Phoebe C. Y. Yau1, Hugo W. F. Mak1, Elizabeth Huiwen Tham2, Punchama Pacharn3, Yuhan Xing4, Hoang Kim Tu Trinh5, Sooyoung Lee6, Kangmo Ahn7, Pantipa Chatchatee8, Sakura Sato9, Motohiro Ebisawa9, Bee Wah Lee2, Gary Wing Kin Wong4, Agnes Sze Yin Leung1
1Department of Paediatrics, Prince of Wales Hospital, Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China;
2Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;
3Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand;
4Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China;
5Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam;
6Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea;
7Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;
8Center 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;
9Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan
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, were 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<0.001). Only 89 (12.3%) children owned an adrenaline device before an episode of anaphylaxis, with significantly different rates of ownership among regions (P<0.001): 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<0.001) and pre-hospital use of adrenaline (49.4% vs. 3.2%, P<0.001) shorter time to first-dose administration (mean: 73.4±98.2 vs. 159.8±476.5 minutes, P<0.001), lower proportion of severe anaphylaxis (World Allergy Organization grade 4–5 reactions; 9.0% vs. 18.4%, P=0.03), and reduced length of admission (mean: 1.0±0.7 vs. 2.3±7.5 days, P<0.001).
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: Pediatric anaphylaxis; adrenaline autoinjector; Asia-Pacific disparities
