Gabriela Zambrano

Anaphylaxis in the Pediatric Emergency Department: Analysis of 133 Cases After an Allergy Workup

BACKGROUND Data on the incidence and characteristics of pediatric anaphylaxis are scarce. Reported causes of anaphylaxis are mostly those suspected by the physician in the emergency department (ED), which may not coincide with the real triggers. OBJECTIVES To investigate the incidence, management, and etiology of pediatric anaphylaxis in the ED of a Spanish tertiary hospital and to determine the concordance between the suspected etiology in the ED and diagnosis after the allergy workup. METHODS We performed an observational, descriptive study of all patients with anaphylaxis attended in the pediatric ED from 2012 to 2014. Cases were considered anaphylaxis based on National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. We recorded data on clinical characteristics, management, etiology suspected by the ED physician and patient (or relatives), and the workup performed in the allergy department. RESULTS We recorded 133 cases of anaphylaxis (incidence, 0.12%), with 20 cases (15%) recorded in children younger than 12 months. Anaphylaxis was correctly diagnosed in the ED in 70 cases (53%). Food allergy was the cause of anaphylaxis in 106 out of 118 studied in the allergy department (AD) (90%). The final etiology differed from the etiology initially suspected in the ED in 42 cases (39%). After the study, the frequency of patients with unidentified triggers decreased by 75%. CONCLUSIONS The incidence of anaphylaxis is higher in children than previously reported in adults from the same center, and food is the trigger in most cases. To prevent erroneous diagnoses, the etiology of anaphylaxis should be established after an appropriate workup.

Erythrodysestesia-like skin eruption due to docetaxel with a nonimmediate positive intradermal skin test result.

Docetaxel is a frequently used chemotherapeutic agent belonging to the taxane family. It was first discovered in 1986 and is a semi-synthetic compound derived from the needles of the European yew (Taxus baccata). These cytotoxic agents are commonly associated with cutaneous adverse reactions such as urticaria, maculopapular exanthemas, pruritus, mucositis, and palmoplantar erythrodysestesia (PPE). Usually, skin tests are not useful for diagnosis in these patients. We report the case of a 77-year-old man without a personal history of allergy. He had a history of several primary tumors: colon (1990), bladder (2005), and prostate (2008). In 2008, he underwent a transurethral resection for treatment of prostate carcinoma. Because of a poor response to treatment with hormonal therapy, in August 2011 he began systemic chemotherapy with docetaxel, with a positive response.