Pediatric Emergency Department Anaphylaxis: Different Patterns From Adults

Abstract

Braganza SC, Acworth JP, Mckinnon DR, Peake JE, Brown AF. Arch Dis Child. 2006;91:159–163 PURPOSE OF THE STUDY. Data on acute pediatric anaphylaxis presentations to the emergency department (ED) are limited. STUDY POPULATION. Patients under 16 years of age who presented to a metropolitan, pediatric teaching hospital ED in Australia over a 3-year period with generalized allergic reactions (skin and/or gastrointestinal symptoms) and anaphylaxis (respiratory, cardiovascular, or hypotensive symptoms) that satisfied relevant International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. METHODS. Medical charts were reviewed for incidence, comorbidities, likely etiology, clinical features, management, and disposal. RESULTS. There were 526 children with generalized allergic reactions (9.3 per 1000 ED presentations) and 57 with anaphylaxis (1 per 1000 ED presentations) included. There were no fatalities. For anaphylaxis cases, a cause was recognized in 68% (food: 56% of total; drug: 5%; sting: 5%; other: 2%), cutaneous features were present in 83%, a past history of asthma was reported in 37%, adrenaline was used in 39%, and follow-up was arranged for 81% (only 28% with an allergy clinic). CONCLUSIONS. The incidence of generalized allergic reactions of 9.3 in 1000 was greater than in the adults. REVIEWER COMMENTS. Food, drug, and stinging-insect reactions are the primary causes of anaphylaxis in children (as in adults). Although skin symptoms are present in the majority, the lack of such symptoms should not exclude the diagnosis. All children who suffer an anaphylactic event deserve a consult to an allergist who can confirm the diagnosis, determine or confirm the cause, and instruct the patient on avoidance measures, emergency treatment for subsequent events should they occur, and provide a prognosis regarding possible resolution.