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Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence
Nannan Jiang1,2,3, Wei Xu1,2,3, Li Xiang4,3
1Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.
Insights
Anaphylaxis in Chinese children shows age-specific patterns, with infants most affected by food allergies like milk and egg. Prompt recognition of symptoms and epinephrine use are crucial for managing allergic reactions.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pediatrics
- Epidemiology of Allergic Diseases
Background:
- Limited data exists on anaphylaxis patterns in Chinese pediatric populations.
- Understanding age-specific triggers and manifestations is crucial for effective management.
Purpose of the Study:
- To investigate the age-specific patterns of anaphylaxis in Chinese children.
- To identify common allergens, clinical presentations, and treatment approaches across different age groups.
Main Methods:
- Retrospective analysis of 279 anaphylaxis cases in 177 pediatric patients treated at a tertiary children's hospital.
- Data collection included patient demographics, triggers, clinical manifestations, and treatments.
Main Results:
- Most first anaphylaxis events (57.6%) occurred in infants (0-2 years), primarily triggered by foods (88.5%).
- Common infant allergens included cow's milk, egg, and wheat. Clinical patterns varied by age, with infants experiencing more hives and vomiting, and adolescents more abdominal pain.
- Epinephrine was administered in 9.3% of anaphylaxis events and 24.1% of life-threatening reactions.
Conclusions:
- Anaphylaxis in Chinese children exhibits distinct age-related clinical patterns.
- Hives and vomiting are common in infants, while cardiovascular symptoms are rare. Wheat is a significant allergen in infancy.
- Improved physician education on recognizing age-specific symptoms and aggressive epinephrine use is essential for prompt diagnosis and management.
Background:
Little is known about anaphylaxis in Chinese children. This study aimed to determine the age-specific patterns of anaphylaxis in Chinese children.
Methods:
We conducted a retrospective study of anaphylaxis cases attending an allergy department in a tertiary children's hospital.
Results:
A total of 279 anaphylactic reactions in 177 patients were analyzed. Overall, 57.6% (102/177) of first anaphylaxis events occurred in infants (0-2 ys). Foods were the most common culprits (88.5%), followed by food + exercise/exercise (4.7%), and drugs (4.3%). The main food allergens were cow's milk (32.9%), egg (21.4%), and wheat (20.7%) in infants, compared with fruits/vegetables at 35.9% in preschool-age children (3-6 ys) and 31.6% in school-age children (7-12 ys). The most commonly implicated drug triggers were vaccines (n = 5, comprising DTaP n = 2, group A + C meningococcal polysaccharide vaccine n = 1, Sabin vaccine n = 1, and not specified n = 1). Among the 5 vaccine-induced anaphylaxis patients, 4 had severe cow's milk allergy. The clinical manifestations were mainly mucocutaneous (86.0%), followed by respiratory (68.8%), gastrointestinal (23.7%), neurological (10.4%), and cardiovascular (0.7%). Compared with patients of other ages, infants had higher rates of hives (0-2ys 77.4%, 3-6ys 50%,7-12ys 57.9%, 13-17ys 38.9%, p = 0.016) and vomiting (0-2ys 20.7%, 3-6ys 1.6%,7-12ys 8.8%, p < 0.001), while wheezing was more frequent in school-age children (0-2ys 21.4%, 3-6ys 25%, 7-12ys 38.6%, 13-17ys 5.6%, p = 0.017) and abdominal pain was more common in adolescents (0-2ys 2.1%,3-6ys 15.6%, 7-12ys 14.0%, 13-17ys 72.3%, p < 0.001). Regarding treatment, 9.3% of anaphylaxis events and 24.1% of life-threatening reactions were treated with epinephrine.
Conclusions:
We observed age-related clinical patterns of anaphylaxis in this study, with hives and vomiting most commonly reported in infants and cardiovascular symptoms rarely reported in children. Wheat was the third most culprit food allergen after egg and milk in infancy. Education regarding more aggressive use of epinephrine in the emergency setting is clearly needed. Recognition of age-related symptoms in anaphylaxis can aid physicians in prompt diagnosis and acute management.
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