Pediatr Emerg Med J.  2019 Dec;6(2):50-56. 10.22470/pemj.2019.00122.

Age group characteristics of clinical features and use of epinephrine in children with anaphylaxis who visited the emergency department

• Baek N
• Lee JS
• Ryu JM

• KMID: 2469718
• DOI: http://doi.org/10.22470/pemj.2019.00122

Abstract

PURPOSE
Diagnosis of anaphylaxis depends on clinical manifestations and a high index of suspicion, and a misdiagnosis can lead to a preventable death. We aimed to investigate age group characteristics of clinical features and epinephrine use in children with anaphylaxis who visited the emergency department (ED).
METHODS
We performed a retrospective chart review of 138 children who visited a tertiary care hospital ED from January through December 2018, and were discharged with anaphylaxis as the diagnosis. Anaphylaxis was defined according to the National Institutes of Allergy and Infectious Disease criteria. The children were divided into 4 age groups; infants (< 1 year), preschoolers (1-5 years), schoolers (6-11 years), and adolescents (12-18 years). Clinical features and epinephrine use were compared among the age groups.
RESULTS
Of the 138 children with presumed anaphylaxis, 108 met the criteria. The most common cause was food (74%), followed by drugs (10.2%). Epinephrine was used in 82 children (75.9%). The infants and preschoolers reported less frequent cardiovascular symptoms (0%-3.6% vs. 26.5%, P = 0.020) and epinephrine use (33.3%-70.9% vs. 91.2%, P = 0.037) compared to the adolescents. The former 2 age groups reported food as triggers more frequent, and often reported food-associated and respiratory or gastrointestinal symptoms.
CONCLUSION
Infants and preschoolers with anaphylaxis may undergo less frequent cardiovascular symptoms and epinephrine use compared to adolescents. This feature prompts to increased epinephrine use in the former age groups even without ageadjusted hypotension.

Keyword

Age Groups; Anaphylaxis; Child; Emergency Service, Hospital; Epinephrine

MeSH Terms

Academies and Institutes
Adolescent
Anaphylaxis*
Child*
Communicable Diseases
Diagnosis
Diagnostic Errors
Emergencies*
Emergency Service, Hospital*
Epinephrine*
Hospitals
Humans
Hypersensitivity
Hypotension
Infant
Retrospective Studies
Tertiary Healthcare
Epinephrine