J Korean Med Sci.  2019 Apr;34(13):e106. 10.3346/jkms.2019.34.e106.

Infantile Anaphylaxis in Korea: a Multicenter Retrospective Case Study

• Jeon YH
• Lee S
• Ahn K
• Lee SY
• Kim KW
• Kim HH
• Kim JH
• Yum HY
• Kim WK
• Park YM
• Song TW
• Kim J
• Lee YJ
• Jang GC
• Jeong K
• Kim YH
• Min TK
• Pyun BY
• on behalf of the Food Allergy and Atopic Dermatitis (FAAD) Study Group in the Korean Academy of Pediatric Allergy and Respiratory Disease

• KMID: 2442639
• DOI: http://doi.org/10.3346/jkms.2019.34.e106

Abstract

BACKGROUND
Anaphylaxis is increasing in young children. The aim of the present study was to analyze the clinical characteristics of anaphylaxis in Korean infants, with a focus on food triggers.
METHODS
The study analyzed the medical records of infants aged 0 to 2 years old who had been diagnosed with anaphylaxis in 23 secondary or tertiary hospitals in Korea.
RESULTS
We identified 363 cases of infantile anaphylaxis (66.9% male). Cutaneous symptoms were most prevalent (98.6%), followed by respiratory (83.2%), gastrointestinal (29.8%), and neurologic (11.6%) symptoms. Cardiovascular symptoms were noted in 7.7% of the cases. Most of the cases of anaphylaxis (338; 93.1%) were induced by foods. The most common trigger food was cow's milk and cow's milk products (43.8%), followed by hen's eggs (21.9%), walnuts (8.3%), wheat (7.7%), peanuts (4.8%), other nuts (3.0%), and fish (2.1%). In cow's milk-induced anaphylaxis cases, more than half the cases had cow's milk specific immunoglobulin E (sIgE) levels that were lower than the diagnostic decision points (DDPs), which is 5 kUA/L for those under the age of 1 and 15 kUA/L for those over the age of 1. In anaphylaxis induced by hen's egg, most of the cases (91.8%) had hen's egg sIgE levels that were higher than the DDP, which is 2 kUA/L for those under the age of 2 and 7 kUA/L for those over the age of 2. Of the infantile anaphylaxis cases, 46.8% had been treated with epinephrine, and 25.1% had been prescribed an epinephrine auto-injector.
CONCLUSION
Cow's milk is the most frequent trigger food of anaphylaxis in Korean infants. However, we found no significant correlation between the sIgE level and clinical severity. Education is required regarding the importance of epinephrine as the first line therapy for anaphylaxis and on properly prescribing epinephrine for infants with a history of anaphylaxis.

Keyword

Anaphylaxis; Epinephrine; Food; Infant

MeSH Terms

Anaphylaxis*
Arachis
Child
Education
Eggs
Epinephrine
Humans
Immunoglobulin E
Immunoglobulins
Infant
Juglans
Korea*
Medical Records
Milk
Nuts
Ovum
Retrospective Studies*
Tertiary Care Centers
Triticum
Epinephrine
Immunoglobulin E
Immunoglobulins