Table 2.
Clinical presentation of children presenting to the Emergency Department with a food-related anaphylaxis.*
| Infants (ages <2) (n=191) % (95%CI) |
Pre-school (ages 2-5) (n=171) % (95%CI) |
School-aged (ages 6-11) (n=150) % (95%CI) |
Adolescents (12-18) (n=145) % (95%CI) |
P value | |
|---|---|---|---|---|---|
| Presentation and clinical course | |||||
| Arrive to ED by ambulance | 43 (32 – 55) | 46 (35 – 58) | 39 (27 – 51) | 40 (28 – 53) | 0.83 |
| Time since exposure | 0.42 | ||||
| < 1 hour | 7 (6 – 28) | 15 (6 – 24) | 15 (7 – 23) | 22 (9 – 35) | |
| 1-3 hours | 67 (55 – 79) | 63 (51 – 75) | 76 (66 – 85) | 57 (43 – 72) | |
| > 3 hours | 16 (8 – 24) | 22 (12 – 33) | NC** | 21 (9 – 32) | |
| Location of exposure | <0.001 | ||||
| Home | 89 (81 – 97) | 65 (53 – 76) | 58 (43 – 73) | 58 (44 – 72) | |
| School/daycare | 9 (0 – 17) | 11 (3 – 18) | 9 (2 – 15) | 12 (5 – 19) | |
| Restaurant | NC** | 17 (6 – 27) | NC** | 17 (6 – 28) | |
| Other | NC** | 8 (3 – 13) | 22 (8 – 36) | 13 (5 – 21) | |
| Specific food trigger causing reaction‡ | |||||
| Peanuts | 31 (20 – 43) | 26 (17 – 36) | 22 (13 – 32) | 10 (7 – 13) | 0.01 |
| Tree nuts | 9 (4 – 14) | 28 (18 – 38) | 21 (9 – 33) | 20 (12 – 28) | 0.02 |
| Seeds | 0 | NC** | NC** | NC** | -- |
| Fruits and vegetables | 4 (0 – 9) | 7 (0 – 13) | 6 (0 – 11) | 19 (7 – 32) | 0.01 |
| Shellfish | NC** | NC** | NC** | 22 (10 – 35) | -- |
| Fish | NC** | NC** | NC** | NC** | -- |
| Food additives | NC** | 0 | 0 | NC** | -- |
| Milk products | 40 (28 - 51) | 16 (7 – 26) | 13 (4 – 21) | NC** | <0.001 |
| Eggs | 9 (3 - 16) | NC** | NC** | NC** | -- |
| Wheat | NC** | NC** | 0 | 0 | -- |
| Other food† | 13 (5 – 22) | 22 (11 – 24) | 28 (14 – 42) | 20 (10 – 31) | 0.29 |
| Signs and symptoms | |||||
| Hives | 88 (79 – 97) | 78 (69 – 88) | 64 (51 – 77) | 59 (46 – 72) | 0.002 |
| Itching | 19 (10 – 29) | 29 (18 – 40) | 54 (40 – 67) | 36 (24 – 48) | 0.001 |
| Swelling | 53 (41 – 65) | 56 (45 – 68) | 44 (30 – 57) | 36 (24 – 48) | 0.09 |
| Angioedema | NC** | NC** | NC** | NC** | -- |
| Trouble swallowing | NC** | 18 (8 – 29) | 41 (27 – 55) | 48 (35 – 61) | <0.001 |
| Trouble breathing/shortness of breath | 37 (26 – 48) | 34 (23 – 45) | 39 (27 – 52) | 57 (44 – 70) | 0.051 |
| Wheezing | 29 (20 – 39) | 55 (43 – 66) | 42 (29 – 56) | 23 (13 – 32) | <0.001 |
| Hoarse voice | NC** | 12 (4 – 19) | NC** | 13 (3 – 22) | 0.80 |
| Stridor | 5 (3 – 7) | 10 (2 – 18) | NC** | NC** | 0.02 |
| Nausea/vomiting | 53 (41 – 65) | 34 (24 – 45) | 29 (17 – 42) | 17 (9 – 26) | <0.001 |
| Abdominal pain/cramps | 0 | NC** | 12 (3 – 21) | NC** | -- |
| Diarrhea | NC** | 0 | 0 | NC** | -- |
| Dizziness/fainting | 0 | 0 | NC** | 12 (4 – 20) | -- |
| Altered mental status | NC** | NC** | NC** | 0 | -- |
| Organ system involvement | |||||
| Respiratory | 59 (47 – 71) | 81 (72 – 89) | 70 (56 – 83) | 71 (58 – 83) | 0.07 |
| Cutaneous | 98 (94 – 100) | 95 (90 – 99) | 92 (87 – 98) | 87 (78 – 96) | 0.11 |
| Gastrointestinal | 56 (44 – 67) | 50 (38 – 61) | 59 (45 – 72) | 59 (46 – 72) | 0.71 |
| Cardiovascular | NC** | NC** | NC** | 12 (4 – 20) | 0.006 |
| ED discharge diagnosis included term “anaphylaxis” (%) | 6 (3 – 9) | 25 (14 – 37) | 13 (7 – 19) | 13 (1 – 24) | 0.02 |
Abbreviation: CI, confidence interval; ED, emergency department.
Anaphylaxis defined as allergic reaction involving 2+ organ systems or hypotension. Hypotension is defined as systolic blood pressure less than (70 + (age multiplied by 2)) for children age <10 years and systolic blood pressure less than 90 mmHg for children age 10-18 years.
NC, non-calculable. When the number of observations was <30, robust estimates could not be produced.
All potential food allergen triggers reported by the patient were documented by reviewer.
Other foods include less frequently reported food allergens (e.g., soy, barley) and foods with multiple potential allergens (e.g., cookies, pizza).