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Development and Evaluation of Modified Criteria for Infant and Toddler Anaphylaxis
Anna Handorf1, Ian R Roy1, Ari Cohen2
1Department of Pediatrics, Mass General for Children, Harvard Medical School, Boston, Mass; Tufts University School of Medicine, Boston, Mass.
Insights
New criteria improve anaphylaxis identification in infants and toddlers. Modified clinical guidelines better detect allergic reactions in young children, addressing an unmet need in pediatric emergency care.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Current anaphylaxis diagnostic criteria lack validation in children under two years old.
- Unique presentation of anaphylaxis in infants and toddlers leads to under-recognition.
- An unmet clinical need exists for improved pediatric anaphylaxis identification.
Purpose of the Study:
- To identify age-specific signs and symptoms for accurate anaphylaxis diagnosis in young children.
- To develop and evaluate modified anaphylaxis criteria against the established NIAID/FAAN guidelines.
- To enhance the recognition of anaphylaxis in infants and toddlers.
Main Methods:
- Retrospective review of 337 pediatric emergency department encounters for suspected anaphylaxis.
- Development of modified clinical criteria for 'likely anaphylaxis'.
- Comparative analysis of modified criteria versus the 2006 NIAID/FAAN criteria.
Main Results:
- The study included infants (33%), toddlers (39%), and older children (29%).
- Modified criteria identified 98% of cases, significantly outperforming NIAID/FAAN criteria (85%, P < .001).
- Improved performance was noted for modified criteria in infants (22.8% increase, P < .001) and toddlers (10.3% increase, P = .04).
Conclusions:
- Modified anaphylaxis criteria incorporating infant-specific symptoms enhance diagnostic accuracy.
- The developed criteria show increased identification of anaphylaxis in infants and potentially toddlers.
- Further validation in larger cohorts is recommended.
Background:
Current clinical criteria for identifying anaphylaxis do not account for unique aspects of infant anaphylaxis presentation and have not been validated in patients younger than 2 years of age. This may contribute to under recognition and is thus an unmet need.
Objective:
To demonstrate age-specific signs and symptoms that more accurately identify anaphylaxis in young children and to develop and compare modified criteria for "likely anaphylaxis" against the widely used 2006 National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria.
Methods:
Retrospective chart review of 337 clinical encounters presenting with suspected allergic or anaphylactic reactions to a pediatric emergency department. Modified criteria for likely anaphylaxis were developed and evaluated against the NIAID/FAAN criteria.
Results:
The study population included 33% infants (age < 12 mo), 39% toddlers (age 12 mo to < 36 mo), and 29% children (age ≥ 36 mo). The NIAID/FAAN criteria captured 85% of all patient encounters in the study and the modified criteria captured 98% (P < .001). Compared with NIAID/FAAN criteria, modified criteria had 22.8% improved performance among infants (p < .001) and 10.3% improved performance among toddlers (P = .04).
Conclusions:
We developed modified anaphylaxis clinical criteria that incorporated symptoms specific to infants and young children. The modified criteria increased identification of anaphylaxis in infants and potentially toddlers. Future research is needed to validate our findings on a larger cohort.
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