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Fatal pediatric anaphylaxis triggered by peanut, milk, and blood products

Published online: April 30, 2019

Since there are only a few reports of allergic reactions requiring intensive care unit (ICU) admission in children, this study was designed to fill a gap in the literature about demographics and characteristics of severe pediatric anaphylaxis episodes. In smaller studies in the United States (US), intravenously administered drugs, female gender, and venom as a trigger were identified as risk factors.

In their 2019 article in The Journal of Allergic Clinical Immunology: In Practice, Ramsey et al. report on 604,729 patients admitted to the ICU in an international pediatric intensive care database, Virtual Pediatric Systems. Of these patients, from 2010-2015, in the US and Canada, 1,989 patients were admitted for anaphylaxis, based on diagnostic code. The study describes identified triggers, clinical and demographic information and probability of death among the included patients.

Peanut was the most common trigger reported and patients were mostly boys when under thirteen and girls when teenagers. Length of stay was two days and intubation occurred in the first hour of admission on average. Patients were disproportionately Asian when under two years old or when the reaction was elicited by food. One percent of these patients succumbed to their illness and among the fatalities, the triggers were noted to be peanut, milk or blood products. This report documents important characteristics of some of the most severe allergic reactions in North American children in recent times.

This is the largest study to describe pediatric critical anaphylaxis cases in North America. The most common trigger was food, and death unfortunately occurred in 19 cases. This study underscores the risk for a serious reaction in pediatric anaphylaxis patients.

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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