Anaphylaxis in infancy: An area that needs to be highlighted
Main Article Content
Keywords
anaphylaxis, diagnosis, infants, management
Abstract
Anaphylaxis, the most severe end of the spectrum of allergic reactions, has shown increasing incidence globally over recent years. This hypersensitivity reaction can occur at any age, including infancy. Recent data, although scarce, show that anaphylaxis is increasingly reported in infancy, with food identified as the leading cause of anaphylaxis cases in this age group. Infants constitute a unique subgroup with specific challenges regarding diagnosis of anaphylaxis due to a variety of factors, such as lack of age-specific diagnostic criteria, inability of infants to describe their symptoms, and the broad spectrum of clinical manifestations that may be mistaken as normal findings. Additionally, there are special issues in reference to the treatment of anaphylaxis during infancy, such as the limited availability of weight-appropriate epinephrine autoinjectors for infants weighing <15 kg. In this study, we review the current literature regarding specific characteristics of anaphylaxis in infants as well as unique challenges in terms of diagnosis, acute treatment, and long-term management of this medical emergency in this vulnerable age group.
References
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13 Samady W, Trainor JL, Smith BM, Gupta RS. Food-induced anaphylaxis in infants and children. Ann Allergy Asthma Immunol. 2018;121(3):360–5. 10.1016/j.anai.2018.05.025
14 Chiampou E, Douros K, Moriki D, Marina M, Anastasiou-Katsiardani A, Tanou K, et al. Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: A 2-year nationwide survey. Allergol Immunopathol (Madr). 2024 May 1;52(3):8–16. 10.15586/aei.v52i3.1032
15 Jiang N, Xu W, Xiang L. Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence. World Allergy Organ J. 2021 Nov 18;14(11):100605. 10.1016/j.waojou.2021.100605
16 Jeon YH, Lee S, Ahn K, Lee SY, Kim KY, Kim HH, et al. Infantile anaphylaxis in Korea: A multicenter retrospective case study. J Korean Med Sci. 2019;34(13):e106. 10.3346/jkms.2019.34.e106
17 Gaspar Â, Santos N, Faria E, Pereira AM, Gomes E, Câmara R, et al. Portuguese Society of Allergology and Clinical Immunology (SPAIC) Anaphylaxis Interest Group. Anaphylaxis in children and adolescents: The Portuguese anaphylaxis registry. Pediatr Allergy Immunol. 2021 Aug 32(6):1278–86. 10.1111/pai.13511. Epub 2021 Apr 18.
18 Kahveci M., Akarsu A., Koken G., Sahiner UM, Soyer O., Sekerel BE. Food-induced anaphylaxis in infants, as compared to toddlers and preschool children in Turkey. Pediatr Allergy Immunol. 2020;31:954–61. 10.1111/pai.13320
19 Simons FE, Sampson HA. Anaphylaxis: Unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol. 2015 May;135(5):1125–31. 10.1016/j.jaci.2014.09.014. Epub 2014 Oct 30.
20 Simons FER. Anaphylaxis in infants: Can recognition and management be improved? J Allergy Clin Immunol. 2007;120:537–40. 10.1016/j.jaci.2007.06.025
21 Anagnostou K. Anaphylaxis in children: Epidemiology, risk factors and management. Curr Pediatr Rev. 2018;14(3):180–6. 10.2174/1573396314666180507115115
22 Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391–7. 10.1016/j.jaci.2005.12.1303
23 Cardenas-Morales M, Hernandez-Trujillo V. Infant anaphylaxis: A diagnostic challenge. Curr Allergy Asthma Rep. 2021 Feb 23;21(2):12. 10.1007/s11882-021-00990-4
24 Pistiner M, Mendez-Reyes JE, Eftekhari S, Carver M, Lieberman J, Wang J, et al. Caregiver-reported presentation of severe food-induced allergic reactions in infants and toddlers. J Allergy Clin Immunol Pract. 2021;9(1):311–20 e2. 10.1016/j.jaip.2020.11.005
25 Fleming JT, Clark S, Camargo CA Jr, Rudders SA. Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract. 2015 Jan–Feb;3(1):57–62. 10.1016/j.jaip.2014.07.004
26 Aun MV, Kalil J, Giavina-Bianchi P. Adults and children with anaphylaxis in the emergency room: Why it is not recognized? Curr Opin Allergy Clin Immunol. 2018 Oct;18(5):377–81. 10.1097/ACI.0000000000000469
27 Brown JC. Epinephrine, auto-injectors, and anaphylaxis: Challenges of dose, depth, and device. Ann Allergy Asthma Immunol. 2018;121(1):53–60. 10.1016/j.anai.2018.05.001
28 Robinson M, Greenhawt M, Stukus DR. Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department. Ann Allergy Asthma Immunol. 2017;119(2):164–9. 10.1016/j.anai.2017.06.001
29 Nunes FA, Zanini F, Braga CS, da Silva AL, Fernandes FR, Solé D, et al. Incidence, triggering factors, symptoms, and treatment of anaphylaxis in a pediatric hospital. World Allergy Organ J. 2022 Aug 21;15(9):100689. 10.1016/j.waojou.2022.100689
30 Delli Colli L, Al Ali A, Gabrielli S, Delli Colli M, Mule P, Lawson B, et al. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Ann Allergy Asthma Immunol. 2023 Dec;131(6):752–8.e1. 10.1016/j.anai.2023.08.606
31 Shroba JA. Infant anaphylaxis: Diagnostic and treatment challenges. J Am Assoc Nurse Pract. 2020 Feb;32(2):176–83. 10.1097/JXX.0000000000000386
32 Fleischer DM, Perry TT, Atkins D, Wood RA, Burks AW, Jones SM, et al. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study. Pediatrics. 2012;130:e25–32. 10.1542/peds.2011-1762
2 Robinson LB, Arroyo AC, Faridi MK, Rudders S, Camargo CA Jr. Trends in US emergency department visits for anaphylaxis among infants and toddlers: 2006–2015. J Allergy Clin Immunol Pract. 2021 May;9(5):1931–38.e2. 10.1016/j.jaip.2021.01.010. Epub 2021 Jan 21.
3 Topal E, Bakirtas A, Yilmaz O, Ertoy Karagol IH, Arga M, Demirsoy MS, et al. Anaphylaxis in infancy compared with older children. Allergy Asthma Proc. 2013 May–Jun;34(3):233–8. 10.2500/aap.2013.34.3658
4 Greenhawt M, Gupta RS, Meadows JA, Pistiner M, Spergel JM, Camargo CA Jr, et al. Guiding principles for the recognition, diagnosis, and management of infants with anaphylaxis: An expert panel consensus. J Allergy Clin Immunol Pract. 2019 Apr;7(4):1148–56.e5. 10.1016/j.jaip.2018.10.052. Epub 2019 Feb 5.
5 Pouessel G, Jean-Bart C, Deschildre A, Van der Brempt X, Tanno LK, Beaumont P, et al. Allergy vigilance network. Food-induced anaphylaxis in infancy compared to preschool age: A retrospective analysis. Clin Exp Allergy. 2020 Jan 50(1):74–81. 10.1111/cea.13519. Epub 2019 Nov 21.
6 Carlisle A, Lieberman J. Clinical management of infant anaphylaxis. J Asthma Allergy. 2021 Jul 8;14:821–7. doi: 10.2147/JAA.S286692
7 Dibek Misirlioglu E, Vezir E, Toyran M, Capanoglu M, Guvenir H, Civelek E, et al. Clinical diagnosis and management of anaphylaxis in infancy. Allergy Asthma Proc. 2017 Jan 1;38(1):38–43. 10.2500/aap.2017.38.4009
8 Brittany G, Anna N, Julie W. Factors contributing to underuse of epinephrine autoinjectors in pediatic patients with food allergy. Ann Allergy Asthma Immunol, 2021;126(2):175–9.e3. 10.1016/j.anai.2020.09.012
9 Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy. 2019 Jun;74(6):1063–80. 10.1111/all.13732. Epub 2019 Mar 6.
10 De Filippo M, Votto M, Albini M, Castagnoli R, De Amici M, Marseglia A, et al. Pediatric anaphylaxis: A 20-year retrospective analysis. J Clin Med. 2022 Sep 7;11(18):5285. 10.3390/jcm11185285
11 Tejedor-Alonso MA, Moro-Moro M, Múgica-García MV. Epidemiology of anaphylaxis: Contributions from the last 10 years. J Investig Allergol Clin Immunol. 2015;25:163–75. PMid: 26182682.
12 Yu JE, Lin RY. The epidemiology of anaphylaxis. Clin Rev Allergy Immunol. 2018;54:366–74. 10.1007/s12016-015-8503-x
13 Samady W, Trainor JL, Smith BM, Gupta RS. Food-induced anaphylaxis in infants and children. Ann Allergy Asthma Immunol. 2018;121(3):360–5. 10.1016/j.anai.2018.05.025
14 Chiampou E, Douros K, Moriki D, Marina M, Anastasiou-Katsiardani A, Tanou K, et al. Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: A 2-year nationwide survey. Allergol Immunopathol (Madr). 2024 May 1;52(3):8–16. 10.15586/aei.v52i3.1032
15 Jiang N, Xu W, Xiang L. Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence. World Allergy Organ J. 2021 Nov 18;14(11):100605. 10.1016/j.waojou.2021.100605
16 Jeon YH, Lee S, Ahn K, Lee SY, Kim KY, Kim HH, et al. Infantile anaphylaxis in Korea: A multicenter retrospective case study. J Korean Med Sci. 2019;34(13):e106. 10.3346/jkms.2019.34.e106
17 Gaspar Â, Santos N, Faria E, Pereira AM, Gomes E, Câmara R, et al. Portuguese Society of Allergology and Clinical Immunology (SPAIC) Anaphylaxis Interest Group. Anaphylaxis in children and adolescents: The Portuguese anaphylaxis registry. Pediatr Allergy Immunol. 2021 Aug 32(6):1278–86. 10.1111/pai.13511. Epub 2021 Apr 18.
18 Kahveci M., Akarsu A., Koken G., Sahiner UM, Soyer O., Sekerel BE. Food-induced anaphylaxis in infants, as compared to toddlers and preschool children in Turkey. Pediatr Allergy Immunol. 2020;31:954–61. 10.1111/pai.13320
19 Simons FE, Sampson HA. Anaphylaxis: Unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol. 2015 May;135(5):1125–31. 10.1016/j.jaci.2014.09.014. Epub 2014 Oct 30.
20 Simons FER. Anaphylaxis in infants: Can recognition and management be improved? J Allergy Clin Immunol. 2007;120:537–40. 10.1016/j.jaci.2007.06.025
21 Anagnostou K. Anaphylaxis in children: Epidemiology, risk factors and management. Curr Pediatr Rev. 2018;14(3):180–6. 10.2174/1573396314666180507115115
22 Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391–7. 10.1016/j.jaci.2005.12.1303
23 Cardenas-Morales M, Hernandez-Trujillo V. Infant anaphylaxis: A diagnostic challenge. Curr Allergy Asthma Rep. 2021 Feb 23;21(2):12. 10.1007/s11882-021-00990-4
24 Pistiner M, Mendez-Reyes JE, Eftekhari S, Carver M, Lieberman J, Wang J, et al. Caregiver-reported presentation of severe food-induced allergic reactions in infants and toddlers. J Allergy Clin Immunol Pract. 2021;9(1):311–20 e2. 10.1016/j.jaip.2020.11.005
25 Fleming JT, Clark S, Camargo CA Jr, Rudders SA. Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract. 2015 Jan–Feb;3(1):57–62. 10.1016/j.jaip.2014.07.004
26 Aun MV, Kalil J, Giavina-Bianchi P. Adults and children with anaphylaxis in the emergency room: Why it is not recognized? Curr Opin Allergy Clin Immunol. 2018 Oct;18(5):377–81. 10.1097/ACI.0000000000000469
27 Brown JC. Epinephrine, auto-injectors, and anaphylaxis: Challenges of dose, depth, and device. Ann Allergy Asthma Immunol. 2018;121(1):53–60. 10.1016/j.anai.2018.05.001
28 Robinson M, Greenhawt M, Stukus DR. Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department. Ann Allergy Asthma Immunol. 2017;119(2):164–9. 10.1016/j.anai.2017.06.001
29 Nunes FA, Zanini F, Braga CS, da Silva AL, Fernandes FR, Solé D, et al. Incidence, triggering factors, symptoms, and treatment of anaphylaxis in a pediatric hospital. World Allergy Organ J. 2022 Aug 21;15(9):100689. 10.1016/j.waojou.2022.100689
30 Delli Colli L, Al Ali A, Gabrielli S, Delli Colli M, Mule P, Lawson B, et al. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Ann Allergy Asthma Immunol. 2023 Dec;131(6):752–8.e1. 10.1016/j.anai.2023.08.606
31 Shroba JA. Infant anaphylaxis: Diagnostic and treatment challenges. J Am Assoc Nurse Pract. 2020 Feb;32(2):176–83. 10.1097/JXX.0000000000000386
32 Fleischer DM, Perry TT, Atkins D, Wood RA, Burks AW, Jones SM, et al. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study. Pediatrics. 2012;130:e25–32. 10.1542/peds.2011-1762
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Published
Jan 1, 2025
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How to Cite
Chiampou, E., Douros, K., Serbis, A., Ladomenou, F., Makis, A., Siomou, E., & Tsabouri, S. (2025). Anaphylaxis in infancy: An area that needs to be highlighted. Allergologia Et Immunopathologia, 53(1), 139-145. https://doi.org/10.15586/aei.v53i1.1212
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Review Article
How to Cite
Chiampou, E., Douros, K., Serbis, A., Ladomenou, F., Makis, A., Siomou, E., & Tsabouri, S. (2025). Anaphylaxis in infancy: An area that needs to be highlighted. Allergologia Et Immunopathologia, 53(1), 139-145. https://doi.org/10.15586/aei.v53i1.1212