Anaphylaxis in children: Effect of age and atopic status

Nutthakit Wong-onta,¹ Adithep Sawatchai,¹ Watcharoot Kanchongkittiphon,¹ Wiparat Manuyakorn¹

Affiliation:
¹ Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Abstract

Background: Anaphylaxis is a life-threatening allergic reaction with rising incidence worldwide. Young children’s limited ability to express symptoms adds unique diagnostic challenges.
Objective: To study on anaphylaxis in children, including triggers, symptoms, treatment, atopic status impact, and adrenaline injection time intervals.
Methods: In-patient medical records of children who were diagnosed with anaphylaxis during 2014-2021 were reviewed.
Results: One hundred thirty-three anaphylaxis events were identified. Food (47%) was the most common trigger, followed by drugs (31%), blood components (17%), insects (3%), and idiopathic causes (2%). Ten cases of refractory anaphylaxis, 2 cases of biphasic reactions, and 1 case of persistent anaphylaxis were found. There were no reported fatalities. The most common presentations involved the skin (94%), followed by the respiratory (73%), gastrointestinal (47%), and cardiovascular (42%) systems. In atopic patients, wheezing was more prominent than in those without atopy (p-value = 0.017). In the non-atopic patients, there was a higher incidence of cardiovascular symptoms, particularly hypotension (p-value = 0.001), compared to individuals with atopy. Children under 5 years old with mild-moderate anaphylaxis required more time to reach the hospital (147.0 vs. 45.0 minutes, p = 0.033) and to receive adrenaline injections (35.0 vs. 9.0 minutes, p-value = 0.017) than those with severe anaphylaxis.
Conclusion: Childhood anaphylaxis is prevalent. Children with mild-moderate anaphylaxis experienced delays in hospital visits and adrenaline administration. Education on allergies is needed to improve the identification and prompt response to anaphylactic reactions, especially in young children.
Key words: anaphylaxis, young, children, atopy, adrenaline