ABSTRACT
La anafilaxia es una reacción alérgica grave de instauración rápida y potencialmente mortal. El diagnóstico de anafilaxia es clínico y debe realizarse de manera precoz. Aparece en las 2 primeras horas tras exposición al alérgeno, en los primeros 30 minutos en alergia alimentaria y más precozmente con medicamentos intravenosos o picaduras de himenópteros. Los síntomas cutáneos suelen ser los primeros en manifestarse y están presentes en la mayoría de los casos, más de un 80%. Pueden ser leves o transitorios e incluso no estar presentes en un 18% de los casos. Si se afecta el sistema cardiocirculatorio estaríamos ante un shock anafiláctico. La causa más frecuente en Pediatría son los alimentos. Existen cofactores cuya presencia aumenta la probabilidad de anafilaxia; los más importantes son: el ejercicio, los fármacos, la fiebre y el estrés. El tratamiento de elección es la adrenalina intramuscular. Tanto los padres como los niños deben saber identificar los signos y/o síntomas del inicio de la anafilaxia para instaurar el tratamiento pautado en el plan de acción escrito.
Anaphylaxis is a severe, rapid and potentially fatal allergic reaction. The diagnosis of anaphylaxis is clinical and must be early. It appears in the first 2 hours after exposure to the allergen, in the first 30 minutes in food allergy and earlier with intravenous drugs or hymenoptera stings. Cutaneous symptoms are generally the first to appear and are present in most cases, more than 80%. They may be mild or transitory, or absent in 18% of cases. If the cardio-circulatory system is affected, an anaphylactic shock occurs. The most frequent cause in pediatrics is nutrition. There are several cofactors whose presence increases the likelihood of anaphylaxis; the most important are: exercise, medication, fever and stress. The treatment of choice is intramuscular adrenaline. Parents and children should be able to identify the signs and/or symptoms of anaphylaxis in order to implement the treatment prescribed in the written action plan. (AU)
Subject(s)
Humans , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Primary Health Care/methods , Epinephrine/administration & dosage , Epinephrine/therapeutic useABSTRACT
Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.
Subject(s)
Asthma , Humans , Child , Asthma/drug therapy , Administration, Inhalation , Nebulizers and Vaporizers , Chronic Disease , Educational StatusABSTRACT
El asma, la enfermedad crónica más prevalente en la edad pediátrica, continúa planteando desafíos en su manejo y tratamiento1. Guías nacionales e internacionales destacan la importancia de la educación terapéutica (ET) para lograr el control de esta enfermedad2,3. Esta educación implica la transmisión de conocimientos y habilidades al paciente y su familia, mejorando la adherencia a la medicación, corrigiendo errores en la técnica de inhalación y ajustando el tratamiento según las características individuales de cada paciente4,5. Es esencial que la ET sea progresiva, gradual e individualizada, y que esté presente en todos los niveles asistenciales. La formación en ET de profesionales sanitarios es crucial, especialmente para los pediatras, quienes además deben conocer la extensa variabilidad de medicamentos e inhaladores disponibles y sus indicaciones para cada edad6. Para abordar esta necesidad, el Grupo red española de grupos de trabajo sobre asma en pediatría (REGAP) ha revisado exhaustivamente los inhaladores actualmente disponibles en España para el tratamiento del asma en la edad pediátrica. La revisión incluye una revisión de los distintos sistemas de inhalación y los distintos fármacos inhalados, utilizados para el tratamiento del asma en la edad pediátrica. Esta revisión se actualizará anualmente, incluyendo información sobre fármacos, dispositivos, cámaras de inhalación, indicaciones y financiación. El Grupo REGAP espera que estas tablas sean una valiosa ayuda para los pediatras en su práctica clínica diaria y constituyen una eficaz herramienta de ET.(AU)
Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Asthma/drug therapy , Administration, Inhalation , Nebulizers and Vaporizers , Health Education , Metered Dose Inhalers , Pediatrics , Spain , Respiratory Tract Diseases/drug therapyABSTRACT
Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting ß2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.
Subject(s)
Adrenergic beta-Agonists , Asthma , Administration, Inhalation , Adrenergic beta-Agonists/therapeutic use , Asthma/diagnosis , Child , Consensus , Drug Therapy, Combination , Humans , Practice Guidelines as Topic , Quality of Life , SpainABSTRACT
El asma es una de las principales enfermedades crónicas de la infancia, por su elevada prevalencia y por su coste sociosanitario. Este artículo es un resumen de la guía de consenso alcanzada por 6 sociedades pediátricas relacionadas con el asma y avalada por la Asociación Española de Pediatría. El asma es fácilmente identificable por criterios clínicos en la mayoría de los pacientes. La espirometría y otras pruebas son de gran ayuda, especialmente en los casos atípicos. La crisis de asma es una manifestación frecuente de la enfermedad y debe ser identificada y tratada con prontitud. Cuando los síntomas de asma son frecuentes y afectan a la calidad de vida es preciso instaurar un tratamiento de mantenimiento para conseguir el control de la enfermedad. Los glucocorticoides inhalados a dosis bajas son eficaces y seguros para su uso prolongado. La educación del paciente con asma es esencial para obtener un buen control. El principal motivo de mal control del asma es el incumplimiento del tratamiento, ya sea por su administración errática e insuficiente, o por la mala técnica de administración de los fármacos inhalados. Si no se obtiene el control pese a un tratamiento adecuado es preciso reconsiderar el diagnóstico, así como los factores o comorbilidades que dificultan el control. Se pueden añadir otros fármacos para evitar las dosis altas de los glucocorticoides inhalados, principalmente el montelukast o los agonistas β2 adrenérgicos de acción prolongada. El asma grave o de difícil control, que no responde a las medidas habituales, debe ser atendida en unidades especializadas. (AU)
Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units. (AU)
Subject(s)
Humans , Child , Adolescent , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Asthma/etiology , Asthma/prevention & control , Recurrence , Spain , Pandemics , Coronavirus Infections/epidemiology , Severe acute respiratory syndrome-related coronavirusABSTRACT
En las últimas décadas, las enfermedades alérgicas han aumentado de forma exponencial y, aunque parece que la prevalencia del asma en pediatría se está estabilizando (en España se estima en torno al 10%) no ocurre lo mismo con la alergia alimentaria y la anafilaxia que están en claro incremento, constituyendo un problema de salud pública de primera magnitud. Considerando las tendencias epidemiológicas, las predicciones de la Academia Europa de Alergología e Inmunología Clínica (EAACI) estiman que, en menos de 15 años, más de la mitad de la población europea padecerá algún tipo de alergia.Los avances en los métodos diagnósticos en alergia alimentaria, sobre todo el diagnóstico molecular, nos permiten conocer el perfil de sensibilización y explicar el fenómeno de la reactividad cruzada, prever el potencial riesgo de las transgresiones alimentarias, e indicar adecuadamente la dieta de evitación en estos pacientes. Así, el desarrollo de la biología molecular y la nanotecnología han llevado a la aparición de nuevas tecnologías (microarrays) que facilitan el estudio, sobre todo de los pacientes polisensibilizados, permitiendo una inmunoterapia específica a alérgenos (ITA) más personalizada. Los últimos avances en tratamientos con biológicos implican un impacto, no solo en la evolución de la enfermedad, sino también en la calidad de vida de los pacientes. (AU)
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, in Spain is estimated around 10%. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a public health problem of the first magnitude. Considering epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of European population will suffer from some type of allergy.The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain the possible cross reactivity, anticipate potential risk of food transgressions, and prescribe the correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in patients quality of life. (AU)
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Hypersensitivity/diagnosis , Hypersensitivity/epidemiology , Immunoglobulin E , Pediatrics , Food Hypersensitivity , SpainABSTRACT
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, it is estimated around 10% in Spain. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a significant public health problem. Taking into account epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of the European population will suffer from some type of allergic disorder. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain possible cross reactivity, anticipate potential risk of food trangressions, and prescribe correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in quality of life.
Subject(s)
Food Hypersensitivity , Quality of Life , Allergens , Child , Desensitization, Immunologic , Food Hypersensitivity/diagnosis , Humans , Immunoglobulin EABSTRACT
Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.
La anafilaxia es una reacción alérgica grave de instauración rápida y potencialmente mortal. Sus manifestaciones clínicas son muy variadas, pudiendo afectar la piel, el sistema cardiovascular, el aparato respiratorio y el digestivo, entre otros. El tratamiento de elección, mediante la inyección intramuscular de adrenalina, debe ser precoz. Por lo anterior, es vital estar preparados para reconocerla adecuadamente. El objetivo de la presente guía de actuación clínica es mejorar el conocimiento de los profesionales sanitarios sobre anafilaxia y, consecuentemente, optimizar el tratamiento y manejo a largo plazo de esta entidad. La guía está adaptada a las peculiaridades de América Latina, especialmente en los aspectos relativos al tratamiento. Se destaca la necesidad de introducir los autoinyectores de adrenalina en los países que no dispongan de ellos.
Subject(s)
Anaphylaxis , Practice Guidelines as Topic , Adrenergic Agonists/administration & dosage , Adrenergic Agonists/therapeutic use , Adult , Algorithms , Anaphylaxis/diagnosis , Anaphylaxis/epidemiology , Anaphylaxis/etiology , Anaphylaxis/therapy , Cardiopulmonary Resuscitation , Child , Combined Modality Therapy , Disease Management , Drug Administration Routes , Epinephrine/administration & dosage , Epinephrine/therapeutic use , Glucagon/administration & dosage , Glucagon/therapeutic use , Humans , Immunologic Tests , Patient Education as Topic , Self Administration , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/therapeutic useABSTRACT
La anafilaxia en la infancia es una enfermedad grave, potencialmente mortal, que precisa ser diagnosticada y recibir tratamiento del pediatra de modo inmediato. La principal causa de anafilaxia en la infancia es la alergia a los alimentos. Su diagnóstico es fundamentalmente clínico y se debe sospechar cuando de modo agudo, en minutos o pocas horas, aparecen en un niño manifestaciones cutáneas (urticaria, angioedema) acompañadas de manifestaciones respiratorias o circulatorias. Ocasionalmente la clínica cutánea puede no aparecer, lo cual dificulta el diagnóstico. El tratamiento de elección es la administración precoz, ante la sospecha, de adrenalina intramuscular en la cara externa del muslo. En la edad pediátrica no existe ninguna contraindicación para el uso de adrenalina ante un caso de anafilaxia. La administración de cualquier otro tratamiento no es prioritaria y su uso dependerá de la evolución de la anafilaxia y siempre después de haber administrado adrenalina intramuscular. Todo niño con anafilaxia deberá acudir a un hospital, aunque su anafilaxia haya mejorado o revertido tras la adrenalina, y permanecerá unas horas en observación. Será dado de alta con un informe escrito en donde se especifiquen los posibles desencadenantes del cuadro y cómo evitarlos, y se le prescribirá al menos un autoinyector de adrenalina adecuado a su peso. Deben ser instruidos, tanto el niño como su familia y cuidadores, en el manejo del autoinyector de adrenalina al alta y posteriormente de modo regular por su pediatra por medio de simuladores. Siempre tiene que ser remitido para valoración y estudio a un especialista en Alergia Infantil
Anaphylaxis in childhood is a serious, life-threatening disease that needs to be diagnosed and treated immediately by the pediatrician. The main cause of anaphylaxis in childhood is food allergy. Its diagnosis is fundamentally clinical and should be suspected when, in minutes or a few hours, acute skin manifestations appear in a child (urticaria, angioedema), accompanied by respiratory or circulatory manifestations. Occasionally the cutaneous clinic may not appear, which makes diagnosis difficult. The treatment of choice is the early administration, on suspicion, of intramuscular adrenaline on the outer side of the thigh. In the pediatric age there is no contraindication for the use of adrenaline in the case of anaphylaxis. The administration of any other treatment is not a priority and its use will depend on the evolution of anaphylaxis and always after administering intramuscular adrenaline. Every child with anaphylaxis should go to a hospital, even if their anaphylaxis has improved or reversed after adrenaline, and will remain in observation for a few hours. They will be discharged with a written report specifying the possible triggers of the box and how to avoid them, and they will be prescribed at least one adrenaline autoinjector appropriate to their weight. They must be instructed, both the child and his family and caregivers, in the handling of the adrenaline autoinjector at discharge and later on a regular basis by his pediatrician through simulators. They always have to be sent for assessment and study to a specialist in Child Allergy
Subject(s)
Humans , Child , Epinephrine/administration & dosage , Anaphylaxis/drug therapy , Food Hypersensitivity/drug therapy , Courses/analysis , Anaphylaxis/epidemiology , Patient Discharge Summaries/standards , Emergency Treatment/methodsABSTRACT
Esta nueva versión de GALAXIA está dirigida a todos los profesionales sanitarios, en todos los niveles de asistencia, para proporcionar recomendaciones en el manejo de la anafilaxia. La anafilaxia es la reacción alérgica más grave que puede ocurrir, e incluso puede llegar a poner en peligro la vida del paciente. Todos los profesionales sanitarios deberían ser capaces de reconocerla y actuar de forma rápida y adecuada. Se incluyen recomendaciones para pacientes adultos y pediátricos, se comentan situaciones especiales, y se consideran situaciones en el ambiente sanitario y fuera de el.