Food-induced anaphylaxis in early childhood and factors associated with its severity

Allergy Asthma Proc. 2021 Sep 1;42(5):e135-e144. doi: 10.2500/aap.2021.42.210051.

Abstract

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.

MeSH terms

  • Allergens
  • Anaphylaxis* / diagnosis
  • Anaphylaxis* / epidemiology
  • Anaphylaxis* / etiology
  • Angioedema*
  • Animals
  • Cattle
  • Egg Hypersensitivity
  • Female
  • Food Hypersensitivity* / complications
  • Food Hypersensitivity* / diagnosis
  • Food Hypersensitivity* / epidemiology
  • Hoarseness
  • Humans
  • Hypotension*
  • Infant
  • Male
  • Milk Hypersensitivity* / complications
  • Milk Hypersensitivity* / diagnosis
  • Milk Hypersensitivity* / epidemiology
  • Nut Hypersensitivity
  • Syncope
  • Turkey

Substances

  • Allergens