Eirini Roumpedaki

Anaphylaxis in children and adolescents: The European Anaphylaxis Registry.

BACKGROUND Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description. OBJECTIVE We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents. METHODS The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. RESULTS Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cows milk and hens egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom- and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions. CONCLUSIONS The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hens egg, cows milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.

Conception via in vitro fertilization and delivery by Caesarean section are associated with paediatric asthma incidence

The association between perinatal factors and asthma inception is under rigorous investigation. Nevertheless, evidence of a correlation between asthma, conception via in vitro fertilization (IVF) and delivery through Caesarean section (C‐section) is inconclusive.

Infantile growth velocity and later asthma/wheeze: GENESIS and the Healthy Growth Study

Rapid infantile growth velocity: positively associated with later wheeze/asthma in preschoolers not pre-adolescents http://ow.ly/sZ3Pr

Contribution of repeated infections in asthma persistence from preschool to school age: Design and characteristics of the PreDicta cohort

The PreDicta cohort was designed to prospectively evaluate wheeze/asthma persistence in preschoolers in association with viral/microbial exposures and immunological responses. We present the cohort design and demographic/disease characteristics and evaluate unsupervised and predefined phenotypic subgroups at inclusion.

A child with anaphylactic reaction by egg remedy applied to burn.

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PD44 - In vitro fertilisation is positively associated with prevalence of asthma in childhood

Background Research on potential perinatal risk factors for asthma, has recently attracted considerable attention. Asthma could be associated with In vitro fertilization (IVF) via epigenetic modification of DNA by IVF drugs/hormones or via a genetic link of asthma with parental subfertility. Nevertheless, evidence of an asthma/IVF correlation is scarce and inconclusive. We therefore opted to explore a potential link, in a cross-sectional population-based study in preadolescent children.

PD02 - Observational follow-up study with the Pan-European standard prick test to determine inhalant allergen sensitisation rates in a Greek population

Skin prick testing (SPT) is the standard method for diagnosing allergic sensitization. Correct diagnosis of inhalant allergies, requires knowledge of the most important inhalant allergen sensitizations. Few data are available regarding the prevalence of these sensitizations in Greece.

PD17 - Food allergy profile in late adolescence in a tertiary healthcare facility

Results Among 56 patients (46 male, age range 14-22,5 years, median 16,6 years) 55% had positive family history of atopy, 64% reported atopic dermatitis and 80% asthma and/or allergic rhinitis. 1/3 developed their first reaction to a food allergen during infancy, the main allergens being egg (11%), milk (9%) and fish (7%).32% first experienced FA as preschoolers, 27% between 6-12 years and only 11% in adolescence. In 21/56 patients the first reaction was anaphylaxis. All subjects became tolerant to milk and egg before adolescence. The most common allergens in late adolescence were nuts (including peanut) (55%), fruits (25%), fish (23%) and sesame seed (9%). Nut allergy appeared in 48,4% (15/31 patients) in preschool years, in 25,8% between 6-12 years and in 25,8% during adolescence. The rates for fish allergy apparition were 69,2%(9/13 patients), 23,1% and 7,7%, respectively. Fruit allergy emerged in most patients between 6 12 years old. Only 2 patients became tolerant to fish and 3 to nuts before/during adolescence. Over half of the patients experienced at least 1 anaphylactic reaction and 20% had 2 or more. An adrenaline auto-injector was prescribed to 80% of the patients. Nevertheless, only 18% reported carrying it at all circumstances and 20% occasionally.

PD19 - Co-recognition of lipid transfer protein in pollen and foods in a Greek pediatric population

PD19 Co-recognition of lipid transfer protein in pollen and foods in a Greek pediatric population Dimitrios Karantoumanis, Savvas Savvatianos, Anastasios P Konstantinopoulos, Dimitrios Koutsalitis, Anna Pananaki , Maria Psomiadou, Kassiani Tzeli, Marianna Tziotou, Dimitrios Mitsias, Eirini Roumpedaki, Stavroula Giavi, Paraskevi Xepapadaki, Nikolaos Douladiris, Emmanouil Manousakis, Nikolaos G Papadopoulos

PD23 - Decision points for boiled egg challenges in Greek children with sensitisation to egg proteins

Decision points based on food-specific IgE antibody concentrations have been proposed and are used in the clinic, in order to predict reactivity to foods and reduce the number of high risk food challenges. In the process of screening for eligibility in a study, we started carrying out open food challenges to boiled egg in children with sensitization to egg proteins, independent of their skin reactivity and specific IgE concentrations. In several occasions, the expected cut-off points were not confirmed. Furthermore, cut-off points have been evaluated in children with clinical indications of allergy and not in those who are only sensitized. Therefore, we hypothesized that decision points for this population may need to be reevaluated.