Anaphylaxis in Infants and Toddlers Presenting to a Pediatric Emergency Department

To characterize the clinical presentation and management of anaphylaxis in infants and toddlers.

We conducted a retrospective cohort study of patients aged 0 to 24 months presenting to a pediatric emergency department between June 2019 and June 2022 with concern for anaphylaxis. Patients were identified using International Classification of Diseases, Ninth and 10th Revision codes associated with anaphylaxis and confirmed to meet 2006 National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network clinical criteria by chart review. Demographic and clinical information-including presenting symptoms, administered treatment, and patient disposition-were abstracted from the electronic medical record. Treatments of interest included epinephrine, antihistamines, corticosteroids, albuterol, and intravenous fluids. Data were analyzed descriptively.

Among 225 potentially eligible encounters, we identified 155 patients who met inclusion criteria. Median age was 10.8 months (interquartile range: 8.4 to 15.6). Food triggered 96.1% of episodes. Skin and mucosal symptoms occurred in 99.4% of patients, gastrointestinal symptoms in 74.2%, respiratory symptoms in 57.4%, and cardiovascular symptoms in 5.8%. Intramuscular epinephrine was administered to 87.1% of patients, 90.4% of whom received a single dose. Most patients (88.4%) were discharged home, and none of those admitted required additional epinephrine.

In this cohort, reactions were most often food-triggered and characterized by mucocutaneous symptoms with gastrointestinal and/or mild-to-moderate respiratory symptoms. Severe respiratory or cardiovascular involvement was uncommon. Symptoms tended to resolve after a single dose of epinephrine, and most patients were discharged home.