PURPOSE OF THE STUDY.
To characterize provoking allergens, clinical features, accompanying factors, and treatment modalities for children presenting with anaphylaxis.
Data were analyzed from the anaphylaxis registry of German-speaking countries, which included 197 reported anaphylactic reactions from children and adolescents between 2006 and 2009. This database is based on an online questionnaire for providers of allergy specialty care in Germany, Austria, and Switzerland.
The questionnaire included demographic data, clinical symptoms, the cause of reaction, accompanying or possible aggravating factors, history of previous reaction, and treatment. To focus on reactions that involved life-threatening symptoms, only children who experienced reactions with at least 1 pulmonary or cardiovascular symptom were included in the analysis.
The most frequently affected organ systems involved in anaphylaxis cases of children and adolescents were the skin (89%) and respiratory tract (87%). Cardiovascular (47%) and gastrointestinal manifestations (43%) were noted less frequently. The most common triggering allergens were foods (58% of cases), followed by insect venoms (24%) and drugs (8%). Peanut was the most frequent food allergen provoking anaphylaxis, followed by tree nuts, cow’s milk, and egg. Accompanying or aggravating factors, such as exercise, drug use, coexisting infection, psychological stress, and menses, were noted in 18% of all cases. Only 26% had a history of a previous reaction. Treatment data demonstrated that antihistamines were given 87% of the time and corticosteroids were given 85% of the time, but epinephrine was given only 22% of the time.
Use of registry data can provide insight into the features of children presenting with anaphylaxis. Food allergens were the most common triggers for anaphylaxis and possible aggravating factors were noted in nearly 1 in 5 cases, with exercise being the most common. The low frequency of epinephrine administration suggests ongoing need for education for both families and physicians.
This study aimed to characterize children with life-threatening anaphylactic reactions by selecting those with cardiovascular and/or pulmonary involvement. Consistent with other studies, food allergens (most commonly peanut) were the most frequent trigger for reaction. The rate of accompanying or aggravating factors suggests that these should be considered in evaluation of all children with anaphylaxis. The low rate of epinephrine use is concerning, especially given that this study focused on more severe reactions, although this is consistent with most other studies of anaphylaxis from around the world.
- Copyright © 2012 by the American Academy of Pediatrics