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Anaphylaxis in the Pediatric Emergency Department: Analysis of 133 Cases After an Allergy Workup
Alberto Alvarez-Perea1, Beatriz Ameiro2, Cristina Morales2
1Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Madrid, Spain.
Insights
Pediatric anaphylaxis incidence is higher than previously thought, with food being the most common trigger. Allergy workups are crucial for accurate diagnosis, reducing unidentified causes by 75%.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Clinical Epidemiology
Background:
- Limited data exists on pediatric anaphylaxis incidence and characteristics.
- Emergency department (ED) suspected causes of anaphylaxis may not reflect actual triggers.
Purpose of the Study:
- To determine the incidence, management, and causes of pediatric anaphylaxis in a tertiary hospital's ED.
- To assess the agreement between ED-suspected and allergy workup-confirmed anaphylaxis etiology.
Main Methods:
- Observational, descriptive study of pediatric anaphylaxis cases from 2012-2014.
- Anaphylaxis diagnosis based on National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria.
- Data collection included clinical features, management, suspected triggers, and allergy department workup.
Main Results:
- 133 anaphylaxis cases recorded (0.12% incidence), with 15% in infants under 12 months.
- Correct ED diagnosis occurred in 53% of cases.
- Food allergy accounted for 90% of confirmed cases; final etiology differed from ED suspicion in 39% of cases.
Conclusions:
- Pediatric anaphylaxis incidence is higher than in adults; food is the primary trigger.
- Accurate etiological diagnosis requires a thorough allergy workup.
- Post-study, unidentified anaphylaxis triggers decreased by 75%.
Background:
Data on the incidence and characteristics of pediatric anaphylaxis are scarce. Reported causes of anaphylaxis are mostly those suspected by the physician in the emergency department (ED), which may not coincide with the real triggers.
Objectives:
To investigate the incidence, management, and etiology of pediatric anaphylaxis in the ED of a Spanish tertiary hospital and to determine the concordance between the suspected etiology in the ED and diagnosis after the allergy workup.
Methods:
We performed an observational, descriptive study of all patients with anaphylaxis attended in the pediatric ED from 2012 to 2014. Cases were considered anaphylaxis based on National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. We recorded data on clinical characteristics, management, etiology suspected by the ED physician and patient (or relatives), and the workup performed in the allergy department.
Results:
We recorded 133 cases of anaphylaxis (incidence, 0.12%), with 20 cases (15%) recorded in children younger than 12 months. Anaphylaxis was correctly diagnosed in the ED in 70 cases (53%). Food allergy was the cause of anaphylaxis in 106 out of 118 studied in the allergy department (AD) (90%). The final etiology differed from the etiology initially suspected in the ED in 42 cases (39%). After the study, the frequency of patients with unidentified triggers decreased by 75%.
Conclusions:
The incidence of anaphylaxis is higher in children than previously reported in adults from the same center, and food is the trigger in most cases. To prevent erroneous diagnoses, the etiology of anaphylaxis should be established after an appropriate workup.