부산지역 아동∙청소년의 식품으로 인한 아나필락시스에 대한 연구

Abstract

The purposes of this study was to establish an effective anaphylaxis management plan by investigating the prevalence and characteristics of anaphylactic reactions caused by food in children and adolescent from Busan. Using the 2020 Food Allergy Survey Data (hosted by the Busan Office of Education), the data were collected from July 22 to 24, 2020. After confirming of anaphylaxis by pediatric allergy specialists based on diagnostic criteria of anaphylaxis, 418 subjects were enrolled.

Anaphylaxis is considered likely to be present if one of the following three sets of criteria are fulfilled: 1. Acute illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both, and at least one of the followings: - Respiratory compromise - Reduced blood pressure or associated symptoms of end-organ dysfunction 2. Two or more of the following that occurs rapidly (minutes to several hours) after exposure to a likely allergen for that patient: - Involvement of the skin, mucosal tissue, or both - Respiratory compromise - Reduced blood pressure or associated symptoms - Persistent gastrointestinal symptoms 3. Reduced blood pressure that occurs rapidly (minutes to several hours) after exposure to a known allergen for that patient. - Infants and children: low systolic blood pressure or a more than 30 percent decrease in systolic blood pressure - Adults: systolic blood pressure of less than 90 mm Hg or a more than 30 percent decrease from that person's baseline.

The subjects were classified into four groups; lower grade elementary school students (grades 1-3), elementary school students in higher grade (grades 4-6), middle school student, and high school student. Data was analyzed by using SPSS Statistics (version 20.0), and a P-value < 0.05 was considered statistically significant.

The Results can be summarized as follows: 1. The prevalence of food allergy among students from Busan was 4.77% and the prevalence of food-induced anaphylaxis was 0.14%. 2. Following analysis of the four age groups, the rate of early onset of food allergy, rate of physician diagnosis of food allergy (p<0.001), and rate of subjects identification and avoidance of causative foods (p<0.01) were a significant relationship. 3. The food that causes anaphylaxis (multiple responses) were walnut (155 people), peanut (131 people), egg (78 people), peach (78 people), shrimp (76 people), crab (73 people), pine nut (66 people), milk (54 people), shellfish (48 people), kiwi (37 people), buckwheat (35 people), tomato (32 people), mackerel (23 people), squid (21 people), soybean (17 people), wheat (16 people), chicken (7 people), pork (6 people) and beef (2 people). The rate of students with egg allergy, milk allergy, walnut allergy, and peanut allergy were lowered in the older generation, while the prevalence proportions of crustacean and peach allergies in the older generation were higher. In contrast to our results, previous study showed that walnut and peanut allergies can develop at any age, even in adulthood. 4. There were cutaneous (95.1%), respiratory (76.0%), neurological (38.6%), gastrointestinal (29.5%), and cardiovascular (15.6%) symptoms (multiple responses). The cutaneous symptom was the most common regardless of age, followed by the respiratory symptom. On the other hand, cardiovascular symptom was rare regardless of age. 5. Nutrition counselling was demanded by about 30% of the subjects, and the younger generation wanted more nutrition counselling (p<0.001). There was a significant relationship between the nutrition counselling and the identification and avoidance of causative food (p<0.01).

Conclusion: Understanding the prevalence of disease and its characteristics according to factors is essential to manage rapidly increasing food-induced anaphylaxis students. Therefore, more data throughout nationwide are needed to monitor the offending factors and identify and deal with patients at risk.