Researchers describe epidemiology, etiology of anaphylaxis in children
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Most episodes of anaphylaxis presenting in a pediatric ED occurred in those without a prior history, with severity increasing with age, according to results of a retrospective chart review.
“ED visits for anaphylaxis have risen significantly in the last 20 years,” Jeremy Owens, MD, resident at Eastern Virginia Medical School and Children’s Hospital of The King’s Daughters in Norfolk, Virginia, and colleagues wrote. “Knowledge of predisposing factors can lead to risk reduction, earlier identification and improved care.”
Owens and colleagues analyzed the 1,023 charts of 229 children (mean age, 6.6 years; 56% male; 51% white; 45% Black) seen at their ED from 2010 to 2020 with ICD-9 and ID-10 codes for anaphylaxis and allergic reactions that met NIH criteria.
Results, presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting, showed children aged 2 years or younger had the highest proportion of anaphylactic episodes, at 30.6%, compared with 19% of cases occurring among those aged 3 to 5 years, 23.6% among those aged 6 to 10 years, 19.5% among those aged 11 to 15 years and 7.3% among those aged older than 15 years.
However, severity scores were significantly higher among children aged 6 to 15 years compared with children aged younger than 1 year (P = .006). Episodes were mild (grade 2 or 3) in 93% of cases, with no significant differences by sex or race.
There was no history of anaphylaxis in 90% of the study population, “suggesting anaphylaxis occurs in younger children and is more challenging to predict,” Owens and associates wrote.
Forty-eight percent of the population had a previous allergy diagnosis, with 18% allergic to peanuts, 15% to tree nuts, 18% to milk, 13% to egg and 6% to penicillin.
Food-induced anaphylaxis comprised 64% of cases (25% peanuts; 21% tree nuts), whereas drug-induced comprised 12% cases, insect stings caused 1% and 19% had an unknown cause. Children aged older than 15 years had a higher association with anaphylaxis caused by drugs.