Anaphylaxis among children hospitalized with severe allergic reactions: a 5-year retrospective analysis

Objective. To determine the frequency, range of triggers, features of clinical symptoms and treatment of anaphylaxis in children hospitalized with severe systemic allergic reactions in the pediatric department in Moscow. Patients and methods. We conducted a retrospective analysis of 1197 medical records of children admitted to the Z.A.Bashlyaeva Children's City Clinical Hospital with severe allergic reactions over the period from 2016 to 2020 to determine the clinical criteria for anaphylaxis. The diagnosis of anaphylaxis was made retrospectively in 86 patients based on corresponding reports of 2 independent allergy specialists. Results. The incidence of anaphylaxis among children hospitalized with severe allergic reactions was 7.18%. The use of the new WAOAG (2020) anaphylaxis criteria, compared with the previously adopted NIAID/FAAN (2006), slightly increased the coverage of patients diagnosed with anaphylaxis (7.18% vs 7.01%, respectively). Food allergens were the predominant cause of anaphylaxis in children (78%); the second most important trigger were medications (5%), and 7% of patients had idiopathic anaphylaxis. The main causes of food anaphylaxis were tree nuts (31%), cow's milk (19%), fish/seafood (16%), and chicken egg (9%); the frequency of anaphylactic reactions to peanuts did not exceed 4%. The incidence of anaphylaxis to cow's milk and chicken egg was higher in the group of children younger than 3 years (p = 0.003, p = 0.01, respectively), and the incidence of anaphylaxis to fruits was lower (p = 0.05) compared with patients aged 3-18 years. The proportion of anaphylaxis to tree nuts in children was highest and irrespective of patient age. In the development of anaphylaxis, skin/mucosal (98%) and respiratory (71%) symptoms were the most frequent, followed by gastrointestinal symptoms (29%) and laryngeal symptoms (26%). In hospital, anaphylaxis was diagnosed in 10 (12%) patients, and only 21% of children received epinephrine for the treatment of anaphylaxis. At discharge, epinephrine was recommended for 13% of patients. Conclusion. The diagnosis of anaphylaxis is to be excluded in patients with severe allergic reactions, since its incidence in this group of patients reaches 7.18%. Food allergens are the main trigger of anaphylaxis in children in the Russian Federation. The age-dependent spectrum of food anaphylaxis triggers in Russia suggests the use of diagnostic allergy panels in infants that include not only cow's milk, chicken egg, fish, but also tree nuts. Less than 1/4 of children receive epinephrine in the treatment of anaphylactic reactions; the rate of verification of the diagnosis of anaphylaxis and prescription of epinephrine is extremely low and does not exceed 13%. Key words: anaphylaxis, anaphylactic reaction, trigger, allergen, children, food allergy, infants