Study Identifies Risk Factors That May Predispose Children to More Severe Initial Angioedema Attacks

Researchers have identified risk factors that may predispose children to more severe initial angioedema attacks — factors such as male gender, preschool age, presence of fever or hives, and a history of allergies.

Epinephrine treatment and receiving care in a pediatric observation unit, on the other hand, were factors that shortened the duration of these initial attacks.

The study, “Significant predictive factors of the severity and outcomes of the first attack of acute angioedema in children,” was published in BMC Pediatrics.

Angioedema, swelling in the deep layers of the skin or mucus membranes, can be triggered by a variety of factors, such as food and medications, and may also be the result of a hereditary condition.

The condition normally affects regions of the face, extremities, genitals, and the intestinal tract, but it might become more severe when the airways are affected, preventing patients from breathing well.

While an angioedema attack can be easily recognized, its severity in children might not be so easily determined, especially in cases of first episodes. Also, because first episodes often lack a rapid response, these swelling attacks may become life-threatening.

Aiming to identify factors that predict the severity of initial angioedema attacks in children, researchers in Taiwan examined 406 children, who were diagnosed with an acute angioedema attack for the first time between the years of 2008 and 2014.

Children were 6.4 years old on average, and their angioedema attack had been caused mostly by infections (in 25.4% of cases), food (24.4%), and medications (22.9%). The respiratory airways were more frequently affected (40.6%), followed by the skin (35.2%) and gastrointestinal tract (7.6%).

The attacks were classified into three groups, depending on their severity: mild (directly discharged from the emergency room, 200 patients), moderate (additional observation needed in a pediatric observation unit, 97 patients), and severe (admitted into the emergency room, 109 patients).

Of the 109 children with severe angioedema, most were male (65.1%) and in the preschool age group (56.4%), meaning they were between 2 and 6. About 6.4% of patients were adolescents (13–18 years old), indicating that younger children are at a greater risk of a severe angioedema attack.

Another important risk factor identified is the cause of the angioedema attack — severe and moderate attacks were largely caused by infections and medications.

The researchers also found that respiratory symptoms were an important predictor of angioedema attack severity, and they recommended treating these potentially life-threatening symptoms immediately.

Similarly, the presence of fever, wheals, and a history of allergies were all significant predictors of severe angioedema.

In addition, the researchers identified factors associated with shorter angioedema attacks. They found that attacks caused by inhalants had the shortest duration (0.8 days on average), followed by medications (2.2 days), food (2.3 days), contact materials (3 days), and infections (3.1 days). The longest attacks were caused by insect bites and stings (3.3 days).

The team also compared three treatments — antihistamines, antihistamine plus corticosteroids, and epinephrine — and found that those who received epinephrine treatments experienced a shorter duration of angioedema attack symptoms compared to those who did not.

Finally, the group of patients who treated in a pediatric observation unit experienced the shortest duration of symptoms, leading researchers to recommend that angioedema attacks be treated in this setting rather than in hospital.

“The co-occurrence of [fever or hives], [causes] related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predictors of severe angioedema,” the researchers said. “More importantly, short-term observation and prompt treatment might be of benefit for patients who did not require hospital admission.”