ANAPHYLAXIS IN CHILDREN - CLINICAL AND ALLERGOLOGICAL FEATURES

Background. Despite the importance of anaphylaxis, little information is available on its clinical features. Objective. To evaluate the clin ical and allergologic features of anaphylaxis in children referred to the allergology and immunology unit of A. Meyer Children's Hospital (F lorence, Italy) from 1994 to 1996. Results. Ninety-five episodes of an aphylaxis occurred in 76 children (50 boys and 26 girls). Sixty-six ch ildren (87%) had only one episode of anaphylaxis, while 10 (13%) had t wo or more episodes. Sixty-two (82%) of the 76 patients had a personal history of atopic symptoms, although 14 (18%) did not. Sixty (79%) of the 76 children studied had at least one positive skin prick test to one or more of the common inhalant and/or food allergens. Children wit h venom-induced anaphylaxis usually had negative skin tests to the all ergens tested. A younger age and eczema were more frequent among child ren with food-dependent anaphylaxis, whereas an older age together wit h urticaria-angioedema were common among those with exercise-induced a naphylaxis. The mean latent period (+/-SD) of the anaphylaxis episodes was 15.4 +/- 27.5 minutes. Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal and card iovascular ones. The most frequent clinical manifestation in children with food anaphylaxis was gastrointestinal symptoms, whereas cardiovas cular symptoms were rare. The most probable causative agents in the 95 episodes described were foods (57%), drugs (11%), hymenoptera venom ( 12%), exercise (9%), additives (1%), specific immunotherapy (1%), late x (1%), and vaccines (2%), but in 6 cases (6%) the agent was never det ermined. Among the foods, seafood and milk were the most frequently in volved. As for location, 57% of the anaphylactic events occurred in th e home (54/95), 12% outdoors (11/95); 5% in restaurants (5/95); 3% in the doctor's office (3/95); 3% in hospitals (3/95); 3% on football fie lds (3/95); 2% on the beach (2/95); 1% in the gym (1/95); 1% at school (1/95); and 1% in the operating room (1/95). In the remaining 12% of cases (11/95) the site remained unknown. Sixty-two percent of the pati ents (59/95) were treated in an emergency room or hospital, while 32% (30/95) were not (this information is lacking in 6% of the cases [6/95 ]). Patients were treated with corticosteroids in 72% of the cases (68 /95), with antihistamines in 20% (19/95), with epinephrine in 18% (17/ 95), with beta(2)-agonists in 5% (5/95), and with oxygen in 4% (4/95). Conclusions. In our area, foods, particularly seafood and milk, seem to be the most important etiologic factors triggering anaphylaxis. Foo d-induced anaphylaxis often occurs in younger children with a severe f ood allergy, whereas exercise-induced anaphylaxis occurs more often in older children with a history of urticaria-angioedema. The venom-indu ced variant usually presents itself in nonatopic subjects. Given the f act that most of the children had only one anaphylactic reaction, prev ention is almost impossible. Epinephrine, although it is the first-cho ice treatment of anaphylaxis, often goes unused, even in hospitals and doctors' offices.