Anaphylaxis in pediatric patients: single-center study in a private hospital

This study aimed to characterize the profile of probable anaphylaxis cases treated at a private pediatric hospital emergency department in São Paulo. It investigated triggering factors, the presence of cofactors, treatments administered, and follow-up for these cases through interviews with the patients' families. A single-center cross-sectional study analyzed medical records of children and adolescents treated between 2016 and 2020. Allergist physicians evaluated cases with symptoms consistent with anaphylaxis to identify probable cases, and the parents or legal guardians of these cases were interviewed to gather detailed information about the episodes. A total of 69 probable cases of anaphylaxis (PCA) were identified among 460,434 visits. Of the 51 PCAs evaluated, most presented with cutaneous and respiratory symptoms, with a male predominance (63%), and 27% were under 2 years old. Foods, particularly nuts and peanuts, were the primary triggers. Nearly one-third of the patients did not undergo investigation following the episode, and intramuscular adrenaline (37%) and auto-injectable adrenaline (4%) were underutilized as treatments. Eight cases exhibited recurrence of symptoms after initial improvement, suggesting a potential biphasic reaction. In conclusion, this study revealed that the majority of PCAs occurred in male children, with nuts and peanuts as the main triggers. The management of PCAs was suboptimal, characterized by the underutilization of intramuscular adrenaline as the first-line treatment and low rates of auto-injectable adrenaline prescriptions during follow-up. Increasing awareness and education about anaphylaxis in children, along with emphasizing the importance of proper treatment, are crucial to reducing the risk of morbidity and mortality in this vulnerable population.