Anaphylaxis admissions in pediatric intensive care units: Follow‐up and risk of recurrence

Abstract

Background Data about the risk of anaphylaxis recurrence in children are lacking. We assessed anaphylaxis recurrence and medical follow‐up in a cohort of children previously hospitalized in a French pediatric intensive care unit (PICU) for anaphylaxis. Methods We conducted a telephone survey of 166 children (≤18 years) hospitalized from 2003 to 2013. Results In all, 106 (64%) completed the survey (boys, 59%; mean age [SD]: 15.3 years [5.5]). The main index triggers were drugs (45%) and foods (37%). The mean duration follow‐up was of 7.7 years (SD: 2.4). Thirty‐eight (36%) children experienced 399 new allergic reactions during a follow‐up period of 282 patient‐years (incidence rate: 1.4/100 patients/y; 95% CI: 0.64‐2.04). Twelve children experienced 19 anaphylaxis reactions including five requiring PICU admission (anaphylaxis recurrence rate: 0.20/100 patients/y; 95% CI non‐calculable). Food was the trigger for 79% of recurrent reactions and drugs for 8%. The food trigger was previously known in 83%, the same as the index trigger in 69%. Overall, 1.5% of the recurrent reactions were treated with adrenaline injection and 8% an emergency hospital admission. Patients with recurrence had more likely a history of food allergy (P < 10−4), asthma (P < 0.005), atopic dermatitis (P < 0.05) than those without. 31% of the 50 children with food allergy did not see an allergist, 23% had no adrenaline auto‐injector, and 26% lacked a school individual healthcare plan. Conclusions Following a PICU admission for anaphylaxis, recurrence is high in children with food allergy compared with drug allergy. Allergic comorbidities increase the risk. Medical follow‐up has to be improved for these at‐risk children.

Intervention in anaphylaxis: the experience of one paediatric centre based on NORA reports

“…since we worked at the tertiary reference centre for diagnostics and immunotherapy for children with allergy to insect venom. However, the majority of the paediatric data including the prospective ones, indicated food as the most common factor triggering anaphylaxis in children [1,3,[14][15][16][17][18]. Nevertheless, the allergy profile in different age groups of our patients corresponded well with the rest of the registry; food allergy was predominant in the preschool group, insect venom was more prevalent in school children.…”

Anaphylaxis in children and adolescents: The Portuguese Anaphylaxis Registry

“…The prescription of AAI also fell short of expectations. AAI underprescription by physicians for immediate anaphylaxis management is well known worldwide, 2,27‐29 as well as AAI underuse by patients and caregivers 8,11,27,28 . AAI should be prescribed, and training on its use should be provided 1,2,7,16,17 to patients and caregivers.…”

Reaction phenotypes in IgE-mediated food allergy and anaphylaxis

“…27 Pouessel et al 28 followed up 39 children admitted to the intensive care unit (ICU) for foodrelated anaphylaxis. 28 Of these patients, 30 (77%) experienced at least 1 further food-related reaction during the follow-up period, 27 of them to the same allergen as the reaction that required the ICU admission. At least 10 children (26%) experienced anaphylaxis, and half required a further ICU admission for management.…”