Pediatric emergency medicine trisk 1680 1680
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There has been a paucity of trials enrolling young children to evaluate the
efficacy of hereditary angioedema therapies. However, international guidelines
recommend treating children with acute attacks given the risk of morbidity and
available safety data. Human C1-esterase inhibitor concentrate has approval by
the FDA for routine prophylaxis in adolescents and adults (Cinryze, 1,000 units
every 3 to 4 days) and in the management of acute attacks. C1-esterase inhibitor
concentrate can be administered parenterally (20 units per kg up to 1,000 units
[Berinert], or 50 units per kg up to 4,200 units of the recombinant product
[Ruconest]) to patients presenting with laryngeal edema or symptoms of an acute
abdominal process. This treatment generally begins to alleviate symptoms within
30 to 60 minutes; however, repeat doses may be required. Hospitalization is often
necessary in patients with upper airway involvement or refractory abdominal
pain. With appropriate training, patients can be prescribed C1-esterase inhibitor
concentrate (Berinert) for home administration provided epinephrine is available
in case of hypersensitivity reactions. Patients who self-administer C1-esterase
inhibitor concentrate for laryngeal attacks are advised to seek immediate medical
treatment due to the risk of airway obstruction.
Other therapies include the plasma kallikrein inhibitor ecallantide (Kalbitor, 30
mg as three 10-mg subcutaneous injections for patients age ≥12 years) and the
bradykinin B2 -receptor antagonist icatibant (Firazyr, 30 mg subcutaneously,
patients ≥18 years).
SERUM SICKNESS
CLINICAL PEARLS AND PITFALLS
True serum sickness reactions are uncommon secondary to decreased
use of medications derived from heterologous serum.
Serum sickness–like reactions are characterized by fever, urticarial or
vasculitic-appearing rash, and arthralgias.
Reactions are most common in young children after antibiotic or other
medication exposures during the preceding 7 to 14 days.
Most children with serum sickness–like reactions can be managed as
outpatients with supportive care (NSAIDs, antihistamines, and oral
corticosteroids for severe/protracted cases).
Current Evidence
