Severe anaphylaxis in children: Definitions, etiology, and preventive approaches

Abstract

Anaphylaxis is a generalized allergic reaction, and its severe course has a potential risk of fatal outcome. The course of each episode of anaphylaxis is the result of a complex interaction between the patient and some internal and external factors (concomitant diseases, profile and level of sensitization, features of allergen exposure, intercurrent infections, etc.). Currently, the clinical and biological features of severe anaphylaxis are not well characterized; however, arterial hypotension and/or loss of consciousness are usually observed in these patients, possibly without typical symptoms from the skin, whereas the outcome of the disease is associated with the possibility of timely emergency medical care. The lack of generally accepted reliable individual prognostic predictors for determining this group of patients is a serious problem. Very little data are available on subfatal/fatal anaphylaxis in pediatric patients, and approaches to it are often based on clinical experience in other age groups. This article presents a systematization of data in the context of severe and subfatal/fatal anaphylaxis in pediatrics to understand the etiology, risk factors, and markers of severe life-threatening allergic reactions in children and the possibilities of their prevention.