Largest study of pediatric anaphylaxis shows food is the most common trigger and treatment is often delayed

This is largest study of childhood anaphylaxis reported as of 2008. It included 117 children presenting with anaphylaxis (123 episodes) over a 5-year period to the Emergency Department at a hospital in Melbourne, Australia. The design was a retrospective chart review at a single center.

There was one death. The median age of presentation was 2.4 years. Home was the most common setting (48%) and food (85%) the most common trigger.

Peanut (18%) and cashew nut (13%) were the most common cause of anaphylaxis.

The median time from exposure to anaphylaxis for all identifiable agents was 10 minutes. The median time from onset to therapy was 40 minutes.

Respiratory features were the principal presenting symptoms (97%).

The authors concluded that most children presenting to the ED with anaphylaxis were first-time anaphylactic reactions ( 83%) and the time to administration of therapy was often delayed (40 minutes).

Most reactions occurred in the home with peanut and cashew being the most common causes of anaphylaxis.


Mind map of food allergy.


Eight top allergens account for 90 percent of all food allergies.


Mind map diagram of anaphylaxis.

A recent study in the Annals of Allergy, Asthma and Immunology reported on development reported on development of the acronym SAFE, a mnemonic to remind physicians of the 4 action steps for anaphylaxis treatment:

Seek support
Allergen identification and avoidance
Follow-up for specialty care
Epinephrine for emergencies

Drugs used for management of anaphylaxis are remembered by the mnemonic EASI:

Epinephrine IM
Antihistamines PO, IM
Steroids PO, IM, IV
Inhaled b2-agonists, if wheezing. IV fluids if hypotension.

References:
Paediatric anaphylaxis: a 5 year retrospective review. de Silva IL, Mehr SS, Tey D, Tang ML. Allergy. 2008 Aug;63(8):1071-6.
Anaphylaxis: A Short Review
Food Allergy: A Short Review

@AllergyNet: Coroner's Report of anaphylactic death due to food allergy in Australia http://bit.ly/k2QK0c - A lot to be learned from this tragic episode.