Paediatric emergency department anaphylaxis: different patterns from adults

Abstract

Background and Aims: Data on acute paediatric anaphylaxis presentations to the emergency department (ED) are limited. All allergic presentations to one Australian paediatric ED were studied to determine epidemiological, clinical, and outcome data. Methods: Retrospective, case based study of patients under 16 years attending one metropolitan, paediatric teaching hospital ED in Australia over three years. The medical records of patients presenting with generalised allergic reactions and anaphylaxis satisfying relevant ICD-9-CM diagnostic codes were studied. The incidence, age, sex ratio, co-morbidities, likely aetiology, clinical features, management, and disposal were determined. Results: A total of 526 children with generalised allergic reactions, and 57 with anaphylaxis were included in the study. This represented incidences of 9.3:1000 ED presentations for generalised allergic reactions and 1:1000 for anaphylaxis. There were no fatalities. In anaphylaxis cases, a cause was recognised in 68.4%. Cutaneous features were present in 82.5%. A past history of asthma was reported in 36.8%. Adrenaline was used in 39.3% of severe anaphylaxis cases. The ED alone definitively cared for 97.8% of all patients. Follow up was inadequate in cases of anaphylaxis. Conclusions: This is the first reported incidence figure for paediatric anaphylaxis ED presentations in Australia, and is less than that reported in adults in the same local population. However, the incidence of generalised allergic reactions of 9.3:1000 was greater than in the adults. Virtually all paediatric allergic cases may be managed in the ED alone, provided that the importance of specialist follow up, particularly for severe anaphylaxis, is recognised.

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

“…Concerning presenting symptoms of anaphylaxis, cardiovascular symptoms are more frequent in adults compared to children, who report more gastrointestinal symptoms than adults, while muco-cutaneous involvement is as frequently reported in children as in adults. Other studies report that cardiovascular symptoms, such as hypotension and shock, are less common as manifestations of anaphylaxis in childhood [25,26]. An important finding of our study is the high prevalence of respiratory allergic disease, rhinitis and asthma due to pollen, mites and pet dander (see Table 2).…”

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

“…However, cutaneous symptoms might be absent in up to 20% of anaphylactic reactions in children with food allergy or insect sting allergy. [11][12][13] Consequently, in patients with a known allergic history and possible exposure, criterion 2 would provide ample evidence that an anaphylactic reaction was occurring. Gastrointestinal symptoms were included as a pertinent target response because they have been associated with severe outcomes in various anaphylactic reactions.…”

Anaphylactic Shock due to Mushroom Soup

“…Skin lesions are observed in 90% of patients with anaphylaxis. Severe anaphylaxis can quickly develop into a life-threatening situation without skin findings (3,4). Skin lesions were evident in our case, which was considered to be severe anaphylaxis.…”