Cianferoni A, Novembre E, Pucci N, Lombardi E, Bernardini R, Vierucci A. Ann Allergy Asthma Immunol. 2004;92:464–468
Purpose of the Study.
To follow children with a previous history of anaphylaxis to determine the clinical course of this syndrome.
A total of 76 children referred between 1994 and 1996 with clinical features of anaphylaxis, which included at least 2 indicators (hypotension, inspiratory dyspnea, urticaria/angioedema) within 2 hours of exposure of the suspected causative agents.
After a mean duration of 7 years, 46 (61%) children were interviewed by telephone.
Of the 46 patients, 14 (30%) had experienced a recurrence of anaphylaxis. Ten had single episodes, 2 had 2 episodes, 1 had 3 recurrences, and 1 had 4 recurrences. None of the patients died or experienced biphasic reactions. Patients who were sensitive to at least 1 food allergen were more likely to have recurrent episodes of anaphylaxis than those without food sensitivity (93% vs 56%; P < .04). For 14 of the 46 who experienced recurrence of anaphylaxis, no specific cause was clearly associated with the recurrence. Children with atopic dermatitis at initial presentation (95% vs 31%; P = .004) and those with angioedema and urticaria at the time of the current study (93% vs 37%; P = .0002) were found to be at significantly higher risk for recurrent anaphylaxis.
Patients may have a greater risk for recurrent anaphylaxis if they have atopic dermatitis, angioedema, or urticaria and 1 positive food skin test.
This is the first study to help define the natural history of pediatric anaphylaxis. It emphasizes the need for a thorough work-up, education, and provision of autoinjectable epinephrine in all of these patients.