Paediatric anaphylaxis: triggers and management
Abstract
Anaphylaxis is an acute-onset, potentially life-threatening allergic reaction that involves at least two organ systems and usually occurs after exposure to a likely allergen. Anaphylaxis is a common presentation seen in children, and it is critical that ambulance clinicians are able to recognise the symptoms of this condition and appropriately manage it, as prompt treatment has been shown to lead to improved outcomes. This article presents an overview of paediatric anaphylaxis including epidemiology, triggers, diagnosis, clinical manifestations, and management, with a focus on how infants and children are similar and different than adult patients. Also discussed is why paediatric anaphylaxis is often underdiagnosed and undertreated, as well as paediatric populations who may require special attention for the management of anaphylaxis, such as infants, patients with a history of multiple emergency department visits for anaphylaxis, and asthmatics.
Anaphylaxis is an acute-onset, potentially life-threatening allergic reaction involving at least two major organ systems that usually occurs after exposure to a likely allergen. New diagnostic criteria were published in 2005 and 2006 to help clinicians recognise the full spectrum of signs and symptoms of anaphylaxis (Sampson et al, 2006). These new guidelines recognise that cutaneous symptoms might be absent in up to 20 % of anaphylactic reactions in children with food allergy or insect sting allergy. Hypotension and shock are less frequent than in adults with anaphylaxis. Ambulance clinicians can help greatly improve the care of paediatric patients with anaphylaxis by providing prompt diagnosis and treatment.
An increase in the incidence of anaphylaxis in the industrialised world has been suggested by recent studies (Yocum et al, 1999; Decker et al, 2008; Simons and Sampson, 2008; Rudders et al, 2010). A study by Decker et al published in 2008 from the Rochester Epidemiology Project reported an increase in annual incidence from 46.9 per 100 000 persons in 1990 to 58.9 per 100 000 persons in 2000 (Decker et al, 2008). The incidence of 46.8 per 100 000 person-years is more than double the incidence reported from 1983 to 1987 in Olmstead Country (Yocum et al, 1999; Decker et al, 2008). In a United Kingdom database study, which included 1 111 124 person-years of data, the estimated anaphylaxis incidence rate was 34.4 per 100 000 person-years (Gonzalez-Perez et al, 2010).
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