Anaphylaxis is increasing among US infants and toddlers

Published Online: May 2021

Anaphylaxis is a severe acute allergic reaction. The lifetime prevalence of anaphylaxis appears to be rising, but little is known about nationwide trends in emergency department visits among infants and toddlers with anaphylaxis. Infants and toddlers are a unique population due to high rates of food allergic reactions and variable clinical presentations. Anaphylaxis is a potential emerging risk as a growing number of infants and toddlers are exposed to potential food allergens (e.g, peanut) early in life.

Lacey B. Robinson, MD and colleagues at the Massachusetts General Hospital sought to better understand the trends in emergency department visits and hospitalizations among infants and toddlers presenting for anaphylaxis. The study, published in The Journal of Allergy and Clinical Immunology: In Practice, was performed using nationally representative US data from the Healthcare Cost and Utilization Project’s Nationwide Emergency Department Sample. From 2006 to 2015, they assessed the rate of emergency department visits and hospitalizations from for anaphylaxis among infants and toddlers. Anaphylaxis, and possible triggers, were identified by diagnosis code.

Emergency department visits among infants and toddlers for anaphylaxis more than doubled during the study period from 20 per 100,000 visits to 50 per 100,000 visits. Conversely, the proportion of infants and toddlers who were subsequently hospitalized decreased from 19% to 6%. Hospitalization was predicted by male sex, private insurance, higher median household income and presentation to an urban or metropolitan teaching hospital.

The authors noted that study data were from a period prior to the publication of updated food allergy guidelines in 2017 and 2021, which recommend early introduction of peanut and other allergic foods. This study shows that even prior to that paradigm shift, anaphylaxis was an emerging risk among infants and toddlers.

The reason for declining hospitalization it not known, but this this might be due to improved management of anaphylaxis, low severity of reaction or patterns in healthcare utilization.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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