Causes of Anaphylaxis in the Pediatric Population

RationaleThe etiology of anaphylaxis is mostly recovered from the medical impression at the emergency departments (ED). In our area, in adults, we found only a 55% concordance with the diagnosis given after the allergologic study. We aimed to study the etiology of anaphylaxis in children.MethodsAn observational descriptive study of all the anaphylaxis cases attended at the pediatric ED of a third-level hospital in Madrid was carried out. Electronic clinical records from March 2012 to March 2013 were searched through keywords related to allergy and considered anaphylaxis if WAO criteria were fulfilled. Patients were sent to the Allergy Unit.ResultsEighty anaphylaxis cases (60 patients) were retrieved at the ED. 87.5% were studied at the Allergy Service. Mean age 4.8±4.2, 52.9% boys, 78.6% previous history of atopy. Food allergy was identified in 93.1% of the cases: milk (47.8%), egg (25.4%), nuts (14.9%), fruits (7.5%) and fish (4.5%). Only 62.7% had been suspected of food allergy at the ED, while only 52.2% had been recommended to avoid the correct food group. Idiopathic anaphylaxis was finally assigned to 2.8% of the cases, a 91.9% reduction from the ED impression (34.7%). Overall, there was a concordance of 47.6% between the ED impression and the definitive diagnosis (Cohen’s kappa 0.493).ConclusionsChildren very often get the allergologic study done after an anaphylactic episode. The concordance between the cause determined at the ED and the confirmed cause after the allergologic study is low. Food allergy is a more frequent cause of anaphylaxis in children than previously suspected. RationaleThe etiology of anaphylaxis is mostly recovered from the medical impression at the emergency departments (ED). In our area, in adults, we found only a 55% concordance with the diagnosis given after the allergologic study. We aimed to study the etiology of anaphylaxis in children. The etiology of anaphylaxis is mostly recovered from the medical impression at the emergency departments (ED). In our area, in adults, we found only a 55% concordance with the diagnosis given after the allergologic study. We aimed to study the etiology of anaphylaxis in children. MethodsAn observational descriptive study of all the anaphylaxis cases attended at the pediatric ED of a third-level hospital in Madrid was carried out. Electronic clinical records from March 2012 to March 2013 were searched through keywords related to allergy and considered anaphylaxis if WAO criteria were fulfilled. Patients were sent to the Allergy Unit. An observational descriptive study of all the anaphylaxis cases attended at the pediatric ED of a third-level hospital in Madrid was carried out. Electronic clinical records from March 2012 to March 2013 were searched through keywords related to allergy and considered anaphylaxis if WAO criteria were fulfilled. Patients were sent to the Allergy Unit. ResultsEighty anaphylaxis cases (60 patients) were retrieved at the ED. 87.5% were studied at the Allergy Service. Mean age 4.8±4.2, 52.9% boys, 78.6% previous history of atopy. Food allergy was identified in 93.1% of the cases: milk (47.8%), egg (25.4%), nuts (14.9%), fruits (7.5%) and fish (4.5%). Only 62.7% had been suspected of food allergy at the ED, while only 52.2% had been recommended to avoid the correct food group. Idiopathic anaphylaxis was finally assigned to 2.8% of the cases, a 91.9% reduction from the ED impression (34.7%). Overall, there was a concordance of 47.6% between the ED impression and the definitive diagnosis (Cohen’s kappa 0.493). Eighty anaphylaxis cases (60 patients) were retrieved at the ED. 87.5% were studied at the Allergy Service. Mean age 4.8±4.2, 52.9% boys, 78.6% previous history of atopy. Food allergy was identified in 93.1% of the cases: milk (47.8%), egg (25.4%), nuts (14.9%), fruits (7.5%) and fish (4.5%). Only 62.7% had been suspected of food allergy at the ED, while only 52.2% had been recommended to avoid the correct food group. Idiopathic anaphylaxis was finally assigned to 2.8% of the cases, a 91.9% reduction from the ED impression (34.7%). Overall, there was a concordance of 47.6% between the ED impression and the definitive diagnosis (Cohen’s kappa 0.493). ConclusionsChildren very often get the allergologic study done after an anaphylactic episode. The concordance between the cause determined at the ED and the confirmed cause after the allergologic study is low. Food allergy is a more frequent cause of anaphylaxis in children than previously suspected. Children very often get the allergologic study done after an anaphylactic episode. The concordance between the cause determined at the ED and the confirmed cause after the allergologic study is low. Food allergy is a more frequent cause of anaphylaxis in children than previously suspected.