Food-induced Anaphylaxis in Infancy Compared with Preschool Age: A Retrospective Analysis

Girish Vitalpur

doi:10.1542/peds.2020-023861QQ

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G Pouessel, C Jean-Bart, A Deschildre. Clin Exp Allergy. 2020;50(1):74–81

PURPOSE OF THE STUDY:

To characterize food anaphylaxis among infants and compare them to children 1–6 years of age.

STUDY POPULATION:

The Allergy Vigilance Network (AVN) in France is a registry to which French allergists voluntarily contribute data on anaphylaxis. Cases of children under the age of 7years, from 2002–2018, were analyzed.

METHODS:

Children aged 1–6 years were labeled pre-school age. Infants were 12 months or younger. These groups were compared regarding demographics, atopic history, allergic triggers and anaphylactic reactions.

RESULTS:

From 2002 to 2018, 1951 cases of food anaphylaxis were recorded in the AVN. Sixteen percent (n = 316) occurred in children aged 1–6 years, and three percent (n = 59) among infants. The pre-school age children were significantly more likely to be male and to have diagnoses of asthma, allergic rhinitis and previous food allergy. History of atopic dermatitis and prior food reactions did not differ between the two groups. For infants, the most common triggers were cow’s milk (59%), hen’s egg (20%), and wheat (7%). For pre-school age children, the most common causes were peanut (27%), cashew (23%), and egg (6%). The first intake of cow’s milk/ milk-based formula contributed to 46% of cases of infant anaphylaxis. Infants were significantly more likely to have hives (70% vs 54%, P = .016), hypotension (21% vs 5%, P = .004), and hypotonia (15% vs 2%, P = .008) than pre-school children. The older group was more likely to have cough (23% vs 10%, P = .02). Epinephrine autoinjectors were available at the time of reaction for 5% of pre-school children and none of the infants. Rates of epinephrine treatment of these reactions were not significantly different (25% for infants vs 22% for pre-school children, P = .61).

CONCLUSIONS:

Milk was the most common trigger for infant anaphylaxis, which often occurred upon discontinuance of breast-feeding. Infant anaphylaxis can involve a range of symptoms, including hypotonia and hypotension. Infants and pre-school age children were both under-equipped and under-treated with epinephrine.

REVIEWER COMMENTS:

This study was a voluntary self-report by allergists. The data may be underreported, but there could also be a population bias. This is one of the few larger studies on infant anaphylaxis. Further studies are need to assess which infants are at risk for anaphylaxis. This study also shows the need to prepare families with food-allergic children with epinephrine auto-injectors, and to use epinephrine promptly with anaphylactic reactions.