Clinical diagnosis and management of anaphylaxis in infancy

Abstract

Background: Anaphylaxis is increasingly reported in infancy. Diagnosis and management of anaphylaxis is difficult, and data are limited in infants. The aim of the present study was to determine the clinical course and management strategies used for anaphylaxis in infancy. Methods: Patients attending to our clinic and who had anaphylaxis under 2 years old were evaluated. Sixty-three patients were enrolled for the study. The mean +/- standard deviation age was 10.6 +/- 6.1 months (median, 11 months). Results: Anaphylaxis occurred at home in 48 infants (76.2%). Food was the most common causative agent (n +/- 52 [82.5%]), with cow's milk (n +/- 21 [40.4%]) and egg white (n +/- 13 [25%]) being the most frequent. Medication was the other causative agent (n +/- 9 [14.3%]), with antibiotics being the most frequent (n +/- 6 [66.7%]). The clinical manifestations were cutaneous (95.2%) and respiratory symptoms (79.4%). The median time lapse between contact and onset of symptoms was 10 minutes (5-15 minutes) (median, interquartile range [IQR] 25-75%). The total duration of symptoms was 2 hours (0.5-3 hours) (median, IQR 25-75%). Six patients had mild (9.5%), 40 moderate (63.5%), and 17 severe (27%) symptoms. A biphasic course was noticed in two infants (3.2%), with a symptom-free interval between a minimum of 30 minutes and a maximum of 4 hours. Forty-three (68.3%) received H-1 antihistamines, 31 received corticosteroids (49.2%), and 23 received adrenaline (36.5%). Only one patient needed intensive care. Conclusion: This study provided detailed clinical information in the diagnosis of anaphylaxis in infants. Diagnosing and managing anaphylaxis are difficult in infancy. Arrangements for definition of symptoms should be made in the new anaphylaxis guidelines.