Anaphylactic reactions in children - results of a questionnaire- based survey in Germany

Despite the seriousness of severe anaphylactic reactions, little is known on their clinical features, particularly in infants and children.

In this study, researchers evaluated trigger factors, patterns of clinical reaction, the sites ofoccurrence and treatment modalities of reported reactions in infants and children below 12 years of age in Germany.A questionnaire-based survey was sent to paediatricians throughout the country wherein they were asked to report accidental anaphylactic reactions over the previous 12 months. The severity of reported reactions were classified in grades I-IV according to symptoms.One hundred and three cases of anaphylaxis were evaluated in total. The median age was 5 years and 58% were male. In the majority (58%) of cases, the site of reaction occurrence was the child's home. Foods were the most common causative allergen (57%), followed by insect stings (13%) and immunotherapy (SIT) (12%). In 8% of cases the anaphylactic agent was unknown. In the food allergen group, peanuts and tree nuts were the most frequent allergens (20% of food allergens in each case). Severe reactions with cardiovascular involvement occurred in 24% of cases. No fatal reaction was observed. Recurrent episodes of anaphylaxis were reported in 27% of cases. Half of these cases were caused by the same allergen in the repeat episode. For treatment, 20% of children received adrenaline, in 8% of cases intravenously. Thirty-six per cent of patients with grade-IV reactions received adrenaline, 24% intravenously. In 17% of allchildren an adrenaline self-injector was prescribed after the episode.Researchers concluded that the data shows physicians demonstrate uncertainty when diagnosing anaphylaxis, that there is a remarkable under-treatment of the majority of children with anaphylaxis, that there is a need for guidelines and training for physicians on managing children with anaphylaxis and that self-management programs for patients and families should be encouraged.Please click here to view the full article.(Source: Allergy 2005: 60: 1440-1445.)