European Journal of Pediatrics

, Volume 167, Issue 11, pp 1251–1261 | Cite as

Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and therapeutic approach

  • Liliane F. A. De Swert
  • Dominique Bullens
  • Marc Raes
  • Anna-Maria Dermaux
Original Paper

Abstract

Anaphylaxis remains under-diagnosed and under-treated. A better knowledge of patterns and triggers of anaphylaxis might contribute to a better management. In this study we evaluated the demographic and clinical features of anaphylaxis in pediatric patients, as well as its triggers and therapeutic approach. From May 1st 2004 until April 30th 2006 we prospectively collected data on all patients referred for investigation of anaphylaxis to the pediatric department of the University Hospital Gasthuisberg Leuven and to two private pediatric practices. Data were stored in a MYSQL database by use of an online encrypted web form. Sixty-four cases of anaphylaxis occurred in 48 children, aged 6 months to 14.8 years. Twenty-seven episodes (42.2%) occurred at home. The symptoms were dermatologic in 62 (96.9%) episodes, respiratory in 57 (89.1%), gastrointestinal in 19 (29.7%), cardiovascular in 14 (21.8%), and neurological or behavioural in 19 (29.7%). Antihistamines were administered in 41/57 (71.9%) cases, corticosteroids in 26/57 (45.6%), beta-2-mimetics in 14/57 (24.6%), and adrenaline in 11/57 (19.3%). Out of nine cases where Epipen was available at the moment of anaphylaxis, it was administered in one case only. Food was the cause of anaphylaxis in 42/55 (76.4%) cases with identified trigger, while medication, insect stings, latex, and birch pollen triggered 5 (9.1%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) case(s), respectively. Allergy to the trigger was known prior to anaphylaxis in 19/55 (34.5%) cases. In conclusion, anaphylaxis in pediatric patients generally presents with dermatologic and respiratory symptoms, while in 1/5 episodes cardiovascular symptoms occur. Food is by far the most frequent trigger. Allergy to the trigger is known in 1/3 cases only. Anaphylaxis is under-treated, even when appropriate medication is available.

Keywords

Anaphylaxis Children and adolescents Symptoms Food allergy Management 

Abbreviations

SPT

skin prick test

References

  1. 1.
    Bock SA, Munoz-Furlong A, Sampson HA (2001) Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 107:191–193PubMedCrossRefGoogle Scholar
  2. 2.
    Bohlke K, Davis RL, DeStefano F, Marcy SM, Braun MM, Thompson RS (2004) Epidemiology and anaphylaxis among children and adolescents enrolled in a health maintenance organisation. J Allergy Clin Immunol 113:536–542PubMedCrossRefGoogle Scholar
  3. 3.
    Boros CA, Kay D, Gold MS (2000) Parent reported allergy and anaphylaxis in 4173 South Australian children. J Paediatric Child Health 36:36–40CrossRefGoogle Scholar
  4. 4.
    Ceuppens JL (2005) Anafylaxie en veralgemeende vormen van acute allergische reacties: een overzicht. Tijdschr voor Geneeskunde 61:1142–1149CrossRefGoogle Scholar
  5. 5.
    De Swert LF (2005) Anafylaxie bij kinderen. Tijdschr voor Geneeskunde 61:1150–1154CrossRefGoogle Scholar
  6. 6.
    Dibs SD, Baker MD (1997) Anaphylaxis in children: a 5-year experience. Pediatrics 99(1):E7Google Scholar
  7. 7.
    Dreborg S, Foucard T (1983) Allergy to apple, carrot and potato in children with birch pollen allergy. Allergy 38:167–172PubMedCrossRefGoogle Scholar
  8. 8.
    Ellis AK, Day JH (2007) Incidence and characteristics of biphasic anaphylaxis: a prospective evaluation of 103 patients. Ann Allergy Asthma Immunol 98:64–69PubMedGoogle Scholar
  9. 9.
    Gupta R, Sheikh A, Strachan P, Anderson HR (2004) Burden of allergic disease in the UK: secondary analyses of national databases. Clin Exp Allergy 34:520–526PubMedCrossRefGoogle Scholar
  10. 10.
    Hebling A, Hurni T, Mueller UR, Pichler WJ (2004) Incidence of anaphylaxis with circulatory symptoms: a study over a 3-year period comprising 940,000 inhabitants of the Swiss Canton Bern. Clin Exp Allergy 34:285–290CrossRefGoogle Scholar
  11. 11.
    Kochuyt AM, Van Hoeyveld EM, Stevens EA (2005) Prevalence and clinical relevance of specific immunoglobulin E to pollen caused by sting-induced specific immunoglobulin E to cross-reacting carbohydrate determinants in Hymenoptera venoms. Clin Exp Allergy 35:441–447PubMedCrossRefGoogle Scholar
  12. 12.
    Krugman SD, Chiaramonte DR, Matsui EC (2006) Diagnosis and management of food-induced anaphylaxis: a national survey of pediatricians. Pediatrics 118:e554–e560PubMedCrossRefGoogle Scholar
  13. 13.
    Lee JM, Greenes DS (2000) Biphasic anaphylactic reactions in pediatrics. Pediatrics 106:762–766PubMedCrossRefGoogle Scholar
  14. 14.
    Lieberman P (2005) Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol 95:217–226PubMedGoogle Scholar
  15. 15.
    Lieberman P, Camargo CA, Bohlke K, Jick H, Miller RL, Sheikh A, Simons FE (2006) Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of anaphylaxis working group. Ann Allergy Asthma Immunol 97:596–602PubMedGoogle Scholar
  16. 16.
    Lieberman P, Decker W, Camargo CA, O’Connor R, Oppenheimer J, Simons FE (2007) SAFE: a multidisciplinary approach to anaphylaxis education in the emergency department. Ann Allergy Asthma Immunol 98:519–523PubMedCrossRefGoogle Scholar
  17. 17.
    Mehl A, Wahn U, Niggeman B (2005) Anaphylactic reactions in children—a questionnaire-based survey in Germany. Allergy 60:1440–1445PubMedCrossRefGoogle Scholar
  18. 18.
    Mullins RJ (2003) Anaphylaxis: risk factors for recurrence. Clin Exp Allergy 33:1033–1040PubMedCrossRefGoogle Scholar
  19. 19.
    Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, Moneret-Vautrin M, Niggeman B, Rancé F; EAACI task force on anaphylaxis in children (2007) The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy 62:857–871PubMedCrossRefGoogle Scholar
  20. 20.
    Muraro MA (2001) Diagnosis of food allergy: the oral provocation test. Pediatr Allergy Immunol 12(suppl 14):31–36PubMedCrossRefGoogle Scholar
  21. 21.
    Novembre E, Cianferoni A, Bernardini R, Mugnaini L, Caffarelli C, Cavagni G, Giovane A, Vierucci A (1998) Anaphylaxis in children: clinical and allergologic features. Pediatrics Apr 101(4):E8CrossRefGoogle Scholar
  22. 22.
    Osterballe O, Weeke B (1979) A new lancet for skin prick testing. Acta Paediatrica Scandinavica 34:209–212Google Scholar
  23. 23.
    Pichler WJ (2007) Drug hypersensitivity reactions: classification and relationship to T-cell activation. In: Pichler WJ (ed) Drug hypersensitivity. Karger, Basel pp169–189Google Scholar
  24. 24.
    Pumphrey R (2004) Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol 4:285–290PubMedCrossRefGoogle Scholar
  25. 25.
    Sampson HA (2004) Update on food allergy. J Allergy Clin Immunol 113:805–819PubMedCrossRefGoogle Scholar
  26. 26.
    Sampson HA, Mendelson L, Rosen JP (1992) Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Eng J Med 327:380–384CrossRefGoogle Scholar
  27. 27.
    Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson F Jr, Bock A, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O’Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW (2006) Second symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol 117:391–397PubMedCrossRefGoogle Scholar
  28. 28.
    Simons FE (2006) Anaphylaxis, killer allergy: long-term management in the community. J Allergy Clin Immunol 367–377Google Scholar
  29. 29.
    Simons FE, Frew AJ, Ansotegui IJ, Bochner BS, Golden DB, Finkelman FD, Leung DY, Lotvall J, Marone G, Metcalfe DD, Müller U, Rosenwasser LJ, Sampson HA, Schwartz LB, van Hage M, Walls AF (2007) Risk assessment in anaphylaxis: current and future approaches. J Allergy Clin Immunol 120:S2–S24PubMedCrossRefGoogle Scholar
  30. 30.
    Taylor SL, Hefle SL (2006) Food allergen labelling in the USA and Europe. Curr Opin Allergy Clin Immunol 6:186–190PubMedCrossRefGoogle Scholar
  31. 31.
    Wood RA (2003) The natural history of food allergy. Pediatrics 111:1631–1633PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Liliane F. A. De Swert
    • 1
    • 2
    • 4
  • Dominique Bullens
    • 1
  • Marc Raes
    • 1
    • 3
  • Anna-Maria Dermaux
    • 2
  1. 1.Pediatric Allergy, Department of PediatricsUniversity Hospital Gasthuisberg, Katholieke Universiteit LeuvenLeuvenBelgium
  2. 2.Pediatric Practice for Allergy and AsthmaMechelenBelgium
  3. 3.Pediatric PracticeHasseltBelgium
  4. 4.Department of PediatricsUniversity Hospital GasthuisbergLeuvenBelgium

Personalised recommendations