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.