Increasing emergency department visits for anaphylaxis in very early childhood: A canary in the coal mine

Author:

Rueter Kristina12345ORCID,Moseley Natasha16,Ta Brennan4,Bear Natasha7,Borland Meredith L.24ORCID,Prescott Susan L.12358

Affiliation:

1. Department of Paediatric Immunology Perth Children's Hospital Perth Western Australia Australia

2. School of Medicine The University of Western Australia Perth Western Australia Australia

3. Centre for Food and Allergy Research Murdoch Children's Research Institute Parkville Victoria Australia

4. Department of Paediatric Emergency Medicine Perth Children's Hospital Perth Western Australia Australia

5. InVIVO Planetary Health Group of the Worldwide Universities Network (WUN) New York New Jersey USA

6. Department of Paediatric General Medicine Perth Children's Hospital Perth Western Australia Australia

7. Department of Clinical Research and Statistics Child and Adolescent Health Service Perth Western Australia Australia

8. Telethon Kids Institute The University of Western Australia Perth Western Australia Australia

Abstract

AbstractAimThe incidence of anaphylaxis is increasing globally in tandem with changing environmental and lifestyle factors. There is very limited data on very early childhood presentations. We aim to assess changes in rates, characteristics and management of infant anaphylaxis in a paediatric ED over a 15‐year period.MethodsWe conducted a retrospective study of children <2 years of age who presented with verified anaphylaxis comparing cases in years 2003–2007 with those in 2013–2017. Standardised information was collected on demographics, clinical presentation, management and triggers.ResultsManually confirmed anaphylaxis rates in <2 year olds increased from 3.6 to 6.2 per 104 population (OR 1.7, 95% CI: 1.3–2.7; p < 0.001) with the greatest increase in <1 year olds. Anaphylaxis severity increased between 2003–2007 and 2013–2017 (OR 2.3, 95% CI: 1.2–4.3; p = 0.018). Failure to administer adrenaline was reduced in 2013–2017 (p = 0.007). Food was the leading anaphylaxis trigger (97.85%).ConclusionThis is the first study to suggest an increase in the incidence and severity of ED anaphylaxis presentations in children aged <2 years. Increased awareness of specific characteristics in this age group is required to facilitate timely recognition and optimal management. Further large‐scale studies are warranted to understand underlying environmental drivers and find prevention strategies to reduce the burden of disease.

Publisher

Wiley

Subject

General Medicine,Pediatrics, Perinatology and Child Health

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