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Incidence, triggering factors, symptoms, and treatment of anaphylaxis in a pediatric hospital
Fabiana A Nunes1,2, Fábio Zanini1, Camilla de S Braga2
1Division of Allergy and Clinical Immunology - Federal University of São Paulo (UNIFESP), Brazil.
Insights
The incidence of anaphylaxis in pediatric emergency rooms in São Paulo was 0.013%, with food being the most common trigger. Most cases were mild, primarily presenting with skin symptoms.
Area of Science:
- Pediatric Emergency Medicine
- Allergy and Immunology
Background:
- Anaphylaxis is a severe allergic reaction requiring prompt recognition and management.
- Understanding the incidence and triggers of anaphylaxis in pediatric populations is crucial for public health strategies.
Purpose of the Study:
- To determine the incidence of anaphylaxis in a pediatric emergency room in São Paulo, Brazil.
- To identify factors associated with anaphylaxis in children, including triggers, symptoms, and comorbidities.
Main Methods:
- A retrospective, cross-sectional study of medical records from 2016-2019.
- Inclusion criteria: patients aged 0-18 years with potential anaphylaxis diagnosis (ICD-10).
- Cases confirmed by medical history review and allergist consensus.
Main Results:
- Anaphylaxis incidence was 0.013% (56 cases).
- Food (53%) was the most frequent trigger, followed by unknown (32%) and drugs (12.5%).
- Cutaneous symptoms were universal; respiratory (74%) and gastrointestinal (53%) symptoms were also common. No shock or death occurred.
Conclusions:
- The incidence of pediatric anaphylaxis in this Brazilian hospital was lower than global estimates.
- Mild reactions with predominant cutaneous symptoms, triggered by food, characterize most cases.
- Adherence to treatment protocols, including intramuscular adrenaline, is essential.
Objective:
Assess the incidence of anaphylaxis in the emergency room (ER) of a private pediatric hospital in the city of São Paulo, Brazil, and describe associated factors.
Method:
This was a cross-sectional, retrospective, and observational study based on the medical records of patients from 0 to 18 years old seen at the emergency unit during the years of 2016-2019, who had a diagnosis potentially related to anaphylaxis according to ICD-10. All medical records were individually reviewed for the presence of compatible signs and symptoms that identified "possible" cases of anaphylaxis. Cases were considered probable anaphylaxis when medical history was compatible and indicative of anaphylaxis in the opinion of at least 2 allergists.
Results:
The incidence of anaphylaxis was 0.013%. Among the 56 patients identified (mean age 4.2 years), food was the most predominant suspected factor (53%), followed by unknown factors (32%), and drugs (12.5%). All patients presented with cutaneous symptoms, 74% with respiratory, and 53% with gastrointestinal. Allergic disease as a comorbidity was found in 39% of the children and 11% had a history of previous anaphylaxis. There were neither cases of syncope or shock, nor deaths. Intramuscular (IM) adrenaline was prescribed in 37.5% of cases.
Conclusions:
The incidence of anaphylaxis was low when compared to the worldwide incidence. The severity of most cases was mild, cutaneous symptoms were predominant, and food was the suspected trigger most frequently associated with reactions.
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