Αλλεργικές αντιδράσεις σε παιδιά προσχολικής ηλικίας με τροφική αλλεργία στο γάλα και το αυγό

Fleischer DM, Perry TT, Atkins D, Wood RA, Burks AW, Jones SM, Henning AK, Stablein D, Sampson HA, Sicherer SH.

Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study.

Pediatrics. 2012 Jul;130(1):e25-32.

Abstract

OBJECTIVE:

To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children.

METHODS:

We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions.

RESULTS:

Over a median follow-up of 36 months (range: 0-48.4), the annualized reaction rate was 0.81 per year (367/512 subjects reporting 1171 reactions [95% confidence interval: 0.76-0.85]). Overall, 269/512 (52.5%) reported >1 reaction. The majority of reactions (71.2%) were triggered by milk (495 [42.3%]), egg (246 [21.0%]), and peanut (93 [7.9%]), with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies (P < .0001) and higher food-specific immunoglobulin E (P < .0001) were associated with reactions.

Of the 11.4% of reactions (n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration.

CONCLUSIONS:

There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers.

Η πρόσβαση στο άρθρο είναι ελεύθερη στο διαδίκτυο :

http://pediatrics.aappublications.org/content/130/1/e25.full

Νήπια και παιδιά προσχολικής ηλικίας με αλλεργία στο γάλα και το αυγό έχουν πιθανότητα 80 % για μία τουλάχιστον αλλεργική αντίδραση κάθε χρόνο σύμφωνα με αυτήν την πολύ ενδιαφέρουσα προοπτική μελέτη από τις Η.Π.Α.

Η από λάθος χορήγηση των αλλεργιογονικών τροφών, αλλά και η ελλιπής επιτήρηση αυτών των παιδιών από το περιβάλλον τους φαίνεται να διαδραματίζει σημαντικό ρόλο στην υψηλή συχνότητα αναφυλακτικών αντιδράσεων σε αυτόν τον πληθυσμό.

Η θεραπεία εκλογής για τις σοβαρές αναφυλακτικές αντιδράσεις, δηλαδή η αδρεναλίνη, χρησιμοποιήθηκε μόνον στο 1/3 των ασθενών με αναφυλακτικό shock.