Management of paediatric anaphylaxis: evaluation of clinical practice according to the 2024 Polish Paediatric Society guidelines

Anaphylaxis is a severe, rapidly progressing allergic reaction that can be life-threatening. It may involve the skin and mucous membranes, as well as the respiratory, cardiovascular, or gastrointestinal systems. In children, it most often occurs at home, in kindergarten, or at school, with food being the predominant trigger. Immediate intramuscular adrenaline is the treatment of choice.

To evaluate clinical practice in managing paediatric anaphylaxis according to the 2024 Polish Paediatric Society recommendations.

A retrospective analysis was conducted on medical records of 615 children aged 6 months-17 years hospitalized in the Allergology and Pulmonology Department of the Institute for Tuberculosis and Lung Diseases in Rabka-Zdroj in 2020-2023 for food-induced anaphylaxis (ICD-10 T78.0). Reactions were classified according to the Błażowski et al. severity scale (systemic allergic reaction - SAR; anaphylaxis grades I-IV). Management, including the use of adrenaline, antihistamines, corticosteroids, and other drugs, was evaluated at three levels: caregivers, prehospital services, and hospital care.

Of 615 reactions, 260 met inclusion criteria. SAR occurred in 8%, grade I anaphylaxis in 5.4%, grade II in 48.5%, grade III in 35.4%, and grade IV in 2.7%. Antihistamines were used in 57.3% of cases, corticosteroids in 63.8%, and adrenaline in 17.7%. Adrenaline use was most frequent in hospital settings, lower in prehospital care, and rare among caregivers. Some children received no treatment despite significant symptoms.

Adrenaline is underused in paediatric anaphylaxis, particularly outside hospitals. Improved education for caregivers and healthcare providers is essential to ensure timely, guideline-based management.