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Anaphylaxis in children: Effect of age and atopic status
Nutthakit Wong-Onta1, Adithep Sawatchai1, Watcharoot Kanchongkittiphon1
1Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Childhood anaphylaxis is common, with food as the main trigger. Young children with mild-moderate reactions faced delays in hospital visits and adrenaline, highlighting the need for better allergy education.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Clinical Pediatrics
Background:
- Anaphylaxis incidence is increasing globally, posing diagnostic challenges in young children due to communication limitations.
- This study addresses the critical need to understand childhood anaphylaxis better.
Purpose of the Study:
- Investigate anaphylaxis in children, focusing on triggers, symptoms, and treatment.
- Analyze the impact of atopic status on anaphylaxis presentation.
- Examine adrenaline injection time intervals in different severity groups.
Main Methods:
- Retrospective review of inpatient medical records for pediatric anaphylaxis cases from 2014 to 2021.
- Data analysis included trigger identification, symptom patterns, and treatment delays.
Main Results:
- Food (47%) and drugs (31%) were primary anaphylaxis triggers in 133 identified events.
- Skin (94%) and respiratory (73%) symptoms were most common; atopic children showed more wheezing, while non-atopic children had higher rates of hypotension.
- Mild-moderate anaphylaxis cases in children under 5 experienced significant delays in hospital arrival and adrenaline administration compared to severe cases.
Conclusions:
- Childhood anaphylaxis is a significant clinical issue requiring prompt recognition and management.
- Delays in care for mild-moderate anaphylaxis in young children underscore the need for improved allergy awareness and education.
- Targeted education can enhance early identification and response to anaphylactic reactions in pediatric populations.
Background:
Anaphylaxis is a life-threatening allergic reaction with rising incidence worldwide. Young children's limited ability to express symptoms adds unique diagnostic challenges.
Objective:
To study on anaphylaxis in children, including triggers, symptoms, treatment, atopic status impact, and adrenaline injection time intervals.
Methods:
In-patient medical records of children who were diagnosed with anaphylaxis during 2014-2021 were reviewed.
Results:
One hundred thirty-three anaphylaxis events were identified. Food (47%) was the most common trigger, followed by drugs (31%), blood components (17%), insects (3%), and idiopathic causes (2%). Ten cases of refractory anaphylaxis, 2 cases of biphasic reactions, and 1 case of persistent anaphylaxis were found. There were no reported fatalities. The most common presentations involved the skin (94%), followed by the respiratory (73%), gastrointestinal (47%), and cardiovascular (42%) systems. In atopic patients, wheezing was more prominent than in those without atopy (p-value = 0.017). In the non-atopic patients, there was a higher incidence of cardiovascular symptoms, particularly hypotension (p-value = 0.001), compared to individuals with atopy. Children under 5 years old with mild-moderate anaphylaxis required more time to reach the hospital (147.0 vs. 45.0 minutes, p = 0.033) and to receive adrenaline injections (35.0 vs. 9.0 minutes, p-value = 0.017) than those with severe anaphylaxis.
Conclusion:
Childhood anaphylaxis is prevalent. Children with mild-moderate anaphylaxis experienced delays in hospital visits and adrenaline administration. Education on allergies is needed to improve the identification and prompt response to anaphylactic reactions, especially in young children.
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