Abstract ID: 43
Authors:
Phoebe C. Y. Yau
Hugo W. F. Mak
Elizabeth Huiwen Tham
Punchama Pacharn
Yuhan Xing
Hoang Kim Tu Trinh
Sooyoung Lee
Kangmo Ahn
Pantipa Chatchatee
Sakura Sato
Motohiro Ebisawa
Bee Wah Lee
Gary Wing Kin Wong
Agnes Sze Yin Leung
Affiliations:
Department of Paediatrics, Prince of Wales Hospital, Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center of Excellence for Allergy and Clinical Immunology, Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan.
Abstract:Background Pediatric anaphylaxis is under-investigated in Asia-Pacific, with its management remains under-reported. This study aims to report and compare the management practice of pediatric anaphylaxis among Asia-Pacific localities. Methods Data from the Asia-Pacific Research Network for Anaphylaxis, a prospective regional pediatric anaphylaxis registry with 16 participating centers from Hong Kong, Singapore, Thailand and Qingdao, was analyzed. The management strategies across regions were compared. The outcomes of patients with and without self-injectable adrenaline before anaphylaxis were also contrasted. Results A total of 721 anaphylaxis episodes in 689 patients, spanning from 2019 to 2022, were included. Overall, while adrenaline was administered in 434 (60.2%) episodes, only 64 (8.9%) were given pre-hospital adrenaline. Almost all patients in Thailand (95.8%, 113/118) and Singapore (93.3%, 237/254) received adrenaline, whose usage was significantly lower in Hong Kong (30.1%, 66/219) and Qingdao (13.8%, 18/130; p <.001). Only 89 (12.3%) children owned an adrenaline device before an episode of anaphylaxis, with significantly different rates of ownership among regions (p <.001): 18.9% (48/254) children in Singapore possessed a device, followed by 15.3% (18/118) in Thailand, 10.5% (23/219) in Hong Kong, and none in Qingdao. Compared to individuals without an adrenaline device before an anaphylactic event, those who owned one had significantly higher overall (80.9% vs. 57.3%, p <.001) and pre-hospital use of adrenaline (49.4% vs. 3.2%, p <.001), shorter time to first-dose administration (mean: 73.4±98.2 minutes vs. 159.8±476.5 minutes, p <.001), lower proportion of severe anaphylaxis (World Allergy Organization Grade 4-5 reactions; 9.0% vs. 18.4%, p =.028) and reduced length of admission (mean: 1.0±0.7 days vs. 2.3±7.5 days, p <.001). Conclusions Disparities in anaphylaxis management persist in Asia-Pacific, likely due to limited adrenaline autoinjector access in developing countries, as well as underuse in developed regions. Patients who owned an adrenaline device demonstrated significantly better outcomes than those who did not.
Keywords: Non-Communicable Diseases (NCDs), Adrenaline, allergy, anaphylaxis, Asia, disparities, pediatric
