Top

Published in:

Open Access 01-12-2012 | PEDIATRIC ALLERGY AND IMMUNOLOGY (JM PORTNOY AND CE CIACCIO, SECTION EDITORS)

Anaphylaxis in Children: Current Understanding and Key Issues in Diagnosis and Treatment

Author: Chitra Dinakar

Published in: Current Allergy and Asthma Reports | Issue 6/2012

Abstract

Anaphylaxis is a severe allergic reaction that is rapid in onset and may cause death. Since it is unpredictable and potentially fatal, prompt recognition and treatment are vital to maximize a positive outcome. The occurrence of anaphylaxis is increasing across all ages in the United States, with increased risk of worse outcome in teenagers/young adults and in those with comorbid conditions such as asthma. Gaps in the assessment of patient-specific risk factors, identification and prevention of triggers, recognition of signs/symptoms, and pharmacologic treatment of anaphylaxis have been identified at the physician and caregiver/patient level. A PubMed literature search (January 2000–December 2011) was conducted to identify publications on childhood anaphylaxis using the following terms: food allergy, food allergens, food hypersensitivity, epinephrine, epinephrine auto-injectors, anaphylactic triggers, and anaphylaxis. This review will critically appraise these key issues and highlight strategies that might result in improved management of anaphylaxis in children.

Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report–Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117:391–7.PubMedCrossRef

•• NIAID-Sponsored Expert Panel, Boyce JA, Assa'ad A, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(Suppl 1):S1–58. This is a must-read for all practitioners taking care of individuals with food allergy. The guidelines succinctly review published literature and present both evidence-based recommendations and expert opinions on controversial aspects of care. PubMed

•• Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practicparameter: 2010 Update. J Allergy Clin Immunol. 2010;126:477–80. An outstanding and comprehensive evidence- based practice parameter on diagnosis and management of anaphylaxis. PubMedCrossRef

Lieberman P, Kemp S, Oppenheimer J, et al. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. 2005;115:S483–523.CrossRef

Clark S, Gaeta TJ, Kamarthi GS, Camargo CA. ICD-9-CM coding of emergency department visits for food and insect sting allergy. Ann Epidemiol. 2006;16:696–700.PubMedCrossRef

Decker WW, Campbell RL, Manivannan V, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol. 2008;122:1161–5.PubMedCrossRef

Bohlke K, Davis RL, DeStefano F, et al. Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization. J Allergy Clin Immunol. 2004;113:536–42.PubMedCrossRef

Ross MP, Ferguson M, Street D, Klontz K, Schroeder T, Luccioli S. Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System. J Allergy Clin Immunol. 2008;121:166–71.PubMedCrossRef

Gaeta TJ, Clark S, Pelletier AJ, Camargo CA. National study of US emergency department visits for acute allergic reactions, 1993 to 2004. Ann Allergy Asthma Immunol. 2007;98:360–5.PubMedCrossRef

10.

Braganza SC, Acworth JP, Mckinnon DR, Peake JE, Brown AF. Paediatric emergency department anaphylaxis: different patterns from adults. Arch Dis Child. 2006;91:159–63.PubMedCrossRef

11.

de Silva IL, Mehr SS, Tey D, Tang ML. Paediatric anaphylaxis: a 5 year retrospective review. Allergy. 2008;63:1071–6.PubMedCrossRef

12.

Russell S, Monroe K, Losek JD. Anaphylaxis management in the pediatric emergency department: opportunities for improvement. Pediatr Emerg Care. 2010;26:71–6.PubMedCrossRef

13.

Bansal PJ, Marsh R, Patel B, Tobin MC. Recognition, evaluation, and treatment of anaphylaxis in the child care setting. Ann Allergy Asthma Immunol. 2005;94:55–9.PubMedCrossRef

14.

•• Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128:e9–17. This randomized, cross-sectional survey of over 40,000 US households not only indicates that more children in the US have food allergies than previously reported, with one third of food-allergic children reporting severe food-induced reactions, but that racial disparities exist in food allergy diagnoses. PubMedCrossRef

15.

• Rudders SA, Banerji A, Corel B, Clark S, Camargo CA Jr. Multicenter study of repeat epinephrine treatment for food-related anaphylaxis. Pediatrics. 2010;125:e711–8. Data from medical chart review shows data supporting the recommendation that children at risk for food-related anaphylaxis carry 2 doses of epinephrine. PubMedCrossRef

16.

Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124:1549–55.PubMedCrossRef

17.

Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol. 2009;123:434–42.PubMedCrossRef

18.

Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001;107:191–3.PubMedCrossRef

19.

Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123:426–33.PubMedCrossRef

20.

Kishimoto TK, Viswanathan K, Ganguly T, et al. Contaminated heparin associated with adverse clinical events and activation of the contact system. N Engl J Med. 2008;358:2457–67.PubMedCrossRef

21.

•• Simons FE, Ardusso LR, Bilò MB, et al. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. 2011;127:587–93. Another excellent, must-read guide for clinical practitioners. PubMedCrossRef

22.

Burks AW, Jones SM, Boyce JA, Sicherer SH, Wood RA. Assa’ad A, et al. NIAID-sponsored 2010 guidelines for managing food allergy: applications in the pediatric population. Pediatrics. 2011;128:955–65.PubMedCrossRef

23.

Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004;114:371–6.PubMedCrossRef

24.

Simons FE, Edwards ES, Read Jr EJ, Clark S, Liebelt EL. Voluntarily reported unintentional injections from epinephrine auto-injectors. J Allergy Clin Immunol. 2010;125:419–23.PubMedCrossRef

25.

Pouessel G, Deschildre A, Castelain C, et al. Parental knowledge and use of epinephrine auto-injector for children with food allergy. Pediatr Allergy Immunol. 2006;17:221–6.PubMedCrossRef

26.

Kapoor S, Roberts G, Bynoe Y, Gaughan M, Habibi P, Lack G. Influence of a multidisciplinary paediatric allergy clinic on parental knowledge and rate of subsequent allergic reactions. Allergy. 2004;59:185–91.PubMedCrossRef

27.

McIntyre CL, Sheetz AH, Carroll CR, Young MC. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics. 2005;116:1134–40.PubMedCrossRef

28.

Krugman SD, Chiaramonte DR, Matsui EC. Diagnosis and management of food- induced anaphylaxis: a national survey of pediatricians. Pediatrics. 2006;118:e554–60.PubMedCrossRef

29.

Sicherer SH, Forman JA, Noone SA. Use assessment of self-administered epinephrine among food-allergic children and pediatricians. Pediatrics. 2000;105:359–62.PubMedCrossRef

30.

AAAAI Board of Directors; American Academy of Allergy, Asthma and Immunology. Anaphylaxis in schools and other childcare settings. J Allergy Clin Immunol. 1998;102:173–6.CrossRef

31.

Liberman DB, Teach SJ. Management of anaphylaxis in children. Pediatr Emerg Care. 2008;24:861–6.PubMedCrossRef

32.

• Kanwar M, Irvin CB, Frank JJ, Weber K, Rosman H. Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution. Ann Emerg Med. 2010;55:341–4. Cases where incorrect doses of epinephrine given in an emergency resulted in cardiac complications are presented, emphasizing the need to have pre-prepared appropriately packaged and labeled syringes. PubMedCrossRef

33.

Simons FE, Roberts JR, Gu X, Simons KJ. Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunol. 1998;101:33–7.PubMedCrossRef

34.

Simons FE, Chan ES, Gu X, Simons KJ. Epinephrine for the out-of-hospital (first-aid) treatment of anaphylaxis in infants: is the ampule/syringe/needle method practical? J Allergy Clin Immunol. 2001;108:1040–4.PubMedCrossRef

35.

Järvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. Use of multiple doses of epinephrine in food-induced anaphylaxis in children. J Allergy Clin Immunol. 2008;122:133–8.PubMedCrossRef

36.

• Simons FE, Lieberman PL, Read EJ Jr, Edwards ES. Hazards of unintentional injection of epinephrine from autoinjectors: a systematic review. Ann Allergy Asthma Immunol. 2009;102:282–7. A systematic review describing safety concerns due to unintentional injection of epinephrine from an autoinjector. PubMedCrossRef

37.

• DeMuth KA, Fitzpatrick AM. Epinephrine autoinjector availability among children with food allergy. Allergy Asthma Proc. 2011;32:295–300. This survey highlights that many children do not have their autoinjectors readily available despite parental report. PubMedCrossRef

38.

•• Sicherer SH, Mahr T. American Academy of Pediatrics Section on Allergy and Immunology. Management of food allergy in the school setting. Pediatrics. 2010;126:1232–9. An informative report outlining the role of the pediatric health care provider in managing students with food allergies. PubMedCrossRef

39.

Simons FE, Gu X, Silver NA, Simons KJ. EpiPen Jr vs EpiPen in young children weighing 15 to 30 kg at risk for anaphylaxis. J Allergy Clin Immunol. 2002;109:171–5.PubMedCrossRef

40.

• Stecher D, Bulloch B, Sales J, Schaefer C, Keahey L. Epinephrine auto-injectors: is needle length adequate for delivery of epinephrine intramuscularly? Pediatrics. 2009;124:65–70. This study of 256 children shows that the needle length in autoinjectors is not long enough to reach the muscle in a significant number of children. PubMedCrossRef

41.

Kaye R, Crowley J. Guidance for industry and FDA premarket and design control reviewers. Medical device use-safety: incorporating human factors engineering into risk management. Document issued on July 18, 2000. Available at: http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM094461.pdf. Accessed March 1, 2012.

42.

Patel BM, Bansal PJ, Tobin MC. Management of anaphylaxis in child care centers: evaluation 6 and 12 months after an intervention program. Ann Allergy Asthma Immunol. 2006;97:813–5.PubMedCrossRef

43.

Kaplan MS, Jung SY, Chiang ML. Epinephrine autoinjector refill history in an HMO. Curr Allergy Asthma Rep. 2011;11:65–70.PubMedCrossRef

44.

Kim JS, Sinacore JM, Pongracic JA. Parental use of EpiPen for children with food allergies. J Allergy Clin Immunol. 2005;116:164–8.PubMedCrossRef

45.

Barnett CW. Need for community pharmacist-provided food-allergy education and auto-injectable epinephrine training. J Am Pharm Assoc (2003). 2005;45:479–85.

46.

Simons FE, Clark S, Camargo Jr CA. Anaphylaxis in the community: learning from the survivors. J Allergy Clin Immunol. 2009;124:301–6.PubMedCrossRef

47.

Pulcini JM, Sease KK, Marshall GD. Disparity between the presence and absence of food allergy action plans in one school district. Allergy Asthma Proc. 2010;31:141–6.PubMedCrossRef

48.

Vadas P, Perelman B. Activated charcoal forms non-IgE binding complexes with peanut proteins. J Allergy Clin Immunol. 2003;112:175–9.PubMedCrossRef

49.

Choo KJ, Simons E, Sheikh A. Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. Allergy. 2010;65:1205–11.PubMedCrossRef

50.

Sheikh A, ten Broek V, Brown SG, Simons FE. H1-antihistamines for the treatment of anaphylaxis with and without shock. Cochrane Database Syst Rev. 2007:CD006160.

51.

Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119:1016–8.PubMedCrossRef

52.

Gupta RS, Springston EE, Smith B, et al. Food allergy knowledge, attitudes, and beliefs of parents with food-allergic children in the United States. Pediatr Allergy Immunol. 2010;21:927–34.PubMedCrossRef

53.

Banerji A, Rudders SA, Corel B, Garth AM, Clark S, Camargo Jr CA. Repeat epinephrine treatments for food-related allergic reactions that present to the emergency department. Allergy Asthma Proc. 2010;31:308–16.PubMedCrossRef

54.

Blumchen K, Ulbricht H, Staden U, Dobberstein K, Beschorner J, de Oliveira LC. Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol. 2010;126:83–91.PubMedCrossRef

55.

Anagnostou K, Clark A, King Y, Islam S, Deighton J, Ewan P. Efficacy and safety of high-dose peanut oil immunotherapy with factors predicting outcome. Clin Exp Allergy. 2011;41:1273–81.PubMedCrossRef

56.

Leung DY, Sampson HA, Yunginger JW, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med. 2003;348:986–93.PubMedCrossRef

57.

Katz Y, Rajuan N, Goldberg MR, et al. Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol. 2010;126:77–82.PubMedCrossRef

58.

Srivastava KD, Kattan JD, Zou ZM, et al. The Chinese herbal medicine formula FAHF-2 completely blocks anaphylactic reactions in a murine model of peanut allergy. J Allergy Clin Immunol. 2005;115:171–8.PubMedCrossRef

59.

Schiavi E, Barletta B, Butteroni C, Corinti S, Boirivant M, Di Felice G. Oral therapeutic administration of a probiotic mixture suppresses established Th2 responses and systemic anaphylaxis in a murine model of food allergy. Allergy. 2011;66:499–508.PubMedCrossRef

Title: Anaphylaxis in Children: Current Understanding and Key Issues in Diagnosis and Treatment
Author: Chitra Dinakar
Publication date: 01-12-2012
Publisher: Current Science Inc.
Published in: Current Allergy and Asthma Reports / Issue 6/2012
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI: https://doi.org/10.1007/s11882-012-0284-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anaphylaxis in Children: Current Understanding and Key Issues in Diagnosis and Treatment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2012

IgE-Mediated Cow’s Milk Allergy in Children

Current Strategies in Treating Severe Contact Dermatitis in Pediatric Patients

The Pathologic and Clinical Intersection of Atopic and Autoimmune Disease

The Impact of Dietary Long-Chain Polyunsaturated Fatty Acids on Respiratory Illness in Infants and Children

Otitis Media in Infancy and the Development of Asthma and Atopic Disease

Pathogenesis of Food Allergy in the Pediatric Patient