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Anaphylaxis and reactions to foods in children--a population-based case study of emergency department visits
M Vetander1, D Helander, C Flodström
1Department of Paediatrics, Sachs' Children's Hospital, Södersjukhuset, Sjukhusbacken 10, Stockholm, Sweden. mirja.vetander@ki.se
Insights
Acute food reactions in children are common, with anaphylaxis often triggered by tree nuts and peanuts. Pollen allergies may increase risk, and wheezing is frequent even without asthma.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pediatrics
- Emergency Medicine
Background:
- Limited data exists on acute food reactions in children.
- Anaphylaxis is a severe allergic reaction requiring prompt medical attention.
Purpose of the Study:
- To determine the incidence of anaphylaxis in a pediatric emergency department (ED).
- To characterize food-induced anaphylaxis in children regarding age, sex, clinical presentation, and management.
Main Methods:
- Retrospective review of medical records for children visiting three pediatric hospitals in Stockholm County in 2007.
- Inclusion criteria: any adverse reaction to foods or anaphylaxis.
Main Results:
- 371 children experienced food reactions; anaphylaxis incidence was 32 per 100,000 person-years, with food implicated in 92%.
- Tree nuts (cashew) and peanuts were common triggers, equally prevalent as milk and egg in children under 3.
- Pollen-allergic children had higher rates of food-induced anaphylaxis during pollen season (P=0.015).
- Wheezing occurred in 49% of anaphylaxis cases without asthma vs. 72% with asthma (P<0.01).
Conclusions:
- Peanut and tree nut reactions are as common as milk and egg reactions in early childhood.
- Co-exposure to airborne allergens may elevate the risk of food-induced anaphylaxis.
- Wheezing is a common symptom in pediatric anaphylaxis, irrespective of asthma diagnosis.
Background:
Information about acute reactions to foods among children is limited.
Objective:
To describe the overall incidence of anaphylaxis in a paediatric emergency department (ED) setting and to describe reactions to foods in relation to sex and age, clinical characteristics and management.
Methods:
In a review of medical records, children with ED visits at any of three paediatric hospitals in Stockholm County during 2007 were targeted. Inclusion criteria were any adverse reaction to foods or anaphylaxis.
Results:
383 children fulfilled the inclusion criteria of which 371 had had reactions to foods. The incidence of anaphylaxis was 32 per 100 000 person years irrespective of cause and food was involved in 92%. Tree nuts, particular cashew, and peanut were the most common eliciting foods, and in children under 3 years, reactions to these two food allergens were as common as reactions to milk and egg. Pollen-allergic children seemed to be admitted due to food-induced anaphylaxis more often during the deciduous tree pollen season compared with the rest of the year (P = 0.015). Symptoms from the lower airways occurred in 49% of children with anaphylaxis but without underlying asthma compared with 72% of children with anaphylaxis and asthma, P < 0.01.
Conclusions And Clinical Relevance:
Reactions to peanut and tree nuts are as common as reactions to milk and egg in early life. Concomitant exposure to airborne allergens seems to increase the risk of anaphylaxis to foods. Among children with anaphylaxis, wheeze is prevalent even in children without asthma diagnosis.
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