Paediatric emergency department anaphylaxis: different patterns from adults

Area of Science:

• Pediatric Emergency Medicine
• Allergy and Immunology
• Epidemiology

Background:

• Limited data exists on acute pediatric anaphylaxis presentations to emergency departments (EDs).
• Understanding the epidemiology, clinical features, and outcomes of pediatric allergic reactions is crucial.

Purpose of the Study:

• To determine the incidence, clinical characteristics, and management of pediatric anaphylaxis and generalized allergic reactions.
• To provide the first reported incidence figures for pediatric anaphylaxis ED presentations in Australia.

Main Methods:

• A retrospective, case-based study of patients under 16 years old presenting to a metropolitan pediatric teaching hospital ED in Australia over three years.
• Analysis of medical records for patients meeting diagnostic codes for generalized allergic reactions and anaphylaxis.
• Determination of incidence, demographics, comorbidities, etiology, clinical features, management, and disposition.

Main Results:

• 526 children had generalized allergic reactions and 57 had anaphylaxis.
• Incidences were 9.3:1000 ED presentations for generalized allergic reactions and 1:1000 for anaphylaxis.
• Cutaneous features were common (82.5%), asthma history was reported in 36.8%, and adrenaline was used in 39.3% of severe anaphylaxis cases. Most patients (97.8%) were managed solely in the ED, with inadequate follow-up noted for anaphylaxis.

Conclusions:

• This study provides the first Australian incidence data for pediatric anaphylaxis in the ED, showing lower rates than in adults.
• Generalized allergic reactions were more common in children than adults presenting to the ED.
• While most pediatric allergic reactions can be managed in the ED, specialist follow-up is essential, particularly for severe anaphylaxis.