Background: Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status. Methods: For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. We included patients who were treated with a 3-year VIT between 1993 and 2009 and had completed a questionnaire. Results: Forty of the 311 patients were included. Mean VIT duration was 3.1 years. Of the 40 patients included, 29 children (72.5%) received VIT with vespid venom, 9 with bee venom, and 2 patients with both venoms. During a mean follow-up period of 13 years, 20/40 patients (50%) suffered re-stings. Six of the 20 (30%) patients developed again anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2 were allergic to vespid and 4 to bee venom. Of the entire cohort, only 5/40 (12.5%) had appropriate emergency kits according to the guidelines of the European Academy of Allergy and Clinical Immunology. Among the patients who had emergency kits available, one third (5/15) felt uncertain about the correct application of the medication. Less than two thirds of our population (25/40) affirmed that they have been educated in emergency management. The vast majority (95%; 38/40) of our patients did not have allergy follow-ups after VIT completion. Conclusions: Anaphylactic relapses are not uncommon, and there are considerable deficits in the emergency management of patients. Hence, comprehensive standardized anaphylaxis education programs as well as regular follow-ups of the allergy status are crucial.
ZusammenfassungDie bronchopulmonale Dysplasie (BPD) stellt eine der bedeutendsten Komplikationen der Frühgeburtlichkeit dar. Sie ist nach wie vor die häufigste chronische Lungenerkrankung im Kleinkindesalter. Frühgeborene mit BPD können bis ins Erwachsenenalter hinein unter pulmonalen Einschränkungen wie Atemwegsobstruktion und Überblähung sowie persistierenden respiratorischen Beschwerden leiden. Frühgeborene aus der Surfactant-Ära scheinen gleichermaßen von den Langzeitfolgen der BPD betroffen zu sein. Unklar ist, ob ein mögliches besseres Langzeitoutcome durch das Überleben von immer unreiferen Frühgeborenen verdeckt wird. Beim Management von Patienten mit chronischer Lungenerkrankung nach BPD sollte auf eine Abgrenzung zum Asthma bronchiale geachtet werden. Bisher konnte kein positiver Effekt einer Therapie mit inhalativen Steroiden beobachtet werden. Die Anwendung von inhalativen Bronchodilatatoren wird bisher nur bei Anzeichen einer reversiblen Atemwegsobstruktion oder Exazerbationen empfohlen.
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