Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Abstract

Background: The study objective was to compare age-related differences in the cause and clinical presentation of anaphylaxis. Methods: We conducted a prospective study of patients visiting the emergency department for anaphylaxis. Data were collected from 3 emergency departments from 1 April 2014 to 31 December 2015. Patient electronic records with the diagnoses of allergy, angioedema, urticaria, and anaphylaxis (ICD-9 codes 9953, 9951, 7080, 9950, 7089) were screened and cases fulfilling World Allergy Organisation criteria for anaphylaxis were included. Results: A total of 426 cases of anaphylaxis were identified with a median age of 23 years (range 3 months to 88 years and 9 months). The causes of anaphylaxis were food (n = 236, 55%), drugs (n = 85, 20%), idiopathic (n = 64, 15%), and insect bites or stings (n = 28, 7%). The most common food was shellfish (n = 58, 14%) and the most common drugs were non-steroidal anti-inflammatory drugs (n = 26, 6%). There were more cases of food anaphylaxis in children than in adults (72 vs. 42%, p < 0.001) and more cases of drug anaphylaxis in adults than in children (28 vs. 10%, p < 0.001). Compared to patients of other ages, infants and young children had more gastrointestinal symptoms (adjusted odds ratio [aOR] 2.1, 95% CI 1.1-3.9), while schoolchildren and adolescents had more respiratory symptoms (aOR 2.7, 95% CI 1.4-5.2). Adults had more cardiovascular symptoms (aOR 2.9, 95% CI 1.8-4.6) and hypotension (aOR 3.7, 95% CI 2.1-6.8) compared to children. However, 42% of the infants lacked blood pressure measurements. Conclusions: Knowledge of age-related variation in the cause and clinical presentation of anaphylaxis aids in diagnosis and acute management.

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

“…In addition, an accurate diagnosis of anaphylaxis in children can prove challenging. This is partially due to the inability of children to accurately describe their symptoms, the lack of cutaneous symptoms in up to 40% of drug‐induced cases, the lack of tryptase measurement in most cases, and difficulties in accurately evaluating blood pressure, especially in infants . A recent work on pediatric anaphylaxis presenting at an ED showed that almost 50% of the diagnosis are actually missed .…”

“…This is partially due to the inability of children to accurately describe their symptoms, the lack of cutaneous symptoms in up to 40% of drug-induced cases, the lack of tryptase measurement in most cases, and difficulties in accurately evaluating blood pressure, especially in infants. [8][9][10][11][12] A recent work on pediatric anaphylaxis presenting at an ED showed that almost 50% of the diagnosis are actually missed. 13 Thus, reports on general anaphylaxis incidence in pediatric ages have a wide variation in number from 10.5 to 70 episodes per 100 000 person-years.…”

Anaphylaxis – Lessons learnt when East meets West

“…Studies with data on anaphylaxis treatment modalities and the prevalence of biphasic anaphylaxis among the studies with available data are summarized in Table S2 3,6,8,10,12,13,23,24,31,33,36,39,41,54 and Table S3, 3,6,8,10,12,13,23,30,31,33,52,55,56 respectively. Few studies were able to identify predictors of biphasic anaphylaxis.…”

“…In-hospital adrenaline (epinephrine) use for the treatment of anaphylaxis was generally low across most studies, except for Canada and Singapore. 8,24,55 Several studies also highlighted a preponderance of inappropriate adrenaline dosing, such as subcutaneous, inhalational, and intravenous routes of administration (bolus and infusion) instead of the gold-standard intramuscular route advocated in anaphylaxis treatment guidelines. 3,6,8,33 There were high rates of steroid and antihistamine administration, which exceeded the usage of adrenaline in almost all the studies.…”

Recent Advances in Clinical Allergy and Immunology

“…Food allergy occurred more often in children, while drug anaphylaxis was more common in adults. There was an age-dependent shift of clinical presentations with gastrointestinal symptoms in infants and young children, respiratory symptoms in schoolchildren and adolescents, and cardiovascular symptoms in adults [97]. A cross-sectional study revealed symptoms of sting reactions in 13% of the overall population, of which half had systemic reactions.…”