Description of two anaphylaxis phenotypes in children: The utility of a clustering analysis approach

Pouessel, G.; Dubus, J.-C.; Lejeune, Stéphanie; Behal, Hélène; Noël, Guilhem; Beaudouin, É.; Deschildre, A.; Corriger, J.

doi:10.1111/all.14328

Cited by 6 publications

(9 citation statements)

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“…The impact of multiple food allergy/sensitization is also reported as a risk factor for severe anaphylaxis. 8 In 696 patients diagnosed with peanut sensitization in the Mirabel study, allergic multi-morbidity (asthma with atopic dermatitis and/or multiple food allergy) was associated with the severity of peanut-induced allergic reactions. 9 We previously found that allergic comorbidities increase the risk of anaphylaxis recurrence in a cohort of 166 children previously hospitalized for anaphylaxis in pediatric intensive care units.…”

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confidence: 99%

Recurrent food anaphylaxis and risk factors in children

Pouessel

Balerdi

Lejeune

et al. 2021

Pediatric Allergy Immunology

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Recurrent food anaphylaxis and risk factors in childrenTo The Editor, Data about anaphylaxis recurrence and medical follow-up after an anaphylaxis reaction are scarce. Identifying the phenotype of the patients who are the most at risk of anaphylaxis recurrences remains challenging.The aim of the study was to determine the incidence of food anaphylaxis recurrence in a cohort of children previously admitted to emergency care units (ECU) for food anaphylaxis and to determine the characteristics of these at-risk children, that is, with anaphylaxis recurrences.All children (<16 years) admitted for food anaphylaxis to one of the 18 pediatric ECU in the Nord-Pas-de-Calais region of France were prospectively included (2015)(2016)(2017). Anaphylaxis was defined according to the National Institute of Allergy and Infectious Diseases/FA and Anaphylaxis Network Symposium. 1 The cohort characteristics and the index anaphylaxis reactions have been previously reported. 2 In this second part, we conducted a telephone survey in families of these children to assess their allergy follow-up using a standardized questionnaire. The 5-grade Astier score was used to assess the anaphylaxis severity. 3 Methods and statistical analysis are described in Appendix S1.

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confidence: 99%

Recurrent food anaphylaxis and risk factors in children

Pouessel

Balerdi

Lejeune

et al. 2021

Pediatric Allergy Immunology

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“…23 But, in French study CMA and HEA constituted only 8% and 7%, of the sample, respectively. 23 Blazowski et al in food systemic allergic reactions, identified two clusters -skin/non-severe respiratory phenotype (81%) and severe respiratory/cardiovascular phenotype, but the study populations are not well comparable, as these authors graded severity by means of the 3-stage scale by Muraro. 24 All these mirror an attempts to characterize more precisely paediatric study population managed due to anaphylaxis.…”

Section: Clinical Phenotypementioning

confidence: 81%

“…23 The first one, with severe anaphylaxis (R&M grade III-IV), mainly due to nut allergy, and multiple atopic comorbidities, and the second one, described as mild anaphylaxis with various triggers and few atopic comorbidities. 23 But, in French study CMA and HEA constituted only 8% and 7%, of the sample, respectively. 23 Blazowski et al in food systemic allergic reactions, identified two clusters -skin/non-severe respiratory phenotype (81%) and severe respiratory/cardiovascular phenotype, but the study populations are not well comparable, as these authors graded severity by means of the 3-stage scale by Muraro.…”

Section: Clinical Phenotypementioning

confidence: 99%

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Cichocka‐Jarosz

Dölle‐Bierke

Jedynak-Wąsowicz

et al. 2023

Clinical & Translational All

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Background Cow's milk (CM) and hen's egg (HE) are leading triggers of anaphylaxis in early childhood. The aim of this study was to identify clinical phenotypes and therapeutic measures for CM anaphylaxis (CMA) compared to HE anaphylaxis (HEA) in children up to 12 years of age, based on a large pan‐European dataset from the European Anaphylaxis Registry. Methods Data from 2007 to 2020 on clinical phenotypes and treatment from 10 European countries, as well as Brazil, were analysed. The two‐step cluster analysis was used to identify the most frequent phenotypes. For each trigger, three clusters were extracted based on sex, age, and existence of symptoms in four vitally important systems. Results Altogether 284 children with CMA and 200 children with HEA were identified. They were characterised as male (69% vs. 64%), infants (65% vs. 61%), with a most frequent grade III of Ring&Messmer classification (62% vs. 64%), in CMA versus HEA, respectively. Respiratory symptoms occurred more often in CMA (91% vs. 83%, p = 0.010), especially in infants (89% vs. 79%, p = 0.008). Cardiovascular symptoms were less frequent in CMA (30% vs. 44%, p = 0.002), in both infants (33% vs. 46%, p = 0.027), and older children (25% vs. 42%, p = 0.021). The clusters extracted in the CMA group were characterised as: (1) mild dermal infants with severe GI (40%), 2. severe dermal (35%), 3. respiratory (25%). While in HEA group: 1. infants with severe GI and/or reduction of alertness (40%), (2) conjunctival (16%), (3) mild GI without conjunctivitis (44%). The severity of the reaction was independent from the amount of ingested allergen protein, regardless of trigger. The first‐line adrenaline application differed between the countries (0%–92%, as well as the reasons for not administering adrenaline, p < 0.001). Conclusions Despite the similarity of their age, sex, and severity grade, the clinical profiles differed between the CMA and HEA children. Adrenaline was underused, and its administration was country dependent. Further studies are needed to assess to what extent the differences in the clinical profiles are related to matrix and/or absorption effects, and/or the allergen itself.

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“…Several anaphylaxis phenotypes have been described so far, but only depending on the time of onset (monophasic, biphasic anaphylaxis), on the allergen that triggered the reaction or on the severity of the reaction (13,14) . However, food-induced anaphylaxis is extremely heterogenous, resulting in a clinical picture which differs significantly not only between episodes in the same patient, but even in the case of the same trigger.…”

Section: Anaphylaxis Phenotypesmentioning

confidence: 99%

“…The evaluation of the immunoglobulin E (IgE) specific antibodies in relation to allergenic molecules (the proper allergens) in the main allergen source allowed for the differentiation of particular allergens in terms of the risk of developing severe anaphylaxis (11) . In addition, CRD has contributed to the definition of new FIA phenotypes and endotypes, according to the assumptions of precision medicine, focused on an individual patient (11)(12)(13)(14)(15) . Food-induced anaphylaxis is the leading cause of death due to an acute allergic reaction in children (16) .…”

Section: Introductionmentioning

confidence: 99%

Food-induced anaphylaxis in children – state of art

Błażowski¹,

Kurzawa²,

Majak³

2021

Pediatr Med Rodz

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Food-induced anaphylaxis is the most frequent type of anaphylaxis and the most common cause of fatal acute hypersensitivity reactions in children. It typically occurs after accidental food exposure, after inhalation of food allergen, cutaneous contact and controlled oral food challenge. There is no consensus on a universal clinical definition of anaphylaxis or a uniform symptoms severity score. Recent advances in molecular allergology allow, in many cases, the detailed identification of the allergenic molecule responsible for anaphylaxis. Along with the development of precision medicine, new phenotypes and endotypes of anaphylaxis are being defined. The anaphylaxis course is entirely unpredictable, and even initially mild symptoms may herald a potentially fatal reaction. At the same time, a significant proportion of immediate food hypersensitivity episodes are mild and known as systemic allergic reactions. The occurrence and severity of clinical course of food-induced anaphylaxis are influenced by factors related directly to the child, coexisting diseases, the type and the nature of the allergen, or the presence of cofactors. The unpredictable course of anaphylaxis justifies immediate treatment based on rapid intramuscular administration of adrenaline, regardless of severity. Delayed adrenaline administration is associated with higher incidence of severe course and death. Appropriate and prompt treatment of anaphylaxis is even more critical during the COVID-19 pandemic due to difficult access to medical facilities, hence current treatment plans for food-induced anaphylaxis emphasise the need to administer adrenaline immediately after the onset of the first, even mild, but rapidly progressive symptoms and recommend that the patient have at least two adrenaline autoinjectors.

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Description of two anaphylaxis phenotypes in children: The utility of a clustering analysis approach

Abstract: Early childhood IgE reactivity to pathogenesis-related class 10 proteins predicts allergic rhinitis in adolescence.

Cited by 6 publications

References 11 publications

Recurrent food anaphylaxis and risk factors in children

Recurrent food anaphylaxis and risk factors in children

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Food-induced anaphylaxis in children – state of art

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