Food, drug, insect sting allergy, and anaphylaxis
Anaphylaxis in children and adolescents: The European Anaphylaxis Registry

https://doi.org/10.1016/j.jaci.2015.11.015Get rights and content

Background

Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description.

Objective

We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents.

Methods

The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form.

Results

Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom– and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions.

Conclusions

The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.

Section snippets

Setting and design

The European Anaphylaxis Registry collected information on anaphylactic reactions through a Web-based data entry system. Data for the current analysis were provided by tertiary referral centers specialized in pediatric allergology, dermatology, or both in Germany, France, Switzerland, Ireland, Greece, Austria, Spain, Bulgaria, Italy, and Poland. The study was approved by the Ethics Committee at Charité - Universitätsmedizin Berlin (the coordinating center) and by the local ethics committees in

Study centers and participants

The European Anaphylaxis Registry collected data on 1970 children from 90 study centers in 10 countries: Germany (n = 1040), France (n = 321), Switzerland (n = 297), Ireland (n = 95), Greece (n = 86), Austria (n = 59), Spain (n = 36), Bulgaria (n = 25), Italy (n = 6), and Poland (n = 5). Six hundred ninety-two (35%) were female, with a higher female proportion in adolescents (43%). All ages (in 1-year intervals) were represented similarly, except for infants (<1 year, n = 18) and 1-year-old

Key results

With 1970 patients, this is the first large-scale description of pediatric anaphylaxis. More data were collected on boys (about two thirds) than on girls, but the European Anaphylaxis Registry covered all age groups, including a sparsely populated first year of life. Although sex differences have been described for several allergic diseases,24 the sampling scheme used here does not support the interpretation of skewed distributions of age, sex, or other baseline information. One in 3 children

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    The European Anaphylaxis Registry was supported by the Network for Online Registration of Anaphylaxis NORA e. V. The Polish study center received support from the Medical University of Lodz Research Fund (503/1-137-01/503-11-001). The Irish study center received a funding grant from the National Children's Research Centre, Dublin, Ireland.

    Disclosure of potential conflict of interest: L. Lange receives payments from Thermo Fisher Scientific, ALK-Abelló, and Novartis. T, Spindler is a member of the Fultiform Advisory Board. F. Ruëff is board member for ALK-Abelló and Firma Bencard; serves as a consultant for DST; serves as an expert on the Advisory Board for ALK-Abelló and Bencard; and has received payments for lectures from Semperit Technische Produkte Gesellschaft, Novartis, Stallergenes, and MEDA Pharma GmbH & Co. E. Roumpedaki receives travel support from Allergie Centrum Charité. M. Fernandez-Rivas serves as a consultant for DBV and Reacta Biotech; has grants pending from the European Union and Spanish Ministry of Science; receives payments for lectures for ALK-Abelló, Merck, and GlaxoSmithKline; and receives travel support from the European Academy of Allergy and Clinical Immunology and Fundacion SEAIC. J. O'B. Hourihane receives research funding from the National Childrens Research Centre, Ireland; serves as a consultant from Aimmune Corporation; receives speaker fees from Thermo Fisher Scientific; and is the Chairman of Irish Food Allergy Network, which receives unrestricted funding for educational purposes from infant formula and adrenaline injector manufacturers. N. G. Papadopoulos receives research funding from GlaxoSmithKline, Nestlè, and Merck; receives payment for development of educational presentations from Abbvie, Sanofi, Menarini, and Meda; serves as a consultant for GlaxoSmithKline, Abbvie, Novartis, Menarini, Meda and ALK-Abelló; and receives payment for lectures from Novartis, AllergoPharma, Uriach, GlaxoSmithKline, Stallergens, and MSD. K. Beyer serves as a consultant for Meda Pharma, Bausch & Lomb, and ALK-Abelló and receives speaker fees from ALK-Abelló and Meda Pharma. M. Worm serves as a consultant and receives speaker fees for ALK-Abelló and receives travel support form Meda Pharma. The rest of the authors declare that they have no relevant conflicts of interest.

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