One-year survey of paediatric anaphylaxis in an allergy department

Â. Gaspar, N. Santos, S. Piedade, C. Santa-Marta, G. Pires, G. Sampaio, C. Arêde, L.M. Borrego, M. Morais-Almeida

Aim. To determine the frequency of anaphylaxis in an allergy outpatient department, allowing
a better understanding regarding aetiology, clinical manifestations and management, in children and adolescents. Methods. From among 3646 patients up to 18 years old observed during one-year period, we included those with history of anaphylaxis reported by allergists.
Results. Sixty-four children had history of anaphylaxis (prevalence of 1.8%), with mean age 8.1 ± 5.5 years, 61% being male. Median age of the first anaphylactic episode was 3 years (1 month - 17 years). The majority of patients had food-induced anaphylaxis (84%): milk 22, egg 7, peanut 6, tree nuts 6, fresh fruits 6, crustaceans 4, fish 4 and wheat 2. Food-associated exercise-induced anaphylaxis was reported in 2 adolescents. Drug-induced anaphylaxis occurred in 8%: 4 non-steroidal anti-inflammatory drugs and 1 amoxicillin. Three children had cold-induced anaphylaxis, one adolescent had anaphylaxis to latex and one child had anaphylaxis to insect sting. The majority (73%) had no previous diagnosis of the etiologic factor.
Symptoms reported were mainly mucocutaneous (94%) and respiratory (84%), followed by gastrointestinal (42%) and cardiovascular (25%). Fifty-one patients were admitted to the
emergency department, although only 33% were treated with epinephrine. Recurrence of anaphylaxis
occurred in 26 patients (3 or more episodes in 14). Conclusions. In our paediatric population, the main triggering agent of anaphylaxis was IgE-mediated food allergy. Epinephrine is underused, as reported by others. Often, children have several episodes before being assessed by an allergist. We stress the importance of systematic notification and improvement of educational programmes in order to achieve a better preventive and therapeutic management of this life-threatening entity.
FULL TEXT