促性腺激素释放激素激发试验中戈那瑞林致儿童严重过敏反应临床特征分析

Analysis of anaphylaxis caused by gonadorelin in children in gonadotropin-releasing hormone stimulation test

目的探讨促性腺激素释放激素(GnRH)激发试验中戈那瑞林导致儿童严重过敏反应的临床特点。方法研究对象为成都市不良反应监测中心数据库2015年1月1日至2021年12月31日收到的不良反应报表中,使用戈那瑞林发生严重过敏反应的儿童,年龄≤14岁,用药目的为GnRH激发试验。通过医院信息系统收集这些患儿的基本信息、戈那瑞林使用情况、严重过敏反应发生情况及过敏反应的治疗和转归等进行回顾性分析。结果共收集GnRH激发试验中戈那瑞林导致儿童严重过敏反应的病例14例,男性3例,女性11例;年龄(9±2)岁;Naranjo因果关系评定法评分≥5分。14例患儿使用戈那瑞林的剂量为(2.55±0.09)mg/kg,均为静脉注射给药。4例严重过敏反应发生于首次进行GnRH激发试验,10例发生于第2次GnRH激发试验;用药至发生严重过敏反应的时间为(6.0±3.5)min。14例患儿严重过敏反应的表现为系统性过敏反应症状,累及全身各个系统,所有患儿均有3种及以上系统的损害。发生过敏反应后,14例患儿均停用戈那瑞林,其中5例给予肾上腺素肌内注射,5例为肾上腺素或异丙肾上腺素静脉注射,1例为异丙肾上腺素静脉注射+肾上腺素肌内注射;3例仅给予地塞米松静脉注射。经治疗患儿症状均得到缓解。结论戈那瑞林导致的儿童严重过敏反应是一种罕见但严重的不良反应,且该药与GnRH类似物存在交叉过敏的可能,故在诊断、治疗儿童性早熟时应在监护条件下给药。

Objective To explore the clinical characteristics of anaphylaxis caused by gonadorelin in children in gonadotropin-releasing hormone(GnRH)stimulation test.Methods The research subjects were children aged≤14 years who experienced anaphylaxis using gonadorelin in the Chengdu Adverse Reaction Center database from January 1,2015 to December 31,2021.The purpose of medication was GnRH stimulation test.Through the hospital information system,the children′s basic information,usage of gonadorelin,occurrence of severe allergic reactions,and treatments and outcomes of anaphylaxis were collected and retrospectively analyzed.Results A total of 14 cases of anaphylaxis in children caused by gonadorelin in the GnRH stimulation test were collected,including 3 males and 14 females,with an age of(9±2)years.All 14 cases were evaluated with a score of≥5 using the Naranjo evaluation method.The dose of gonadorelin in the 14 children was(2.55±0.09)μg/kg and the drug was all given by intravenously injection;anaphylaxis occurred in 4 children during the first GnRH stimulation test and in 10 children during the second GnRH stimulation test.The time from medication to anaphylaxis occurence was(6.0±3.5)minutes.The symptoms of anaphylaxis in 14 children were systemic allergic reactions,involving various systems throughout the body.All children had 3 or more types of systemic damage.After anaphylaxis occurrence,gonadorelin was discontinued in all 14 patients;5 received intramuscular injection of adrenaline,5 received intravenous injection of adrenaline,1 received intravenous injection of isoprenaline and intramuscular injection of adrenaline,and 3 received intravenous injection of dexamethasone only.After treatments,all children were improved.Conclusions Anaphylaxis caused by gonadorelin in children is a rare but severe adverse reaction,and the drug may have a possibility of cross allergy with GnRH analogues.Therefore,when diagnosing and treating precocious puberty in children,medication should be given under monitoring conditions.