Most infants experiencing anaphylaxis receive epinephrine, few require hospitalization
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LOUISVILLE, Ky. — More than 80% of a population of infants presenting to the ED with anaphylaxis received epinephrine there or prior to arrival, but only 10% of patients required hospital admission, according to study results.
Also, the results, presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting, showed that food triggered almost all of these cases of anaphylaxis.
“Diagnosing anaphylaxis in infants can be challenging due to a variety of factors,” Juhee Lee, MD, attending physician in the division of allergy and immunology at Children’s Hospital of Philadelphia (CHOP), told Healio. “Symptoms can be nonspecific and may even overlap with normal infant behaviors, and infants are unable to verbalize subjective symptoms. There has been limited research focusing on this age group, however, and our study examined the presentation and treatment of anaphylaxis in infants in our pediatric ED.”
Specifically, symptoms of anaphylaxis may differ among infants and adults, according to Colleen Shannon, MD, MPH, a resident pediatrician at CHOP.
“For example, infants may be more likely to present with gastrointestinal and behavioral symptoms and less likely to present with respiratory or cardiovascular symptoms,” Shannon told Healio. “This raises the possibility that diagnosis may be delayed or missed by providers unfamiliar with the symptomology of anaphylaxis in this age group.”
The researchers conducted a retrospective chart review, identifying 169 patients aged 0 to 24 months (mean age, 1 year; standard deviation, 0.41; 56.2% aged 12 months or younger; 64.5% boys) who presented to the ED of a pediatric tertiary referral center between June 2019 and June 2022 with anaphylaxis.
“The number of infants presenting to our emergency department with anaphylaxis was higher than we had expected,” Shannon said. “While our study was not designed to calculate incidence, it did suggest that infant anaphylaxis was not rare at our hospital. Over the last 3 years, on average, we saw at least one infant per week with anaphylaxis.”
Results showed that food triggered almost all episodes (96.5%), with the most common food triggers being egg (26.6%), peanut (25.4%), milk (13.6%) and cashew (10.1%).
Patients most often presented with skin/mucosal (97.6%), gastrointestinal (74.6%), respiratory (56.8%) and cardiovascular (34.3%) symptoms, with isolated tachycardia representing the most frequent cardiovascular symptom (84.5%).
In total, 146 patients (86.4%) received epinephrine, including 51 (30.1%) who received it prior to arriving at the ED. Only 16 patients (9.5%) required more than one dose of epinephrine.
“We found that reassuringly, the vast majority of infants presenting with anaphylaxis improved with one dose of epinephrine and were able to be discharged from the ED without need for hospitalization,” Lee said.
Clinicians admitted 17 patients (10.1%) to the hospital, but none of these infants required intensive care.
“It’s important that infants, just like older children and adults, need quick and accurate diagnosis to make sure their anaphylaxis is treated appropriately,” Lee said in an ACAAI-issued press release. “Fortunately, most cases of anaphylaxis in infants seem to resolve with a single dose of epinephrine. The vast majority were able to go home from the emergency room without further intervention.”
More research is needed evaluating risk factors associated with more severe cases of infant anaphylaxis and to identify criteria that should prompt admission after presenting to the ED, Lee told Healio.
The researchers also are interested in conducting a prospective study to determine the frequency and quality of behavioral changes seen in infants, Shannon said.
“In this chart review, documentation regarding the presence or absence of behavioral changes tended to be inconsistent,” she said. “Given that behavioral changes are thought to be a common presenting symptom, it would be helpful to learn more.”
Reference:
- Study shows 86.4% of infants with anaphylaxis appropriately received epinephrine. https://annualmeeting.acaai.org/2022/epinephrine.cfm. Published Nov. 10, 2022. Accessed Nov. 10, 2022.