Disparities in pediatric anaphylaxis triggers and management across Asia

Abstract

BackgroundThe epidemiology and management of anaphylaxis are not well‐reported in Asia.MethodsA regional pediatric anaphylaxis registry was established by the Asia‐Pacific Research Network for Anaphylaxis (APRA), using standardized protocols for prospective data collection, to evaluate the triggers and management of anaphylaxis in the Asia‐Pacific region. Pediatric patients below 18 years presenting with anaphylaxis across four Asian countries/cities (Thailand, Singapore, Hong Kong (HK), and Qingdao) were included. Allergen triggers, symptoms, anaphylaxis severity, and management were compared.ResultsBetween 2019 and 2022, 721 anaphylaxis episodes in 689 patients from 16 centers were identified. The mean age at anaphylaxis presentation was 7.0 years (SD = 5.2) and 60% were male. Food was the most common trigger (62%), particularly eggs and cow's milk in children aged 3 years and below. In school‐age children, nut anaphylaxis was most common in HK and Singapore, but was rare in the other countries, and wheat was the top allergen in Bangkok. Shellfish anaphylaxis was most common in children aged 7–17. Adrenaline was administered in 60% of cases, with 9% given adrenaline before hospital arrival. Adrenaline devices were prescribed in up to 82% of cases in Thailand but none in Qingdao.ConclusionsThe APRA identified food as the main trigger of anaphylaxis in children, but causative allergens differed even across Asian countries. Fewer than two‐thirds of cases received adrenaline treatment, pre‐hospital adrenaline usage was low, and adrenaline device prescription remained suboptimal. The registry recognizes an unmet need to strengthen anaphylaxis care and research in Asia‐Pacific.

Trends in Childhood Anaphylaxis in Singapore: 2015–2022

“…We observed unique triggers of anaphylaxis specific to the Asia-Pacific region [3,29]. Shellfish allergy was more common in Asian countries [7,30] and our study found a similar pattern of shellfish anaphylaxis with predominance in adolescence.…”

“…Our study reflected the presence of NSAID hypersensitivity in the Asia-Pacific region [33] and served as an unfortunate reminder of its widespread use as 21.2% of NSAID anaphylaxis patients reported prior reactions. While wheat was among the top three triggers of food anaphylaxis in Thailand, Korea and China [27,29,34], it was less common in our population.…”

Childhood Anaphylaxis in Asia

“…A small number of studies suggest that FA/anaphylaxis presentations may be increasing in Asia in line with other countries. Even within Asia, there is significant heterogeneity in estimated rates of anaphylaxis, with the lowest rates observed in Qingdao in mainland China (1/10 5 population/year), followed by Hong Kong (11/10 5 ), Singapore (21/10 5 ) and Thailand (21-25/10 5 ) [6]. Shellfish was the major trigger in all countries, but curiously peanut allergy was reported as absent in Qingdao and Thailand.…”

“…While the study by Goh et al was not designed to examine risk factors for this increase, other studies describe the highest rates of FA/anaphylaxis in the most urbanized and population dense centres of Asia. This may reflect a so-called 'westernized lifestyle', associated with dietary habits, composition of gut microbiota, socio-economic status, city versus rural residency but in Asia, not necessarily exposure or timing of introduction of common allergenic foods [5,6]. One needs to acknowledge the many potential caveats associated with use of hospital-derived data in these studies [5,6], such as coding errors, anaphylaxis treatment guidelines and hospital admission policies, difficulty differentiating between unique or multiple presentations by the same individual, changes in patient health-seeking behaviour, availability of community care, more effective anaphylaxis treatment in the community or availability of adrenaline autoinjectors for self-administration.…”