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Classification of anaphylaxis and utility of the EAACI Taskforce position paper on anaphylaxis in children
Mirja Vetander1, Daiva Helander, Charlotta Lindquist
1Department of Paediatrics, Sachs' Children's Hospital, Södersjukhuset, Stockholm, Sweden. mirja.vetander@ki.se
Insights
Accurate anaphylaxis classification is crucial for children. A modified European Academy of Allergy and Clinical Immunology (EAACI) system, incorporating specific respiratory and neurological signs, improved the diagnosis of food-induced anaphylaxis in Swedish pediatric emergency departments.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Clinical Classification Systems
Background:
- Anaphylaxis management requires accurate classification and grading of severity.
- Existing classification tools, such as the European Academy of Allergy and Clinical Immunology (EAACI) guidelines, may have limitations in specific populations.
- Food-induced anaphylaxis is a common emergency presentation in children.
Purpose of the Study:
- To evaluate the applicability of the EAACI Taskforce position paper on Anaphylaxis in Children for classifying food-induced anaphylaxis in a Swedish pediatric emergency department cohort.
- To identify limitations in the EAACI classification for accurately diagnosing and grading anaphylaxis in children.
- To propose modifications to the EAACI classification to improve its utility for Swedish children.
Main Methods:
- Retrospective analysis of 381 emergency department visits for food reactions in 371 children at three Stockholm pediatric hospitals in 2007.
- Comparison of recorded symptoms and signs with the EAACI Taskforce position paper criteria.
- Modification of the EAACI classification to include additional respiratory, neurological, and cardiovascular signs and symptoms.
Main Results:
- The original EAACI classification was insufficient for accurate anaphylaxis diagnosis in 65% of cases.
- After modification, 128 children (35%) were classified with anaphylaxis.
- Seventy children (19%) did not meet modified criteria but received adrenaline, potentially preventing anaphylaxis; 173 (47%) had neither anaphylaxis nor adrenaline administration.
- Several severe signs (respiratory, neurological, cardiovascular) were not adequately described in the original EAACI paper, hindering classification.
Conclusions:
- The EAACI classification tool is valuable but requires adaptation for specific populations, particularly for Swedish children.
- Incorporating detailed descriptions of respiratory, neurological, and cardiovascular signs is essential for accurate anaphylaxis classification and severity grading.
- Modified classification systems enhance the diagnosis of food-induced anaphylaxis in pediatric emergency settings.
Abstract:
Correct management and classification of anaphylaxis is mandatory. Records of emergency department (ED) visits to any of the three pediatric hospitals in Stockholm, because of reactions to foods during 2007, were identified. A retrospective analysis of clinical ED records of 371 children with 381 unique occasions of reactions to foods was performed. Symptoms/signs of reactions to foods recorded for classification of anaphylaxis were related to those presented in the EAACI Taskforce position paper on Anaphylaxis in Children (Allergy 2007; 62: 857). Forty-six different symptoms/signs of reactions to foods were retrieved. Several severe signs or symptoms from the respiratory tract and signs indicating reduced brain perfusion were not described in detail in the EAACI paper, hampering correct classification of anaphylaxis including grading of severity in our material. After modification of the EAACI classification including such signs and symptoms, we were able to classify 128 (35%) children with anaphylaxis. Seventy children (19%) did not fulfill our modified EAACI's criteria for anaphylaxis. They had been given adrenaline before or at arrival to hospital, possibly preventing anaphylaxis. Another 173 (47%) children/adolescents had neither been given adrenalin, nor fulfilled the criteria for anaphylaxis. Classification of food-induced anaphylaxis and severity grading should be built on signs and symptoms to facilitate diagnosis. The existing EAACI tool is helpful, but for Swedish children it is not quite applicable, in particular because of the lack of description of some respiratory, neurological or possible cardiovascular signs and symptoms.
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