JnI ArA Allergy Appi fmmunol. 1985;77:364-371. 18. Buffum WP, Setiipane GA. Prognosis of asthma in childhood. Am… 10.3928/0090-4481-19981101-08

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