Infant Anaphylaxis: Study Characterizes Symptoms, Treatment

LOUISVILLE, Kentucky — A majority of infants who presented to the emergency department (ED) with anaphylaxis appropriately received epinephrine, with symptoms typically resolving after a single treatment dose, research findings indicate.

Given that early administration of epinephrine can be potentially lifesaving for infants with anaphylaxis, the study highlighted the real-world successes in increased uptake of treatment in this vulnerable patient population.

Most infants in the study who presented to the ED and received epinephrine were able to be discharged home after just a few hours, with only 1 out of 10 requiring hospitalization.

The study also reported that most symptoms were in the skin/mucosal, gastrointestinal (GI), respiratory, and cardiovascular (CV) systems, providing improved characterization of anaphylaxis symptoms in the infant population.

Nearly "all episodes were triggered by food, especially egg, peanut, milk, and cashew," commented Colleen Shannon, MD, a pediatrician at Children's Hospital of Philadelphia, who presented the research findings here at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting 2022.

Shannon noted that despite previous research demonstrating age-based differences in the presentation of anaphylaxis, the symptomatology of anaphylaxis in infants has not been robustly characterized. Better characterization of anaphylaxis in infants with allergies may help ensure earlier and more accurate diagnosis and management, she said.

For the study, the researchers performed a retrospective chart review of 169 patients between 0-24 months of age (mean age, 1.0 years) who presented to the emergency department of a pediatric tertiary referral center between 2019 and 2022.

All patients in the study met diagnostic criteria for anaphylaxis. The investigators used the medical records of patients to evaluate for demographics as well as presenting symptoms and treatment.

More than half (56.2%) of infants in the study were 12 months of age or younger, and 64.5% were male.

Nearly all (96.5%) anaphylaxis episodes presenting to the ED were triggered by food. The most common foods triggering these episodes were egg (26.6%), peanut (25.4%), milk (13.6%), and cashew (10.1%).

Most symptoms involved the skin/mucosal (97.6%) and GI (74.6%) systems, followed by respiratory (56.8%) and CV (34.3%) systems. Isolated tachycardia was recorded in 84.5% of patients with CV-related symptoms.

Epinephrine was administered to 86.4% of infants who presented to the ED with anaphylaxis. Nearly a third (30.1%) of these infants received epinephrine before arriving to the ED, and 9.5% required more than 1 dose.

The researchers also found that 10.1% of patients required hospital admission, but none had symptoms severe enough to require intensive care.

Jennifer Hoffmann, MD, an emergency medicine physician at the Lurie Children's Hospital of Chicago, told Medscape Medical News that while characterizing anaphylaxis symptoms is relevant for clinicians, it also remains vitally important "to teach parents of infants how to recognize the signs of anaphylaxis, particularly as they begin to introduce new foods," to ensure timely treatment.

Hoffman added that since most infants in the study improved after a single dose of epinephrine, most infants presenting to the ED with anaphylaxis can therefore be safely discharged home after only a brief period of observation. "That is, age alone should not be a reason for admission," commented Hoffmann, who wasn’t involved in the research study.

The study was independently supported. Shannon and Hoffmann report no relevant financial relationships.

American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting 2022: Poster P014. Presented November 12, 2022.

Brandon May is a freelance medical journalist who has written more than 2100 articles for medical publications in the United States and the UK. Twitter: @brandonmilesmay

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