Çocuklarda Anafilaksi’nin Tanı ve Tedavisine Güncel Yaklaşım

ÖzAnafilaksi, yaşamı tehdit eden ve ölümle sonuçlanabilen ani başlangıçlı sistemik aşırı duyarlılık reaksiyonudur. Anafilaksi sıklığı son yirmi yılda tüm dünya genelinde önemli oranda artmıştır. Anafilaksi klinik bir tanı olmasına rağmen ortaya çıkanhiçbir belirti ve bulgu anafilaksiye özgün değildir. Aynı zamanda akut dönemde tanıyı doğrulayabilecek ve rutin pratikte kullanılabilecek altın standart bir laboratuvar testte yoktur. Geliştirilmiş klinik tanı kriterleri tanısal sorunların çözümüne önemli oranda katkıda bulunmuş olsa da halen klinik pratikte birçok olgunun tanısı atlanabilmektedir. Anafilaksi tedavisi acil bir durumdur ve tek hayat kurtarıcı tedavi adrenalindir. Anafilaksiye bağlı ölümler için bilinen en önemli neden adrenalinin uygulanmaması ya da geç uygulanmasıdır. Bu nedenle anafilaksi tanı kriterlerini karşılayan her hastada adrenalin vakit kaybedilmeden uygulanmalıdır. Antihistaminler ve kortikosteroidler hiçbir zaman adrenalin yerine kullanılmamalıdır. Mutlaka her hastanın bir izlem süresi olmalıdır. Taburcu edilmeden önce hasta ve/veya ebeveynlere tetikleyicilerden kaçınma/korunma yöntemleri anlatılmalı, acil durum hazırlığı tamamlanmalı ve uzun süreli izlem için allerji kliniklerine konsülte edilmelidir.

Anahtar Kelimeler:

anafilaksi, adrenalin, çocuk, tanı, tedavi

Current Approach to the Diagnosis and Management of Anaphylaxis in Children

Abstract Anaphylaxis is a serious allergic reaction that is rapid in onset and maycause death. Its prevelance has increased dramatically throughout the world over thelast two decades. Although anaphylaxis is a clinical diagnosis, there are no specificsigns or symptoms that are diagnostic for anaphylaxis. Further, there is no gold standard laboratory test that can confirm the diagnosis in the acute phase and can be usedin routine practice. Although improved clinical diagnostic criteria have contributed significantly to the resolution of diagnostic problems, diagnosis of many cases canstill be missed in clinical practice. Anaphylaxis is a medical emergency and the only lifesaving treatment is adrenaline. The most important cause of anaphylaxis related death is no or delayed administration of adrenaline. Adrenaline should be administered without any loss of time in any patient who meets the diagnostic criteria for anaphylaxis. Antihistamines and corticosteroids should never be used instead of adrenaline. Every patient should have a certain follow-up time. Patients and/or parents should be instructed for trigger avoidance/prevention before discharge, emergency preparedness should be completed and allergists shouldbe consulted for long-term follow-up.

Keywords:

anaphylaxis, epinephrine, child, diagnosis, therapy,

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