Food-induced anaphylaxis in children up to 3-years-old – preliminary study

Main Article Content

Julia Gawryjołek
Aneta Krogulska


anaphylaxis, children, infants, allergy, allergen, food, specific IgE, epinephrine, cow's milk, atopy


Introduction and objectives: The aim of this study was to determine the frequency of food-induced anaphylaxis, analyze the symptoms, and triggering factors in a group of youngest children. Also, the study aims to estimate the frequency of anaphylaxis episodes in children in the Kuyavian-Pomeranian Voivodeship region.
Methods: Retrospective analysis of medical records of 29 children aged 0–3 years that presented symptoms of food-induced anaphylaxis. Medical charts were reviewed using a collection of documents with the clinical data.
Results: The frequency of anaphylaxis was determined to be 0.3% of all hospitalized children aged 0–3 years and 1.9% of children suspected of food allergy. The mean age of an anaphylactic reaction was 12±9 months. The most common symptom was mild-moderate urticaria. The respiratory symptoms were significantly more prevalent in toddlers than in infants (p = 0.148). Cardiac symptoms occurred only in the infant group, i.e., in two (11%) infants. As a possible cause of the symptoms, in 18 (62%) cases, parents most often indicated the consumption of milk or milk-rice porridge. Anaphylaxis as the first manifestation of food-allergy was significantly more prevalent in infants than in older children (p = 0.0002).
Conclusions: The incidence of anaphylactic reactions rated at 0.3% of all children hospitalized at this age. The most common symptoms of anaphylactic reaction were skin lesions. The primary cause of allergic reactions was cow’s milk after the first exposure at home. Anaphylaxis has different patterns of symptoms depending on the age of the child.

Abstract 36 | PDF Downloads 17 XML Downloads 1 HTML Downloads 3


1. Muraro A, Roberts G, Worm M, Biló MB, Brockow K, Fernàndez Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69:1026–1045.
2. Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1):32. s40413-015-0080-1
3. Parlaman JP, Oron AP, Uspal NG, DeJong KN, Tieder JS. Emergency and hospital care for food-related anaphy-laxis in children. Hosp Pediatr. 2016;6:269–274.
4. Rudders SA, Banerji A, Clark S, Camargo CA Jr. Age-related differences in the clinical presentation of food-induced anaphylaxis. J Pediatr. 2011;158:326–328. jpeds.2010.10.017
5. Huang F, Chawla K, Jarvinen KM, Nowak-Węgrzyn A. Anaphylaxis in a New York City pediatric emergency depart-ment: triggers, treatments and outcomes. J Allergy Clin Immunol. 2012;129:162–168. jaci.2011.09.018
6. Lieberman P, Camargo CA Jr, Bohlke K, Jick H, Miller RL, Sheikh A, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006;97:596–602. S1081-1206(10)61086-1
7. Sampson HA. Anaphylaxis and emergency treatment. Pediatrics. 2003;111:1601–1608.
8. Grabenhenrich LB, Dolle S, Moneret-Vautrin A, Köhli A, Lange L, Spindler T, et al. Anaphylaxis in children and ado-lescents: The European Anaphylaxis Registry. J Allergy Clin Immunol. 2016;137:1128.e1–1137.e1. jaci.2015.11.015
9. Simons FE, Sampson HA. Anaphylaxis: unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol. 2015;135:1125–1131.
10. Lee AJ, Thalayasingam M, Lee BW. Food allergy in Asia: how does it compare? Asia Pac Allergy. 2013;3:3–14.
11. Chen J, Hu Y, Allen KJ, Ho MH, Li H. The preva-lence of food allergy in infants in Chongqing, China. Pediatr Allergy Immunol. 2011;22:356–360.
12. Ngamphaiboon J, Chatchatee P, Thongkaew T. Cow’s milk allergy in Thai children. Asian Pac J Allergy Immunol. 2008;26:199–204.
13. Koplin JJ, Dharmage SC, Ponsonby AL, Tang ML, Lowe AJ, Gurrin LC. Environmental and demographic risk for egg allergy in a population-based study of infants. Allergy. 2012;67:1415–1422.
14. Robinson ML, Lanser BJ. The role of baked egg and milk in the diets of allergic children. Immunol Allergy Clin North A. 2018;38:65–76.
15. Kim JS, Nowak-Wegrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked-milk accelerates resolution of cow’s milk allergy in children. J Allergy Clin Immunol. 2011; 128: 125-131 doi:10.1016/j.jaci.2011.04.036.
16. Meglio P, Bartone E, Plantamura M, Arabito E, Giampietro PG. A protocol for oral densensitization in children with IgE-mediated cow’s milk allergy. Allergy. 2004;59:980–987.
17. Leonard SA, Sampson HA, Sicher SH, Noone S, Moschier EL, Godbold J, et al. Dietary baked egg accelerates resolution of egg allergy in children. J Allergy Clin Immunol. 2012;130:473– 480.
18. Mullins RJ, Dear KBG, Tang MLK. Time trends in Australian hospital anaphylaxis admissions in 1998-1999 to 2011-2012. J Allergy Clin Immunol. 2015;136:367–375.
19. Rudders SA, Arias SA, Camargo Jr CA. Trends in hospitalizations for food-induced anaphylaxis in US children, 2000-2009. J Allergy Clin Immunol. 2014;134:960.e3–962.e3.
20. Nocerino R, Leone L, Cosenza L, Berni Canani R. Increasing rate of hospitalizations for food-induced anaphylaxis in Italian children: an analysis of the Italian Ministry of Health data-base. J Allergy Clin Immunol. 2015;135:833.e3–835.e3.
21. Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European Academy of Allergology and Clinical Immunology. Allergy. 2007;62:857–871. https://doi. org/10.1111/j.1398-9995.2007.01421.x
22. Mullins RJ, Wainstein BK, Barnes EH, Liew WK, Campbell DE. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy. 2016;46:1099–1110. https://doi. org/10.1111/cea.12748
23. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl. 1980;92:44–47.
24. Global Initiative for Asthma. Global strategy for asthma management and prevention 2020. Available from: www.ginasthma. org
25. Brożek JL, Bousquet I, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines – 2016 revision. J Allergy Clin Immunol. 2017;140:950–958.
26. Joyce E Yu, Robert T Lin. The epidemiology of anaphylaxis. Clinic Rev Allerg Immunol. 2018;54:366–374.
27. Wang Y, Allen KJ, Suaini NHA, McWiliam V, Peters RL, Koplin J. The global incidence and prevalence of anaphylaxis in children in the general population: a systemic review. Allergy. 2019;74(6):1063–1080.
28. Yoon L, Kim BR, Lee JY, Kim K, Kim YM, Kim SH, et al. Clinical features of anaphylaxis according to age in a single University hospital in Korea. Asian Pac J Allergy Immunol. 2017;35:96– 101.
29. 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;38:38–43. https://
30. Samady W, Trainor J, Smith B, Gupta R. Food-induced anaphylaxis in infants and children. Ann Allergy Asthma Immunol. 2018;121:360–365.
31. Jeon YH, Lee S, Ahn K, Lee SY, Kim KW, Kim HH, et al. Infantile anaphylaxis in Korea: a multicenter retrospec-tive case study. J Korean Med Sci. 2019;8:34.
32. Lee SY, Ahn K, Kim J, Jang GC, Min TK, Yang HJ, et al. A multi-center retrospective case study of anaphylaxis triggers by age in Korean children. Allergy Asthma Immunol Res. 2016;8:535– 540.
33. Dosanjh A. Infant anaphylaxis: the importance of early recognition. Journal of Asthma and Allergy. 2013;6:103–107.
34. Greenhawt M, Gupta R, 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;7:1148.e5–1156.e5.
35. 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;34:233–238.
36. Tsuang A, Menon NR, Bahri N, Geyman LS, Nowak-Węgrzyn A. Risk factors for multiple epinephrine doses in food-triggered anaphylaxis in children. Annals Allergy Asthma Immunol. 2018;121:469–473. anai.2018.06.015
37. Simon FE, Clark S, Camargo CA Jr. Anaphylaxis in the com-munity: learning from the survivors. J Allergy Clin Immunol. 2009;124:301–306.
38. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008–1025. all.12429