Infantile Anaphylaxis in Korea: a Multicenter Retrospective Case Study

Abstract

Background Anaphylaxis is increasing in young children. The aim of the present study was to analyze the clinical characteristics of anaphylaxis in Korean infants, with a focus on food triggers. Methods The study analyzed the medical records of infants aged 0 to 2 years old who had been diagnosed with anaphylaxis in 23 secondary or tertiary hospitals in Korea. Results We identified 363 cases of infantile anaphylaxis (66.9% male). Cutaneous symptoms were most prevalent (98.6%), followed by respiratory (83.2%), gastrointestinal (29.8%), and neurologic (11.6%) symptoms. Cardiovascular symptoms were noted in 7.7% of the cases. Most of the cases of anaphylaxis (338; 93.1%) were induced by foods. The most common trigger food was cow's milk and cow's milk products (43.8%), followed by hen's eggs (21.9%), walnuts (8.3%), wheat (7.7%), peanuts (4.8%), other nuts (3.0%), and fish (2.1%). In cow's milk-induced anaphylaxis cases, more than half the cases had cow's milk specific immunoglobulin E (sIgE) levels that were lower than the diagnostic decision points (DDPs), which is 5 kU A /L for those under the age of 1 and 15 kU A /L for those over the age of 1. In anaphylaxis induced by hen's egg, most of the cases (91.8%) had hen's egg sIgE levels that were higher than the DDP, which is 2 kU A /L for those under the age of 2 and 7 kU A /L for those over the age of 2. Of the infantile anaphylaxis cases, 46.8% had been treated with epinephrine, and 25.1% had been prescribed an epinephrine auto-injector. Conclusion Cow's milk is the most frequent trigger food of anaphylaxis in Korean infants. However, we found no significant correlation between the sIgE level and clinical severity. Education is required regarding the importance of epinephrine as the first line therapy for anaphylaxis and on properly prescribing epinephrine for infants with a history of anaphylaxis.

Can sIgE Levels to Food Allergens Predict Food-induced Anaphylaxis in Infants?

“…However, epinephrine is significantly less likely to be injected in food-induced anaphylaxis than in venom-induced anaphylaxis. In this study of Jeon et al,2 46.8% of the anaphylaxis patients treated with epinephrine injection. Furthermore, only 25.1% of the cases had a prescription of epinephrine auto-injector.…”

“…Instead of DBPCFC, DDP values of sIgE have been used in clinical settings for the diagnosis and monitoring of food-induced anaphylaxis in Korea as well. In this Jeon et al's study,2 the serum sIgE levels to hen's egg using ImmunoCAP were related to the anaphylaxis symptoms to hens' egg; however, those of cow's milk were not. In contrast to a good correlation between hen's egg sIgE and anaphylaxis, sIgE levels to cow's milk did not correlate with anaphylaxis well.…”

“…Further, the food-induced anaphylaxis cases are more common in the younger age group. Jeon et al2 also showed that over 90% of infantile anaphylaxis was triggered by food followed by drug and insect bite. In accordance with previous epidemiologic data,3 cow's milk, hen's egg, nuts and fish are the predominant food triggers in their study.…”

“…In the current issue of Journal of Korean Medical Science , Jeon et al2 and Food Allergy and Atopic Dermatitis Study Group in the Korean Academy of Pediatric Allergy and Respiratory Disease demonstrated clinical characteristics of 363 infants diagnosed with anaphylaxis between 2009 and 2013. The authors demonstrated strikingly increasing prevalence of anaphylaxis in infants, with the number of cases nearly quadrupling during the study period.…”

IgE-Mediated Fish Allergy in Children

“…However, there is significant variability in the prevalence of anaphylaxis caused by fish between different countries. For example, fish was a causative agent in 2.1% of Korean children with anaphylaxis [ 57 ]. Another common presentation of fish allergy is gastrointestinal involvement, with clinical manifestations like nausea, vomiting, and diarrhoea [ 58 ].…”