Peanut induced anaphylaxis in children and adolescents: data from the European Anaphylaxis Registry

Abstract

Background: Peanut allergy has a rising prevalence in high-income countries, affecting 0.5-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods: Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food induced anaphylaxis cases in a tertiary paediatric allergy centre. Results: 3514 cases of food anaphylaxis were reported between July 2007-March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs 38%; p=0.001), asthma comorbidity (47% vs 35%; p<0.001), relevant co-factors (29% vs 22%; p=0.004) and biphasic reactions (10% vs 4%; p=0.001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs 56% and grade IV 1.1% vs 0.9%; p=0.001). Self-administration of intramuscular adrenaline was low (17% vs 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs 26%; p=0.003). Hospitalisation was higher for peanut anaphylaxis (67% vs 54%; p=0.004). Conclusions: The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g. presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.

Recent update on the management of anaphylaxis

“…2 Moreover, laboratory tests can help physicians evaluate anaphylaxis phenotypes and find causative agents. As shown in Table 3, 25,26,[62][63][64][65][66] inflammatory mediators (histamine, tryptase, chymase, carboxypeptidase A3, and platelet-activating factor) are measured during the acute phase and/or stable condition (at least 24 hours after all signs and symptoms have been resolved) to confirm the diagnosis of anaphylaxis. 67 Meanwhile, the basophil activation test, serum-specific IgE measurement, and skin tests as well as component-resolved diagnostics are used to find causative agents.…”

“…Histamine can be useful for the evaluation of early-onset anaphylaxis Insufficiency for evaluating anaphylaxis Serum tryptase 25,26 Mast cells Basophils High specificity and more stable than histamines The gold standard for anaphylaxis diagnosis…”

“…Increases in some cases of adult healthy controls Limitations in food-allergy in children Skin tests 25,26 -Useful for evaluation of penicillin allergy, food allergy A safe and non-invasive method for patients with a history of anaphylaxis and mastocytosis False positives: β-blockers and angiotensin-converting enzyme inhibitors False negatives: Hymenoptera hypersensitivity Monoclonal antibody: the specificity and sensitivity are not well-defined. Specific serum IgE 25,26 B cells High sensitivity and specificity in Hymenoptera venomspecific IgE Evaluation of platins-specific IgE in the short-time Evaluation of cross-reactivity with drugs Limitations in food allergies, penicillin allergy Component-resolved diagnostics [63][64][65] -Prediction of allergic reaction severity Have greater specificity in food allergy Capable of detecting the causal agent A useful tool in Hymenoptera allergy Lower sensitivity in food allergy Expensive, labour intense Basophil activation test 25,26,66 Basophils Easily assessed Useful diagnosis and management for β-lactams, muscle relaxants, Hymenoptera venom allergies, fish allergy A true reflection of sensitized mast cells Expensive, labour intense Others 25,26 Serum PAF, serum TNF-α, IL-6, and IL-1β, Prostaglandin D2 and leukotrienes E4 and C4, chymase and carboxypeptidase, mast cell activation test PAF, platelet-activating factor; TNF-α, tumour necrosis factor α; IL, interleukin.…”

“…23 Recently, contributions of T cells, macrophages, and monocytes have been reported in cases induced by chemotherapy and monoclonal antibodies. 25,26 Therefore, a new classification of anaphylaxis phenotypes is based on type I, cytokine storm like, and mixed reactions. 25,26 Various phenotypes from different pathomechanisms made anaphylaxis difficult to diagnose and treat.…”

“…25,26 Therefore, a new classification of anaphylaxis phenotypes is based on type I, cytokine storm like, and mixed reactions. 25,26 Various phenotypes from different pathomechanisms made anaphylaxis difficult to diagnose and treat. This review summarizes recent updates on the diagnosis and management of anaphylaxis.…”