PMID- 29168013 OWN - NLM STAT- MEDLINE DCOM- 20180615 LR - 20200121 IS - 1432-1076 (Electronic) IS - 0340-6199 (Print) IS - 0340-6199 (Linking) VI - 177 IP - 1 DP - 2018 Jan TI - Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data. PG - 145-154 LID - 10.1007/s00431-017-3048-z [doi] AB - We assessed the clinical features and treatment of pediatric patients with drug-induced anaphylaxis in clinical settings. Pediatric drug-induced anaphylaxis cases collected by the Beijing Pharmacovigilance Database from 2004 to 2014 were analyzed. A total of 91 cases were identified. Drug-induced anaphylaxis was primarily caused by antibiotics (53%). Children of 0-5 years were more likely to develop cyanosis symptoms than children of 13-17 years (OR = 5.14, 95%CI [1.74, 15.20], P = 0.002). Children of 13-17 years were more likely to develop hypotension than children of 6-12 years (OR = 11.79, 95%CI [2.28, 60.87], P = 0.002), and to manifest both neurological symptoms (OR = 3.56, 95%CI [1.26, 10.08], P = 0.015) and severe anaphylaxis than children of 0-5 years (OR = 15.46, 95%CI [1.85, 129.33], P = 0.002). Supratherapeutic doses of epinephrine were more likely with intravenous (IV) bolus (92%) in contrast to either intramuscular (IM) (36%, OR = 19.25, 95%CI [1.77, 209.55], P = 0.009) or subcutaneous (SC) injections (36%, OR = 19.80, 95% CI [1.94, 201.63], P = 0.005). Only 62 (68%) patients received epinephrine treatment as the first-line therapy. CONCLUSION: This study demonstrates that antibiotics were the most common cause of pediatric drug-induced anaphylaxis. Children may present with different anaphylactic signs/symptoms based on age groups. Epinephrine is under-utilized and provider education on the proper management of drug-induced anaphylaxis is warranted. What is Known: * The most common causes of anaphylaxis in children are allergies to foods. Drugs are the second most common cause of pediatric anaphylaxis. * IM epinephrine is the recommended initial treatment of anaphylaxis. What is New: * Drug-induced anaphylaxis in pediatric patients has age-related clinical features. * IV bolus epinephrine was overused and associated with supratherapeutic dosing. FAU - Xing, Yan AU - Xing Y AD - Department of Pediatrics, Division of Pulmonology & Allergy, Peking University Third Hospital, Beijing, China. FAU - Zhang, Hua AU - Zhang H AD - Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China. FAU - Sun, Shusen AU - Sun S AD - College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, USA. FAU - Ma, Xiang AU - Ma X AD - Department of Pharmacy, Peking University Third Hospital, Beijing, China. FAU - Pleasants, Roy A AU - Pleasants RA AD - Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Asthma, Allergy, and Airways Center, Durham, NC, USA. FAU - Tang, Huilin AU - Tang H AD - Department of Pharmacy, Peking University Third Hospital, Beijing, China. AD - Richard M. Fairbanks School of Public Health, Department of Epidemiology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA. FAU - Zheng, Hangci AU - Zheng H AD - Department of Pharmacy, Peking University Third Hospital, Beijing, China. FAU - Zhai, Suodi AU - Zhai S AD - Department of Pharmacy, Peking University Third Hospital, Beijing, China. AD - Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China. FAU - Wang, Tiansheng AU - Wang T AD - Department of Pharmacy, Peking University Third Hospital, Beijing, China. tianwang@unc.edu. AD - Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China. tianwang@unc.edu. AD - Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. tianwang@unc.edu. LA - eng PT - Journal Article DEP - 20171122 PL - Germany TA - Eur J Pediatr JT - European journal of pediatrics JID - 7603873 SB - IM MH - Adolescent MH - *Anaphylaxis/diagnosis/etiology/therapy MH - Child MH - Child, Preschool MH - China MH - *Drug Hypersensitivity/diagnosis/etiology/therapy MH - Female MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Pharmacovigilance MH - Practice Patterns, Physicians'/*statistics & numerical data MH - Risk Factors PMC - PMC5748398 OTO - NOTNLM OT - Children OT - Drug-induced anaphylaxis OT - Epinephrine OT - Signs and symptoms COIS- This study was considered to be exempt from further review by the Institutional Review Board, Peking University Third Hospital. CONFLICT OF INTEREST: RP declares research relationships with Astra Zeneca, Boehringer Ingelheim, Genentech, Glaxo Smith Kline, and TEVA. The other authors declare that they have no conflict of interest. INFORMED CONSENT: Not applicable. CLINICAL TRIALS REGISTRATION: Not applicable. EDAT- 2017/11/24 06:00 MHDA- 2018/06/16 06:00 PMCR- 2017/11/22 CRDT- 2017/11/24 06:00 PHST- 2017/08/09 00:00 [received] PHST- 2017/11/09 00:00 [accepted] PHST- 2017/08/09 00:00 [revised] PHST- 2017/11/24 06:00 [pubmed] PHST- 2018/06/16 06:00 [medline] PHST- 2017/11/24 06:00 [entrez] PHST- 2017/11/22 00:00 [pmc-release] AID - 10.1007/s00431-017-3048-z [pii] AID - 3048 [pii] AID - 10.1007/s00431-017-3048-z [doi] PST - ppublish SO - Eur J Pediatr. 2018 Jan;177(1):145-154. doi: 10.1007/s00431-017-3048-z. Epub 2017 Nov 22.