{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:19:55Z","timestamp":1791537595735,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T00:00:00Z","timestamp":1649808000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Allergy"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is limited ability to predict the severity of allergic reactions in children. Data derived predominantly from adults have implicated the platelet\u2010activating factor pathway as a potential contributor to severe anaphylaxis. In this study, we sought to prospectively assess involvement of key components of the platelet\u2010activating factor pathway in pediatric patients with anaphylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty\u2010six pediatric patients (&lt;18\u00a0years) presenting with acute anaphylaxis were assessed. Anaphylaxis severity was graded and serum anaphylaxis markers were measured acutely and in 36 children who returned for follow\u2010up &gt;4\u00a0weeks after their acute presentation. These markers were compared with pediatric laboratory reference sera.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Severe anaphylaxis was experienced by 12\/46 (26%) and mild\u2010moderate anaphylaxis in 34\/46 (74%) children. Platelet\u2010activating factor acetylhydrolase (PAF\u2010AH) activity was inversely associated with severe anaphylaxis: 9\/12 children with severe anaphylaxis had reduced PAF\u2010AH activity as compared with 14\/34 with mild\u2010moderate anaphylaxis (<jats:italic>p<\/jats:italic> &lt; .05). Furthermore, 3\/3 children who required intensive care had markedly reduced mean PAF\u2010AH (nmol\/ml\/min) (13.73, 95%CI: 7.42\u201320.03) versus 20\/23 who required ward\/emergency department care (17.81, 95%CI: 16.80\u201318.83; <jats:italic>p<\/jats:italic> &lt; .05). In children with anaphylaxis, PAF\u2010AH during acute anaphylaxis was unchanged relative to the child's basal levels (mean, 17.26, 95%CI: 16.10\u201318.42 vs 17.50, 95%CI: 16.21\u201318.78, <jats:italic>p<\/jats:italic> = .63) and was lower than healthy pediatric controls (mean 19.21; 95%CI:18.21\u201320.21; <jats:italic>p<\/jats:italic> &lt; .05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Decreased serum PAF\u2010AH activity is a biomarker of severe anaphylaxis. Levels of this enzyme do not change from basal levels during acute anaphylaxis. Our results show that PAF\u2010AH is a biomarker of anaphylaxis severity in children. This key regulatory enzyme may modulate susceptibility to severe anaphylaxis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/all.15308","type":"journal-article","created":{"date-parts":[[2022,4,9]],"date-time":"2022-04-09T08:20:24Z","timestamp":1649492424000},"page":"2665-2676","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Platelet\u2010activating factor acetylhydrolase is a biomarker of severe anaphylaxis in children"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5320-4232","authenticated-orcid":false,"given":"Julia E. M.","family":"Upton","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Toronto  Toronto Ontario Canada"},{"name":"Department of Pediatrics Division of Immunology and Allergy The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Department of Medicine Division of Clinical Immunology and Allergy St. Michael's Hospital University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9264-1881","authenticated-orcid":false,"given":"Jennifer A.","family":"Hoang","sequence":"additional","affiliation":[{"name":"Department of Immunology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilde","family":"Leon\u2010Ponte","sequence":"additional","affiliation":[{"name":"Developmental and Stem Cell Biology Program The Hospital for Sick Children  Toronto Ontario 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2914-7829","authenticated-orcid":false,"given":"Thomas","family":"Eiwegger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Toronto  Toronto Ontario Canada"},{"name":"Department of Pediatrics Division of Immunology and Allergy The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Department of Immunology University of Toronto  Toronto Ontario Canada"},{"name":"Translational Medicine Research Institute The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"University of Health Sciences University Hospital St. Poelten  Krems Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Grunebaum","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Toronto  Toronto Ontario Canada"},{"name":"Department of Pediatrics Division of Immunology and Allergy The Hospital for 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