Infant anaphylaxis: Diagnostic and treatment challenges

Development and Evaluation of Modified Criteria for Infant and Toddler Anaphylaxis

BACKGROUND

Current clinical criteria for identifying anaphylaxis do not account for unique aspects of infant anaphylaxis presentation and have not been validated in patients younger than 2 years of age. This may contribute to under recognition and is thus an unmet need.

OBJECTIVE

To demonstrate age-specific signs and symptoms that more accurately identify anaphylaxis in young children and to develop and compare modified criteria for "likely anaphylaxis" against the widely used 2006 National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria.

METHODS

Retrospective chart review of 337 clinical encounters presenting with suspected allergic or anaphylactic reactions to a pediatric emergency department. Modified criteria for likely anaphylaxis were developed and evaluated against the NIAID/FAAN criteria.

RESULTS

The study population included 33% infants (age < 12 mo), 39% toddlers (age 12 mo to < 36 mo), and 29% children (age ≥ 36 mo). The NIAID/FAAN criteria captured 85% of all patient encounters in the study and the modified criteria captured 98% (P < .001). Compared with NIAID/FAAN criteria, modified criteria had 22.8% improved performance among infants (p < .001) and 10.3% improved performance among toddlers (P = .04).

CONCLUSIONS

We developed modified anaphylaxis clinical criteria that incorporated symptoms specific to infants and young children. The modified criteria increased identification of anaphylaxis in infants and potentially toddlers. Future research is needed to validate our findings on a larger cohort.

Incidence, triggering factors, symptoms, and treatment of anaphylaxis in a pediatric hospital

Objective

Assess the incidence of anaphylaxis in the emergency room (ER) of a private pediatric hospital in the city of São Paulo, Brazil, and describe associated factors.

Method

This was a cross-sectional, retrospective, and observational study based on the medical records of patients from 0 to 18 years old seen at the emergency unit during the years of 2016–2019, who had a diagnosis potentially related to anaphylaxis according to ICD-10. All medical records were individually reviewed for the presence of compatible signs and symptoms that identified “possible” cases of anaphylaxis. Cases were considered probable anaphylaxis when medical history was compatible and indicative of anaphylaxis in the opinion of at least 2 allergists.

Results

The incidence of anaphylaxis was 0.013%. Among the 56 patients identified (mean age 4.2 years), food was the most predominant suspected factor (53%), followed by unknown factors (32%), and drugs (12.5%). All patients presented with cutaneous symptoms, 74% with respiratory, and 53% with gastrointestinal. Allergic disease as a comorbidity was found in 39% of the children and 11% had a history of previous anaphylaxis. There were neither cases of syncope or shock, nor deaths. Intramuscular (IM) adrenaline was prescribed in 37.5% of cases.

Conclusions

The incidence of anaphylaxis was low when compared to the worldwide incidence. The severity of most cases was mild, cutaneous symptoms were predominant, and food was the suspected trigger most frequently associated with reactions.