Metin Aydogan1, Erdem Topal2, Nalan Yakıcı3, Hazal Cansu Acar4, Zeynep Hızlı Demirkale5, Mustafa Arga6, Pınar Uysal7, Sezin Aydemir8, Isıl Eser Simsek1, Zeynep Tamay5, Sükrü Cekic9, Ozlem Cavkaytar6, Fatih Kaplan2, Ayca Kıykım8, Müjde Tugba Cogurlu1, Ayse Süleyman5, Esra Yücel5, Emre Akkelle10, Gonca Hancıoglu11, Adem Yasar12, Tuba Tuncel13, Hikmet Tekin Nacaroglu14, Cigdem Aydogmus15, Nermin Güler5, Haluk Cokugras8, Nihat Sapan9, Hasan Yüksel12, Recep Sancak11, Mehmet Sarper Erdogan4, Oner Ozdemir16, Cevdet Ozdemir5, Fazıl Orhan3. 1. From the Pediatric Allergy and Immunology Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. 2. Pediatric Allergy and Immunology Department, Faculty of Medicine, Inonu University, Malatya, Turkey. 3. Pediatric Allergy and Immunology Department, Faculty of Medicine, Karadeniz Teknik University, Trabzon, Turkey. 4. Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 5. Pediatric Allergy and Immunology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey. 6. Pediatric Allergy and Immunology Department, Faculty of Medicine, Medeniyet University, Istanbul, Turkey. 7. Pediatric Allergy and Immunology Department, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey. 8. Pediatric Allergy and Immunology Department, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 9. Pediatric Allergy and Immunology Department, Faculty of Medicine, Uludağ University, Bursa, Turkey. 10. Pediatric Allergy and Immunology Department, Sancaktepe Training and Research Hospital, Istanbul, Turkey. 11. Pediatric Allergy and Immunology Department, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. 12. Pediatric Allergy and Immunology Department, Faculty of Medicine, Celal Bayar University, Manisa, Turkey. 13. Pediatric Allergy and Immunology Department, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey. 14. Pediatric Allergy and Immunology Department, Faculty of Medicine, Medipol University, Istanbul, Turkey. 15. Pediatric Allergy and Immunology Department, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey, and. 16. Pediatric Allergy and Immunology Department, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
Abstract
Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.
Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.