Characteristics and Treatment of Anaphylaxis in Children Visiting a Pediatric Emergency Department in Korea

Abstract

Anaphylaxis is a serious life-threatening allergic disease in children. This study is aimed at determining the characteristics of pediatric patients who experienced anaphylaxis along with treatments administered in order to determine the usefulness of tryptase level assessment as a marker of anaphylaxis in Korean children. A total of 107 patients who were diagnosed with anaphylaxis in a single pediatric emergency center over a 3-year period were included in the study. Patient clinical characteristics, symptoms, signs, allergy history, trigger factors, treatments, and laboratory findings, including serum tryptase levels, were included in the analysis. Food allergies (39.3%) were the most commonly reported patient allergic history, and 58 patients (54.2%) were triggered by food. Among this group, nuts and milk exposure were the most common, affecting 15 patients (25.9%). History of anaphylaxis and asthma were more common in severe anaphylaxis compared to mild or moderate anaphylaxis cases. Epinephrine intramuscular injection was administrated to 76 patients (71.0%), and a self-injectable epinephrine was prescribed to 18 patients (16.8%). The median tryptase level was 4.80 ng/mL (range: 2.70–10.40) which was lower than the 11.4 ng/mL value commonly documented for standard evaluation in adults with anaphylaxis. The most common cause of pediatric anaphylaxis was food including nuts and milk. The rate of epinephrine injection was relatively high in our pediatric emergency department. The median tryptase level associated with anaphylaxis reactions in children was lower than 11.4 ng/mL. Further studies are needed to help improve diagnostic times and treatment accuracy in pediatric patients who develop anaphylaxis.

Association Between Allergen Sensitization and Anaphylaxis in Patients Visiting a Pediatric Emergency Department

“…One study indicated that nuts, such as peanuts and cashews, were the most common food triggers in childhood anaphylaxis ( 6 ). Although these were not included in this study, the most common trigger in our patients was also food (54%) with the most common food triggers being nuts (25%), milk (25%), and egg (20%) ( 4 ). The results of our study confirmed that anaphylactic children were highly sensitized to these foods.…”

“…Emergency treatment is important for patients with anaphylaxis because severe symptoms can affect various organs within a short time ( 2 ). The lifetime prevalence of anaphylaxis is increasing ( 3 ) and the incidence of anaphylaxis in children is higher than that in adults ( 4 ).…”

Anaphylaxis in Children: Experience of an Egyptian Center

“…It was noticeable in many studies that anaphylaxis is more prevalent in children compared with adults, however, the reactions used to be milder 5,6 . Castells and colleagues stated that severe reactions are 9-fold for adults compared with children 17 . We noticed in this study that frequency rate of anaphylaxis decreased with age' being higher-most in infants and lowermost in adolescents, however, the study duration and population were relatively limited being a single center.…”

“…Second line medications in the form of glucocorticoids and type1 antihistamines were supplied to all the studied patients. Although they have no role in the management of anaphylaxis as recommended by WAO 10 and National Institute of Allergy, Immunology, and Infectious Diseases (NIAID) guidelines 29 , glucocorticoids and histamine1 blockers were commonly prescribed to control the muco-cutaneous manifestations and to reduce hospitalization of anaphylactic patients 30 . Unfortunately, long term management was not provided to any of our studied patients including proper family education or scheduled appointment for follow up in the Specialized Allergy Clinic in our University hospital.…”

Pediatric Anaphylaxis: Etiology and Predictive Factors in an Emergency Setting

“…6 This can cause morbidity and mortality consequences since this condition needs an immediate specific treatment. 5,[7][8][9][10][11] Anaphylaxis in children has various allergic triggers. The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk and nuts.…”