What Triggers Pediatric Anaphylaxis?

A study of nearly 2000 pediatric ICU admissions found that peanuts drive the most food-induced allergic reactions.

Carla M. Davis, MD

A comprehensive analysis of data collected from nearly 2000 pediatric admissions to intensive care units (ICU) has outlined the causes, mortality, demographics, and factors surrounding anaphylaxis in children.

The report on the potentially fatal allergic reaction was presented at the 2018 American Academy of Allergy, Asthma & Immunology (AAAAI) and World Allergy Joint Congress in Orlando, FL, this week. Led by Carla M. Davis, MD, a specialist in the Allergy and Immunology section, Department of Pediatrics, Baylor College of Medicine, researchers collected data from 1989 pediatric anaphylaxis admissions in North American ICUs, ranging from 2010 to 2015.

Davis noted the study’s intent was important in the field of allergies, as the burden of anaphylaxis in pediatric patients is a critical topic at an international level.

What she and researchers found was that food is the most common specified trigger of anaphylaxis. Peanut butter comprised approximately 45% of all food-induced cases. Tree nuts and seeds made up another 19% of the cases, and milk (10%) was another notable cause of food-induced anaphylaxis.

The allergic reaction was reportedly most common in children aged 6 to 18 years old, as compared to the overall ICU patient population. Children aged 2 to 5 years old were the least likely to suffer from anaphylaxis. Admissions were also most likely to occur during the fall, in the Northeast and Western regions of the United States.

Anaphylaxis only comprised about 0.3% of all ICU admissions, according to the study. But that limited rate included an overall probability of death at 0.9%, with 1% mortality. Peanut and dairy-based reactions were the leading causes of death among food-induced anaphylaxis.

Though mortality rates are low, about 19% of patients needed a tracheal intubation. As the burden of allergic reaction was greater than what Davis anticipated, she called for its treatment as a “serious medical condition” that is prevented and treated aggressively. Further research could also aid the pursuit of improved care.

“The characteristics of anaphylaxis in children including epidemiology, morbidity, and mortality tend to be underreported, even though the information could give insights into patterns and possible interventions,” Davis said.

Alexia Beauregard, MS, RD, CSP, LD, a dietician with Gastroenterology Associate Providers, told MD Magazine at AAAAI that it’s crucial for providers to educate families and pediatric patients with food allergies at a level that’s easier for them to understand.

“The dietician’s role is to be able to work with allergists, gastroenterologists, maybe even primary care providers, as part of a multi-disciplinary team that can help make sure families have those survival skills — especially in children,” Beauregard said.

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