Insights from 275 cases of childhood anaphylaxis in the United States

Records were reviewed by 3 different allergists, and information was recorded on age, gender, race, ethnicity, allergic comorbidities, family history, presenting signs and symptoms, triggers, timing to onset of symptoms, treatment administered, biphasic reactions, hospitalizations, intensive care unit (ICU) admissions, follow-up, and fatalities. The study was approved by the Baylor College of Medicine institutional review board. There was also a strong association between asthma history and requiring 2 or more doses of epinephrine for symptom resolution (P = .01), supporting the notion that asthma is a risk factor for severe allergic reactions. New findings include a high proportion of anaphylactic episodes as a result of a new trigger, tree nuts surpassing peanuts as a recorded food for pediatric anaphylaxis, egg as the dominant trigger in infant anaphylaxis, multiple epinephrine doses administration in 20% of infants, a low rate of reported anaphylaxis in schools/daycare settings, a high rate of epinephrine administration, and an appropriately high referral rate to an allergist after the episode.Online Repository Variable N Percentage Treatment Treatment received Antihistamines 253 92% Epinephrine (IM) 243 88% Racemic epinephrine∗ 3 1% Epinephrine infusion∗ 3 1% Steroids 163 59% Inhaled β2-agonist (albuterol) 69 25% Inhaled ipratropium 3 1% Unspecified inhalers or nebulizers 2 0.7% Normal saline bolus 45 16% Intubation 2 0.7% None 2 0.7% Unrecorded 5 2% Used as first-line treatment Epinephrine (IM) 138 50% Antihistamines 113 41% Inhaled β2-agonist (albuterol) 8 3% Steroids 2 0.7% None 2 0.7% Not documented 12 3% Number of epinephrine doses administered 1 218 79% 2 20 7% >2 5 2% No epinephrine 32 12% Epinephrine available at the time of reaction No 189 69% Yes 86 31% Biphasic reaction No 227 82% Yes 31 11% Unrecorded 17 6% Hospital admission No 228 83% Yes 41 15% Unrecorded 6 2% Timing Time from exposure to symptoms developing 2 h 17 6% Unrecorded 103 37% Time to initiate treatment 2 h 30 11% Unrecorded 24 9% No treatment administered 1 0.4% Time to symptom resolution 2 h 62 23% Unrecorded 81 29% Prior assessment and follow-up Previously seen by allergist Yes 72 26% No 162 59% Not recorded 41 15% Referred to allergist Yes 259 94% No 11 4% Unrecorded 3 1% Referred to other health professional Primary care physician 4 1.4%