D3.353 - Clinical Characteristics and Triggers of Pediatric Anaphylaxis Cases: A Retrospective Single-Center Experience

Pediatric anaphylaxis is a heterogeneous, potentially life-threatening emergency, most commonly triggered by foods in childhood. Large cohorts suggest that reactions often occur at home or outdoors, with age-related differences in triggers and symptom patterns. Reported care gaps include under-recognition, mismatch between suspected and confirmed triggers, and variable epinephrine use. In this study, we aimed to describe triggers, clinical presentation, and acute management of anaphylaxis in children.

We conducted a retrospective, single-center study including children aged 0–18 years with anaphylaxis defined according to World Allergy Organization (WAO) criteria. Eligible episodes occurred between November 2014 and January 2026. We extracted demographics, atopic comorbidities, trigger categories, organ system involvement, and acute treatments.

We analyzed 144 patients with a median age (IQR) of 7.47 (1.7–13.0) years; 59.2% were male (Table 1). The most common trigger was food (56.9%), with leading foods milk, egg, and tree nuts. Other triggers, in descending order, included bee venom (24.3%) and medications (13.8%); additional triggers were cold urticaria (n=3, 2.0%), vaccination (n=2, 1.3%), exercise (n=1, 0.69%), and idiopathic causes (n=5, 3.4%). Among drug-triggered reactions, amoxicillin and ceftriaxone were the most common medications. At least one atopic comorbidity (asthma, allergic rhinitis, and/or atopic dermatitis) was present in 41.6% of patients. Mucocutaneous, respiratory, gastrointestinal, neurological, and cardiovascular involvement occurred in 95.8%, 70.1%, 43.7%, 26.3% and 17.3%, respectively. Reactions occurred at home in 58.3% of cases, outdoors in 20.8%, and in the hospital in 11.1%. Thirty-one patients (21.5%) did not seek hospital care despite experiencing anaphylaxis. Epinephrine was administered in 22.9% of cases, antihistamines in 59.0%, and corticosteroids in 37.5%. Biphasic reactions occurred in 6 patients (4.2%).

In this single-center cohort, pediatric anaphylaxis was predominantly food-triggered and most commonly occurred at home, with frequent mucocutaneous and respiratory involvement. Low epinephrine administration underscores the need for targeted education and standardized emergency protocols to improve guideline-adherent first-line treatment.