Age-related differences in pediatric anaphylaxis: a single-center experience

Pediatric anaphylaxis is a potentially life-threatening systemic hypersensitivity reaction with age-related differences in triggers and clinical manifestations. Real-life data are important to improve recognition, risk assessment, and management. This study aimed to evaluate the demographic and clinical characteristics, triggers, management, and factors associated with moderate-to-severe anaphylaxis in children, with particular emphasis on age-related differences.

This retrospective observational study was conducted at a pediatric allergy clinic between April 1, 2023, and July 1, 2025. Potential cases among children aged 0-18 years were identified using anaphylaxis-related ICD-10 codes and were subsequently re-evaluated according to the World Allergy Organization 2020 and European Academy of Allergy and Clinical Immunology 2021 diagnostic criteria. Demographic characteristics, triggers, clinical manifestations, treatment, clinical outcomes, and laboratory findings were analyzed.

A total of 116 patients were included; 45 (38.8%) were female, and the mean age was 9.7 ± 5.9 years. Anaphylaxis most commonly occurred at home (66.4%), and oral exposure was the most frequent route of allergen exposure (67.2%). Foods were the most common triggers (42.2%), followed by drugs (37.1%) and Hymenoptera venom (12.9%). Tree nuts, cow's milk, and hen's egg were the leading food triggers. Food-induced anaphylaxis was significantly more frequent in children aged 0-5 years, whereas drug-induced reactions were more common in older children. Cardiovascular involvement was more frequent in patients aged ≥ 12 years and in Hymenoptera venom- and drug-induced reactions, whereas neurological involvement was more frequent in children aged 0-5 years. Hymenoptera venom-induced reactions had the shortest onset time (15 min [IQR, 5-30]). Intramuscular epinephrine was administered to 94.0% of patients. Moderate-to-severe anaphylaxis was observed in 64 patients. In multivariable logistic regression analysis, a history of food allergy was independently associated with moderate-to-severe anaphylaxis (OR, 5.08; 95% CI, 1.32-19.52; p = 0.018).

Clinical manifestations and triggers of pediatric anaphylaxis varied according to age. Food-induced reactions were more common in younger children, whereas drug-induced reactions increased with age. A history of food allergy may indicate an increased risk for moderate-to-severe anaphylaxis.