Most infants who experience anaphylaxis receive epinephrine, few require hospitalization

November 11, 2022

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Shannon C, et al. Abstract P014. Presented at: ACAAI Annual Scientific Meeting; Nov. 10-14, 2022; Louisville, Ky.

Lee and Shannon report no relevant financial information.

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LOUISVILLE, Ky. — More than 80% of the population of infants presenting to the emergency room with anaphylaxis received epinephrine there or before arrival, but only 10% of patients required hospitalization, according to study results.

Also, the results, presented at the American College of Allergy, Asthma & Immunology Scientific Meeting, showed that food caused almost all of these anaphylaxis cases.

Data were obtained from Shannon C, et al. Abstract P014. Presented at: ACAAI Annual Scientific Meeting; Nov. 10-14, 2022; Louisville, Ky.

“Diagnosing anaphylaxis in infants can be challenging due to a variety of factors,” Juhee Lee, MD, MD, director of allergy and immunology at the Children’s Hospital of Philadelphia (CHOP), Healio said. “Symptoms may be nonspecific and may even overlap with normal infant behavior, and infants may not verbalize subjective symptoms. However, there has been limited research focusing on this age group, and our study examined the presentation and management of anaphylaxis in infants in the pediatric ED.

In particular, the symptoms of anaphylaxis can be different in infants and adults, according to Colleen Shannon, MD, MPH, family pediatrician at CHOP.

“For example, infants may be more likely to have gastrointestinal and behavioral symptoms and less likely to have respiratory or cardiovascular symptoms,” Shannon told Healio. “This raises the possibility that diagnosis could be delayed or missed by providers unfamiliar with the symptoms of anaphylaxis in this age group.”

The investigators conducted a retrospective chart review of 169 patients aged 0 to 24 months (mean age, 1 year; SD, 0.41; 56.2% age 12 months or younger; 64.5% boys) who developed emergency department for pediatric tertiary referral. center between June 2019 and June 2022 with anaphylaxis.

“The number of infants presenting to our emergency department with anaphylaxis was higher than we had anticipated,” Shannon said. “Although our study was not designed to calculate incidence, it indicated that infant anaphylaxis is not uncommon in our hospital. In the last 3 years, we saw an average of at least one infant per week with anaphylaxis.”

Results showed that food triggered almost all attacks (96.5%), with the most common food triggers being eggs (26.6%), nuts (25.4%), milk (13.6%) and cashews (10, 1%).

Patients most often had skin/mucosal (97.6%), gastrointestinal (74.6%), respiratory (56.8%) and cardiovascular (34.3%) symptoms, with isolated tachycardia being the most common symptom from the heart and blood vessels (84.5%).

A total of 146 patients (86.4%) received epinephrine, of which 51 (30.1%) received it before arriving at the emergency department. Only 16 patients (9.5%) required more than one dose of epinephrine.

“Reassuringly, we found that the vast majority of infants who developed anaphylaxis recovered with a single dose of epinephrine and were able to be discharged from the emergency department without hospitalization,” Lee said.

Doctors admitted 17 patients (10.1%) to the hospital, but none of these infants required intensive care.

Juhee Lee, MD

Juhee Lee

“It is important that infants, just like older children and adults, need a prompt and accurate diagnosis to ensure that their anaphylaxis is treated appropriately,” Lee said in an ACAAI press release. “Fortunately, most cases of anaphylaxis in infants seem to resolve with a single dose of epinephrine. The vast majority were able to go home from the emergency room without further intervention.”

More research is needed to assess risk factors associated with more severe cases of anaphylaxis in infants and to identify criteria that should prompt admission after presentation in the emergency room, Lee Healio said.

The researchers are also interested in conducting a prospective study to determine the frequency and quality of behavioral changes seen in infants, Shannon said.

“In this chart review, documentation regarding the presence or absence of behavioral changes tended to be inconsistent,” she said. “Given that behavioral changes are believed to be a common symptom, it would be useful to learn more.”


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