Food‐induced anaphylaxis in infancy compared to preschool age: A retrospective analysis

Abstract

Objective: Little is known regarding food anaphylaxis in infancy. We aimed to describe specificities of food anaphylaxis in infants (≤12 months) as compared to preschool children (1-6 years). Methods:We conducted a retrospective study of all food anaphylaxis cases recorded by the Allergy Vigilance Network from 2002 to 2018, in preschool children focusing on infants.Results: Of 1951 food anaphylaxis reactions, 61 (3%) occurred in infants and 386 (20%) in preschool children. Two infants had two anaphylaxis reactions; thus, we analyzed data among 59 infants (male: 51%; mean age: 6 months [SD: 2.9]); 31% had a history of atopic dermatitis, 11% of previous food allergy. The main food allergens were cow's milk (59%), hen's egg (20%), wheat (7%) and peanut (3%) in infants as compared with peanut (27%) and cashew (23%) in preschool children. Anaphylaxis occurred in 28/61 (46%) cases at the first cow's milk intake after breastfeeding discontinuation. Clinical manifestations were mainly mucocutaneous (79%), gastrointestinal (49%), respiratory (48%) and cardiovascular (21%); 25% of infants received adrenaline. Hives, hypotension and neurologic symptoms were more likely to be reported in infants than in preschool children (P = .02; P = .004; P = .002, respectively).Antihistamines and corticosteroids were more often prescribed in preschool children than in infants (P = .005; P = .025, respectively). Conclusion:Our study found that in infants presenting with their first food allergy, in a setting with a high rate of infant formula use, the most predominant trigger was cow's milk. As compared to older preschool children, hives, hypotonia and hypotension were more likely to be reported in infants. We believe that this represents a distinct food anaphylaxis phenotype that can further support developing the clinical anaphylaxis criteria in infants. | 75POUESSEL Et aL.

Food‐induced anaphylaxis in infants, as compared to toddlers and preschool children in Turkey

“…Recently, it was reported that hives, hypotension, and neurologic symptoms were more common in infants than in preschool children. 14 We also demonstrated that skin (especially redness and pruritus), nausea-vomiting, and neurologic symptoms were noted more frequently in the infant group, whereas respiratory symptoms were noted more frequently in the groups of toddlers and preschool children. (36.5%) adrenaline.…”

“…28 We determined that moderate-to-severe anaphylaxis was least common in the infant group and a history of recurrent wheezing, tree nut allergy, and an elevated eosinophil count were observed to be risk factors for moderate-to-severe versus mild anaphylactic reactions in the infant group; nevertheless, some studies have shown that there were no differences between age-groups. 14 In conclusion, FIA is a potentially life-threatening condition that frequently affects children of all ages. The strengths of the present study are a large patient population, real-life practice, and its age-dependent description of typical triggers, symptoms, and emergency treatment.…”

“…In terms of the relationship between FIA treatment and food triggers, The European Anaphylaxis Registry recorded a cohort of pediatric anaphylaxis reactions, and cow's milk and hen's egg were common etiologies in those aged 0-2 years, hazelnut and cashew were common etiologies in preschool-aged children, and peanut was a common trigger in all age-groups. 13 Pouessel et al 14…”

Anaphylaxis in children

“…Infants presented as their first anaphylaxis triggered by cow's milk and manifested more hives, hypotonia, and hypotension than pre-school children. 10 There are unusual clinical forms of anaphylaxis in childhood, such as exercise-induced anaphylaxis, anaphylaxis linked to allergy to alpha-galactose, which should be investigated when suspected.…”

“…Recently, a study suggested a distinct food‐induced anaphylaxis phenotype when compared infants (≤12 months) to pre‐school children (1‐6 years). Infants presented as their first anaphylaxis triggered by cow's milk and manifested more hives, hypotonia, and hypotension than pre‐school children 10 …”