PEDIATRIC ANAPHYLAXIS, INSECT STINGS, AND BITES - 08/09/11
Résumé |
Anaphylaxis is a clinical syndrome for which precise definition is difficult largely because the signs and symptoms of anaphylaxis are the same as those found with other less severe allergic reactions. Typical manifestations of anaphylaxis include urticaria; angioedema, especially of the eye lids, lips, and glottis; conjunctivitis and lacrimation; rhinorrhea and sneezing; bronchospasm; abdominal cramping; nausea; vomiting; diarrhea; arrhythmias; and hypotension. Although no specific guidelines have been proposed for precisely defining anaphylaxis, the principal distinguishing features of anaphylaxis are the severity of symptoms and the simultaneous involvement of multiple organ systems.6, 8, 60 In two recent studies, researchers have attempted to define anaphylaxis operationally so that appropriate cases could be identified.4, 5 In one study, the authors included cases with two or more typical symptoms: hypotension, bronchospasm, and angioedema or urticaria.41 The other study required either signs of respiratory obstruction (e.g., laryngeal edema or bronchospasm) or cardiovascular symptoms (e.g., documented hypotension, syncope, or orthostatic hypotension) plus signs of general mediator release, such as pruritus, urticaria, angioedema, or flushing.61
Both animal studies and case reports suggest that airway obstruction is the most frequent cause of death from anaphylaxis, although hypotension can also be prominent.8, 39, 53, 54 Airway obstruction can occur either at the level of the glottis or within the lungs. The risk of intrapulmonary airway obstruction from bronchospasm appears to be especially severe in children who have preexisting asthma and food allergies.44
Some authorities carefully distinguish anaphylactic from anaphylactoid reactions. Anaphylactic reactions result from the IgE-mediated release of chemical mediators, whereas anaphylactoid reactions result from non-IgE-mediated mediator release. Although the mechanisms of mediator release may differ, anaphylactic and anaphylactoid reactions are clinically indistinguishable and the acute symptoms are treated identically.8 The distinction is most important in establishing the origin of the event.
Le texte complet de cet article est disponible en PDF.Plan
| Address reprint requests to Dennis R. Ownby, MD, Departments of Pediatrics and Medicine, Section of Allergy–Immunology, BG 244, Medical College of Georgia, Augusta, GA 30912–3790, e-mail: [email protected] |
Vol 19 - N° 2
P. 347-361 - mai 1999 Retour au numéro
Article précédent
- EOSINOPHILIA IN CHILDHOOD
- Michael J. Chusid
- PEDIATRIC URTICARIA AND ANGIOEDEMA
- Michael C. Zacharisen
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?