Is the clinical manifestation of anaphylaxis in children influenced by the trigger of reaction?

Abstract

Introduction The number of anaphylaxis diagnoses in children is rising, being still based on the clinical picture. Aim To determine whether triggers of anaphylaxis influence its clinical characteristics in children and adolescents. Material and methods The study group included 114 children (5 months–17 years, mean age: 8.0 ±4.8 years), (66%: boys) with the episode of anaphylaxis up to 1 year back. Medical data were entered to the NORA Registry by means of a validated structured on-line questionnaire. Results Three most frequent triggers of anaphylaxis were: insect venom (47.4%), food (35.1%), drugs (5.3%), with a predominance of food (egg white, cow’s milk, nuts and peanuts) in the 0–6 years age group, while insect venom (bee predominance) in the 7–17 years age group ( p = 0.016). Clinical manifestations differed between food vs. venom allergic reactions and presented as gastro-intestinal (GI) (61.4%) ( p = 0.004), respiratory (RS) (93.9%) ( p = 0.036), and cardiovascular (CVS) (74.6%) ( p = 0.022) symptoms. Among objective symptoms, vomiting was the most common symptom in the 0–2 years age group (47.1%) ( p = 0.006), while hypotension in those aged 7–12 years (40%) ( p = 0.010). Severity of symptoms evaluated as Mueller’s grade (IV – 74.5%) and as Ring and Messmer’s grade (III – 65.8%), depended on the trigger ( p = 0.028, p = 0.029, respectively). Life-threatening symptoms occurred in 26 children (fall of the blood pressure – 22%, loss of consciousness – 4.4%). Conclusions The clinical manifestation of anaphylaxis in children is both trigger and age dependent, irrespective of the gender. A typical patient with food anaphylaxis was younger, presenting predominantly GI symptoms, while a typical patient with venom anaphylaxis was older, with mostly cardiovascular symptoms.

The 2020 update on anaphylaxis in paediatric population

“…Phenotypes of anaphylaxis, similarly to phenotypes of asthma, may alter according to its trigger. Typically, food allergy is associated with vomiting, nausea and gastrointestinal symptoms [ 36 ], while allergy to drugs and insect venom results in hypotension regardless of age [ 13 , 37 ].…”

Evaluation of hemostatic derangements associated with canine anaphylaxis and the relationship to syndrome severity

“…However, recent literature indicates a burgeoning understanding that multiple clinical phenotypes may exist, that the clinical picture is often dynamic, and that several other less-considered systems can also be profoundly affected. [1][2][3][4] Hemostatic abnormalities have been documented as a sequela of APX in people. There is some variability in the specific alterations identified in APX-associated hemostatic derangements (AAHDs), including predominantly factor-based, fibrinogenolytic, and fibrinolytic phenotypes.…”

“…Historical paradigms indicate the involvement of multiple organ systems, including the respiratory, cardiovascular, gastrointestinal, or integumentary systems in some combination as a criterion of diagnosis. However, recent literature indicates a burgeoning understanding that multiple clinical phenotypes may exist, that the clinical picture is often dynamic, and that several other less‐considered systems can also be profoundly affected 1–4 …”