@misc{Tarczoń_Izabela_Analysis_2021,
 author={Tarczoń, Izabela},
 address={Kraków},
 howpublished={online},
 year={2021},
 school={Rada Dyscypliny Nauki medyczne},
 language={pol; eng},
 abstract={The primary goal of the study was to determine a clinical pattern of anaphylaxis in response to the most common allergens in pediatric population, such as foods and insect venoms. The secondary goal was to identify main areas requiring better education and increased quality of medical care in regards to patient management during and after anaphylactic event. The following research problems underwent scrutinized and detailed analyses: 1. Identification of trigger factors in children with anaphylaxis within one clinical center. 2. The profile of anaphylaxis symptoms in Polish pediatric population compared to data from the European Registry of Anaphylaxis (ERA). 3. Type of medical intervention during anaphylaxis, and its comparison to the international standards. 4. Analysis of patient management following anaphylaxis (i.e. prescription and/or supply of intervention medications, training in techniques of adrenaline application). The analyzed group included children admitted to the Department of Pediatrics between 30.09.2015 and 31.03.2019 (in days 30.09.2015-19.11.2015 – pilot survey). The patients were hospitalized due to either acute anaphylaxis episode or as part of diagnostic procedures following a documented anaphylaxis during the preceding 12 months. The study included only the children with moderate or serious generalized allergic reactions. The parents, caregivers an},
 abstract={d patients older than 16 singed voluntary informed consents prior to entering the questionnaire-based study. The study was carried out in cooperation with European Registry of Anaphylaxis (Network for Online-Registration of Anaphylaxis, NORA). The group consisted of 114 children aged between 5 months and 17 years (average age 8,0 years, SD=4,8 years), with the majority of boys (76; 66%) in all the age groups: 0-2 years (n=17, 64,7%), 3-6 years (n=32, 75%), 7-12 (n=40, 62,5%), >=13 (n=25, 64%). The evaluated group reflected 12,5% of the international population (909 cases) of children and adolescents recorded in the above Registry. Review article based on the analysis of 69 published articles, out of which 37 were published between 2019 and 2020. The two most common allergens causing anaphylaxis in the analyzed patient groups included hymenoptera venom with predominance of bees in 47,4%, and foods in 35,1%. Our reported data differed from the ones in the Registry, which indicated that the main allergenic substance was food (66%), then hymenoptera venom (19%) with predominance of wasps. The type of anaphylaxis causative agent differed in various age groups. In the group of preschoolers, there was mostly food allergy. Insect venom allergy was more common in the school age children, similarly to the ERA database. The most common food allergens were hen egg, cow milk, tree nuts (c},
 abstract={hestnut, walnut, cashew), sesame, peanuts. Hen egg white and cow milk predominated in the youngest patients up to 3 years (70,6%) and the preschoolers group (43,8%), which was also comparable with the ERA data. However, the most common food allergen in the population of European children overall were peanuts (28%). The skin symptoms in order of their appearance included utricaria, angio-oedema, itching and erythema, which affected almost all the patients in the analyzed population (99,1%) regardless the causative factor. Our observations were similar to the Registry data, which reported skin symptoms to be the most frequent (92%) and developing in the same order as listed above. The next system to be affected was the respiratory tract, listed as such both in the presented work and European population (93,9% and 80% respectively), and the most common symptom was dyspnea. The other symptoms such as cough, voice change, nasal discharge, stridor, feeling of throat swelling and wheezing were described in the two populations with different frequencies. All the children allergic to foods developed respiratory symptoms, which was statistically different from the children developing anaphylaxis following insect bites (100% vs 88,9%, p=0,036). In this work, the cardio-vascular symptoms (according to frequency of occurrence: decrease of alertness, hypotension, tachycardia, dizziness) aff},
 abstract={ected 74,6% children, which was significantly higher in children allergic to insect venom compared to the ones with food allergy (85,2% vs 65%, p=0.022). According to the Registry, the circulatory system symptoms affected less than half of the patients (41%) and manifested slightly differently than in Polish children, mostly in form of dizziness, hypotension and shock. The results of our work indicated that 61,4% children developed gastrointestinal (GI) symptoms, which occurred significantly more frequently in the children allergic to foods than to hymenoptera venom (77,5% vs 48,1%, p=0.004). The most common GI tract symptom was abdominal pain. In the analyzed group of children up to 6 years, vomiting was the symptom differentiating patients with food allergy from the ones allergic to insect venom. It was significantly more common in the former group, 48% vs 13%. The Registry data indicated that vomiting was less prevalent, since it was present in 45% patients, though vomiting was the predominant symptom in the preschool age groups, similarly to this work.Children allergic to foods were younger, and the life threatening symptoms were less common. The symptoms from the GI and respiratory systems were significantly more frequent in anaphylaxis caused by foods than insect venoms. On the other hand, insect venom allergy led to pronounced cardiovascular symptoms manifested as decrea},
 abstract={se in blood pressure or loss of consciousness, both life threatening symptoms. The above observations confirmed our hypothesis that there were certain phenotypes of anaphylaxis, which depended on the type of the causative factor and child’s age, therefore we decided to define the two most common clinical types of anaphylaxis. The patient’s phenotype with food allergy is typically a small child with symptoms predominantly from GI tract, who usually presents with vomiting, and occasionally nasal discharge and cough. On the other hand, the patient’s phenotype with insect venom caused anaphylaxis is an older child with the cardiovascular symptoms, in particular such as decrease in blood pressure and even cardiovascular failure. The patient after insect bite more often reported subjective symptoms such as tingling, stinging/burning of hands and/or feet, paresthesis, etc. The first line of medical intervention in anaphylaxis in the majority of children evaluated both in our center, and in the Registry (64,9% vs 72%) was carried out exclusively by the medical personnel, mostly an emergency medical doctor or a medical specialist other than allergologist. In both groups, one third of the patients (33,3% vs 30%) received first aid from a person without medical education (a family member in 95% cases), then medical personnel in the majority of the remaining cases (76,3%). Almost all th},
 abstract={e children received some kind of pharmacological treatment (n=112, 98,2%). The most common medications given by the non-medical people both in Polish study and the Registry included oral antihistaminic drugs (AH1) (81,6 % vs 78%), oral glucocorticosteroids (GCS) (21,1% vs 52%), beta-agonist medications (SABA) (18,4 vs 28%). Pharmacotherapy provided by medical personnel both as the first, and second line of intervention was based on the following medications listed according to the order of their use – AH1 (89,3%), GCS (83%), and intravenous fluids (61,3%). The comparable rate of GCS use (82%) and slightly lower rate of AH1 use (76%) were reported in the patients records in the Registry. Adrenaline, as the first line intervention, was used in 39 patients in our analysis (34,8%), which was slightly higher compared to the Registry (28%), but overall the recorded rate was still too low. In the summary, careful analysis demonstrated that in this study almost 2/3 children (65,2%) with severe anaphylaxis did not receive adrenaline as the first line intervention. Immediately following anaphylactic event, only 1/3 patients received prescriptions for adrenaline for self-administration, and less than 10% was trained on management of anaphylaxis in case of recurrent event. Administration of adrenaline in merely 1/3 children with severe systemic reaction demonstrated its limited use in a},
 abstract={naphylaxis. Insufficient use of adrenaline during first medical intervention, as well as poorly executed management plan following anaphylaxis (such as prescription for adrenaline, dedicated training of the patient and his caregivers on use of the ampule-syringes or self-injectors of adrenaline, recommendations on how to avoid allergens) might result from the insufficient understanding of anaphylaxis as a complex clinical problem. The results of this study identified areas in diagnostics and anaphylaxis treatment that still required education. We stressed the importance of education of medical professionals on teaching their patients on indications and techniques of adrenaline administration, including self-injections. The narrative review presented selected news on the current recommended approach to anaphylaxis diagnosis, its treatment and application of those recommendations in daily clinical practice. The paper presented a novel definition of anaphylaxis according to WAO (2019), which novelty was not to include skin changes as indispensable element of anaphylaxis diagnosis. It was re-confirmed that adrenaline immediate administration was safe, indicated for treatment of severe symptoms and it prevented biphasic reactions. Also, the newest data showed that use of systemic GCS, regarded as medications diminishing risk of biphasic reactions, not only did not demonstrated such},
 abstract={effects, but it actually increased such a probability in the pediatric population. The publication also listed modern self-injectors with a properly selected dose of medicine, also for the babies, which could be more frequently used by the patients in case of anaphylaxis once introduced onto the market. At the same time, there were e-learning modules, multidisciplinary education programs, and personal training with the patient, which might be helpful in future decision making by the patient or his/her caregiver to administer adrenaline without anxiety/fear of the drug side effects.},
 title={Analysis of causative factors, clinical symptoms and treatment of anaphylaxis in children aged from birth to 18 years},
 type={Praca doktorska},
 keywords={anaphylaxis, children, trigger, clinical manifestation, adrenaline},
}