Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and therapeutic approach

Abstract

Anaphylaxis remains under-diagnosed and under-treated. A better knowledge of patterns and triggers of anaphylaxis might contribute to a better management. In this study we evaluated the demographic and clinical features of anaphylaxis in pediatric patients, as well as its triggers and therapeutic approach. From May 1st 2004 until April 30th 2006 we prospectively collected data on all patients referred for investigation of anaphylaxis to the pediatric department of the University Hospital Gasthuisberg Leuven and to two private pediatric practices. Data were stored in a MYSQL database by use of an online encrypted web form. Sixty-four cases of anaphylaxis occurred in 48 children, aged 6 months to 14.8 years. Twenty-seven episodes (42.2%) occurred at home. The symptoms were dermatologic in 62 (96.9%) episodes, respiratory in 57 (89.1%), gastrointestinal in 19 (29.7%), cardiovascular in 14 (21.8%), and neurological or behavioural in 19 (29.7%). Antihistamines were administered in 41/57 (71.9%) cases, corticosteroids in 26/57 (45.6%), beta-2-mimetics in 14/57 (24.6%), and adrenaline in 11/57 (19.3%). Out of nine cases where Epipen was available at the moment of anaphylaxis, it was administered in one case only. Food was the cause of anaphylaxis in 42/55 (76.4%) cases with identified trigger, while medication, insect stings, latex, and birch pollen triggered 5 (9.1%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) case(s), respectively. Allergy to the trigger was known prior to anaphylaxis in 19/55 (34.5%) cases. In conclusion, anaphylaxis in pediatric patients generally presents with dermatologic and respiratory symptoms, while in 1/5 episodes cardiovascular symptoms occur. Food is by far the most frequent trigger. Allergy to the trigger is known in 1/3 cases only. Anaphylaxis is under-treated, even when appropriate medication is available.

About the role and underlying mechanisms of cofactors in anaphylaxis

“…According to the anaphylaxis registries of different European countries, next to exercise, alcohol consumption is a relevant cofactor in up to 15.2% of anaphylactic events and drugs such as ASA were registered as a cofactor in 6.1-9% of severe anaphylactic reactions (Table 1). The role of infections as cofactors of anaphylaxis is reported to be relevant in 2.5-3% of anaphylactic reactions in children and in 1.3-11% in adults (8,(13)(14)(15)(16)(17)(18). Infections are particularly dangerous for patients with a risk to develop anaphylaxis, because in contrast to most other relevant cofactors of anaphylaxis, infections cannot simply be avoided or foreseen.…”

Epidemiological and Clinical Features of Anaphylaxis: Single Center Experience with 109 Children

“…5,7,12,13 Novembre et al 13 found out male predominance of 2:1 and hypothesized that it might be attributable to the larger number of boys with hymenoptera sting or exercise-induced anaphylaxis. In our study, male predominancy was obvious in venom induced anaphylaxis (68%) and in children £ 2 years old (74%).…”

“…In our study, drugs mainly antibiotics and nonsteroid anti-inflammatory medications took the first place in the etiology of anaphylaxis rather than food which was determined as the first offending agent in other studies, [5][6][7]12 . In a study carried out by Dibs and Baker 14 , food was the second trigger after latex.…”

Cutaneous and Systemic Mastocytosis in Children: A Risk Factor for Anaphylaxis?

“…The major triggers of anaphylaxis in adults are drugs, food, and venom [11••, 12, 27], respectively, whereas in children the major triggers are food, drugs, venom, and unknown causes (Table 2) [2,3,15,17,18,20,21,29]; interestingly, galactose-α-1,3 galactose sensitivity, and delayed anaphylaxis recently documented in children has not be reported in children with mastocytosis [30].…”