Paediatric anaphylaxis in a Singaporean children cohort: changing food allergy triggers over time

Abstract

BackgroundWe have noticed changes in paediatric anaphylaxis triggers locally in Singapore.ObjectiveWe aimed to describe the demographic characteristics, clinical features, causative agents and management of children presenting with anaphylaxis.MethodsThis is a retrospective study of Singaporean children presenting with anaphylaxis between January 2005 and December 2009 to a tertiary paediatric hospital.ResultsOne hundred and eight cases of anaphylaxis in 98 children were included. Food was the commonest trigger (63%), followed by drugs (30%), whilst 7% were idiopathic. Peanut was the top food trigger (19%), followed by egg (12%), shellfish (10%) and bird's nest (10%). Ibuprofen was the commonest cause of drug induced anaphylaxis (50%), followed by paracetamol (15%) and other nonsteroidal anti-inflammatory drugs (NSAIDs, 12%). The median age of presentation for all anaphylaxis cases was 7.9 years old (interquartile range 3.6 to 10.8 years), but food triggers occurred significantly earlier compared to drugs (median 4.9 years vs. 10.5 years, p < 0.05). Mucocutaneous (91%) and respiratory features (88%) were the principal presenting symptoms. Drug anaphylaxis was more likely to result in hypotension compared to food anaphylaxis (21.9% vs. 2.7%, Fisher's exact probability < 0.01). There were 4 reported cases (3.6%) of biphasic reaction occurring within 24 h of anaphylaxis.ConclusionFood anaphylaxis patterns have changed over time in our study cohort of Singaporean children. Peanuts allergy, almost absent a decade ago, is currently the top food trigger, whilst seafood and bird's nest continue to be an important cause of food anaphylaxis locally. NSAIDs and paracetamol hypersensitivity are unique causes of drug induced anaphylaxis locally.

Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis

“…1). The 85 remaining articles [3, 9, 13-21, 24-97] were included in the qualitative analysis (online suppl. Table S1; for all online suppl.…”

“…While the mechanism underlying acetaminophen allergy is not yet fully understood, we can hypothesize that immediate reactions are likely IgE-mediated, as described by de Paramo et al [23]. Studies also report a high risk of hypersensitivity to acetaminophen in patients who experience ibuprofen-induced anaphylaxis [24], so it is important to assess cross-intolerance to acetaminophen in such patients.…”

Food allergy in Singapore: opening a new chapter

“…The shift in peanut sensitisation patterns in atopic children from fourth to second place was the initial signal of this change. (25)(26)(27) In a recent study by Liew et al, peanut was found to be the top cause of anaphylaxis in a Singapore paediatric emergency centre, (28) whereas it was an absent cause of food anaphylaxis 14 years ago. (29) It is therefore important for medical professionals to watch for this rise in peanut allergy, as it is a frequent cause of fatal anaphylaxis, particularly in adolescents, and is carried into adulthood, with less than 10% outgrowing this allergy.…”

“…(14,28) Drugs in children (30%) and insect stings in adults (32%) are the second most common triggers after food.…”

“…In adults, shellfish accounts for a vast 66%, followed by tree nuts (6.7%), fruit (6.7%), bird's nest (3.3%), peanut (3.3%) and fish (3.3%). (28) Previously, bird's nest was the most prominent cause of anaphylaxis, (27) but this has changed over the years. Even though food allergy in Singapore is comparatively low, it is not surprising that food-triggered anaphylaxis is common given that shellfish and peanuts are hidden foods ubiquitous in Asian cooking.…”