Insights on severe childhood anaphylaxis from a European registry

Published Online: January 21, 2016

Allergies to foods and insect venom worry parents and caretakers of infants and children because of potentially life-threatening reactions, called anaphylaxis. In reality, the majority of allergic reactions are mild. However, severe reactions, for example involving breathing difficulties, can occur. Very severe anaphylaxis is not common, and there are limited studies describing a comprehensive picture of the most severe allergic reactions in childhood.

In a research article recently published in The Journal of Allergy and Clinical Immunology (JACI) Grabenhenrich and colleagues present an extensive description of almost 2000 cases of severe childhood anaphylaxis, obtained through the European Anaphylaxis Registry. They collected data from 2007 to 2015 from 10 European countries, involving 90 tertiary allergy specialist centers by using a web-based data entry system. Study centers were asked to enter data on the most severe cases of anaphylaxis.

The authors highlighted a shift from food as the predominant cause for severe allergic reactions in early childhood, towards insect sting and drug anaphylaxis becoming more frequent in older age groups. For example, foods caused 88% of the episodes in those under age 6 years, but less than 50% of reactions among adolescents. Cow’s milk and hen’s egg consumption was responsible for most of the cases in infancy, whereas peanut anaphylaxis was recorded throughout childhood. Interestingly, some clinical symptoms were mainly seen at certain ages, for example, vomiting and cough was very frequent in preschoolers, when breathing difficulties and circulatory collapse became the typical appearance in early school age and puberty. Only a small percentage of cases were treated with epinephrine by lay persons, a problem identified in a number of prior studies. The fraction of intramuscular epinephrine administered in the emergency department increased from 12% in 2011 to 25% in 2014, suggesting improved professional education and guidelines, but perhaps continued under-utilization.

The authors took a closer look at 26 of the most severe cases, with intensive care unit admissions or circulatory/cardiac arrest, and among them 5 died. The detailed description of these cases showed that the most severe and life-threatening reactions were caused by all typical elicitors and occurred at any age.

The authors explain that this registry suggests that a small percentage of children with severe reactions have a life-threatening course, but this possibility remains a true threat. They hope that this registry will allow assessment of adherence to new guidelines and provide further insights on treatment modalities.

The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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