[USE OF MULTIPLE DOSES OF ADRENALINE FOR FOOD-INDUCED ANAPHYLAXIS].

BACKGROUND: The aim of this study was to determine the rate, characteristics, and risk factors in patients who required multiple doses of adrenaline for treatment of anaphylaxis. METHODS: We retrospectively reviewed the positive oral food challenges (OFCs) with anaphylaxis in pediatric patients at Saitama City Hospital between January 2013 and November 2014, analyzing age, sex, comorbid allergic disease, specific IgE level, food, symptoms, and treatment. RESULT: There were 42 positive challenges with anaphylaxis, and the median age of the patients was 4 years old. Eighteen patients were treated with adrenaline, 5 of whom (11.9% of anaphylaxis cases) were administered multiple doses of adrenaline. Among the 5 patients, 3 were treated with infusion. We compared patients who were not administered adrenaline or were administered a single dose of adrenaline with those who were administered multiple doses of adrenaline. No significant differences were found among the groups in relation to age, sex, comorbid allergic disease, and the aim of OFCs. The number of patients who received multiple doses of adrenaline treatment was more in the milk OFCs than the other foods OFCs. Cardiovascular and neurological symptoms were more severe in patients who received multiple doses of adrenaline. CONCLUSION: Information that multiple doses of adrenaline may be required at the time of anaphylaxis should be widely disseminated.

[A CASE OF A CHILD DIAGNOSED AS HYPERSENSITIVITY REACTIONS TO NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AFTER ONSET OF ORAL MITE ANAPHYLAXIS].

Oral mite anaphylaxis (OMA) caused by mite-containing food that was initially reported in 1993 has become commonly known after accumulating the case reports. Although it has been pointed out as being related to aspirin intolerance overseas, there are only a few cases reported in Japan so far, particularly no case for children. We report a child case which is seemingly related to OMA and aspirin intolerance. The case is for a boy at the age of 10. After eating Takoyaki with the ingredient of mite-containing flour, he was diagnosed as OMA due to the occurrence of anaphylaxis with respiratory discomfort, abdominal pain, and vomiting. One month later, he was suspected of aspirin intolerance, since he presented with symptoms such as swelling of the eyelid and coughing after taking loxoprofen which he never have taken, and intradermal test with loxoprofen was negative. Because the mechanism with a connection between mite allergy and aspirin intolerance still remains unknown, it would be necessary to accumulate more cases and clarify the pathology in future.

Listeria monocytogenes Meningitis Complicating Rotavirus Gastroenteritis in an Immunocompetent Child.

Listeria monocytogenes only occasionally causes bacterial meningitis in immunocompetent children. We report a case of L. monocytogenes meningitis associated with rotavirus gastroenteritis. The patient was a previously healthy 20-month-old girl who was admitted because of sustained fever and lethargy after suffering from gastroenteritis for 6 days. The patient's peripheral white blood cell count was 18,600/µL and the C-reactive protein level was 2.44 mg/dL. A stool sample tested positive for rotavirus antigen. A cerebrospinal fluid (CSF) sample showed pleocytosis. Cultures of the CSF and stool samples revealed the presence of L. monocytogenes. The patient was successfully treated with ampicillin and gentamicin. We speculate that translocation of enteric flora across the intestinal epithelium that had been damaged by rotavirus gastroenteritis might have caused bacteremia that disseminated into the CSF. Both listeriosis and secondary systemic infection after rotavirus gastroenteritis are rare but not unknown. Initiation of appropriate treatment as soon as possible is important for all types of bacterial meningitis. This rare but serious complication should be taken into consideration even if the patient does not have any medical history of immune-related problems.