Is the clinical manifestation of anaphylaxis in children influenced by the trigger of reaction?

Abstract

Introduction: The number of anaphylaxis diagnoses in children is rising, being still based on the clinical picture.

Aim: To determine whether triggers of anaphylaxis influence its clinical characteristics in children and adolescents.

Material and methods: The study group included 114 children (5 months-17 years, mean age: 8.0 ±4.8 years), (66%: boys) with the episode of anaphylaxis up to 1 year back. Medical data were entered to the NORA Registry by means of a validated structured on-line questionnaire.

Results: Three most frequent triggers of anaphylaxis were: insect venom (47.4%), food (35.1%), drugs (5.3%), with a predominance of food (egg white, cow's milk, nuts and peanuts) in the 0-6 years age group, while insect venom (bee predominance) in the 7-17 years age group (p = 0.016). Clinical manifestations differed between food vs. venom allergic reactions and presented as gastro-intestinal (GI) (61.4%) (p = 0.004), respiratory (RS) (93.9%) (p = 0.036), and cardiovascular (CVS) (74.6%) (p = 0.022) symptoms. Among objective symptoms, vomiting was the most common symptom in the 0-2 years age group (47.1%) (p = 0.006), while hypotension in those aged 7-12 years (40%) (p = 0.010). Severity of symptoms evaluated as Mueller's grade (IV - 74.5%) and as Ring and Messmer's grade (III - 65.8%), depended on the trigger (p = 0.028, p = 0.029, respectively). Life-threatening symptoms occurred in 26 children (fall of the blood pressure - 22%, loss of consciousness - 4.4%).

Conclusions: The clinical manifestation of anaphylaxis in children is both trigger and age dependent, irrespective of the gender. A typical patient with food anaphylaxis was younger, presenting predominantly GI symptoms, while a typical patient with venom anaphylaxis was older, with mostly cardiovascular symptoms.

Keywords: anaphylaxis; children; clinical manifestation; trigger of anaphylaxis.

Figure 1

Frequency of the listed anaphylaxis clinical symptoms as a function of the age group (A) or a specific trigger (B). A – the age groups included ages 0–2 (green column), 3–6 (red), 7–12 (blue) and 13+ (orange). B – the trigger was either insect venom (blue) or food ingestion (orange)

Figure 2

Frequency of grade IV and grade III anaphylaxis as a function of different anaphylaxis triggers (A) or selected age groups (B)