Symptoms of Anaphylaxis Have Greater Cardiovascular Involvement, Differ from Older Adults

Younger children were shown to have different signs and symptoms of anaphylaxis compared to those who are older, specifically with more involvement with the cardiovascular system, according to new findings.

This data was presented at the the American Academy of Allergy, Asthma & Immunology (AAAAI) 2023 Annual Meeting in San Antonio, TX. The study was led by Lourdes Ramirez, MD, from Brigham and Women’s Hospital at MassGeneral Hospital for Children’s Food Allergy Center.

The investigators noted that recognizing anaphylaxis in young children is particularly difficult, adding that it can lead to delayed administration of epinephrine which can be dangerous. Infants and toddlers pose particular challenges for clinicians in trying to recognize anaphylaxis as they cannot communicate their symptoms verbally.

Additionally, it can be challenging to differentiate between normal behavior in this age group and symptoms of anaphylaxis, and the current diagnostic criteria for anaphylaxis have not been validated for children under age 2.

The study presented at AAAAI is prospective, and it encompasses 523 oral food challenges (OFCs) administered to children below the age of 36 months.

The primary objective of the study was to highlight the cases where the children experienced a systemic allergic reaction that necessitated the use of epinephrine.

These challenges were performed at the Food Allergy Center of the Massachusetts General Hospital for Children, with the study period spanning from November of 2019 to July of 2022.

Throughout the study, the children's symptoms and signs were documented periodically until they resolved.

The investigators found that 2.7% of the 523 OFCs (14) had systemic reactions, and of these, 92.9% showed symptoms that were dermatologic.

Among those with dermatologic reactions, 8 were reported to have urticaria and 2 were reported to have angioedema.

Nine of the participants were found to have respiratory symptoms, 4 were found to have nasal congestion symptoms, 2 of those had reported wheezing, and 1 had stridor.

Additionally, 13 of the participants were found to have changes in behavior, 2 of them were found to have gastrointestinal symptoms and 7 showed somewhat mild cardiovascular symptoms (with all of these latter 7 cases having tachycardia before receiving epinephrine.