D3.328 - Paediatric Anaphylaxis: The Importance Of Recognition

Anaphylaxis is a potentially life-threatening allergic reaction. Intramuscular adrenaline is the first-line treatment for anaphylaxis.

However, the presence of heterogeneous diagnostic criteria and their variable interpretation compromise its recognition in clinical practice, particularly in the Emergency Department, leading to underdiagnosis and inappropriate management.

In our study we want to see the adequacy of both: diagnosis and treatment of anaphylaxis in a paediatric population.

A retrospective observational study was carried out by analyzing patients attended at the Paediatric Emergency Department (PED) of our third-level hospital, between 2020 and 2022. Patients who met the NIAID/FAAN criteria were included.

We recorded demographic characteristics, in addition to information regarding diagnosis and treatment.

A total of 150 patients were included: 32 % were girls and 68% boys with a mean age of 6.8 years (SD 4.9). A personal history of previous allergy was present in 119 patients (79.3%), and 40 patients (26.7%) had a prior history of anaphylaxis.Although all patients fulfilled diagnostic criteria for anaphylaxis, only 126 (84%) were recognised as anaphylaxis.Prior to arrival at the Emergency Department, 8 patients (5.3%) received systemic corticosteroids and 55 (36.7%) received antihistamines. An adrenaline autoinjector had already been prescribed to 83 patients, 15 of them (18%) used it.

Following medical assessment, 93 patients (62%) received systemic corticosteroids and 79 (52.6%) received antihistamines. One hundred and five patients (70%) received intramuscular adrenaline. It was used more frequently in the cases diagnosed as anaphylaxis (80%) (p<0,0001)

Recognition of anaphylaxis at the PED remains suboptimal and is closely associated with appropriate administration of intramuscular adrenaline. Failure to recognise anaphylaxis reduces the likelihood of receiving first-line treatment, emphasising the critical importance of accurate diagnosis in the management of paediatric anaphylaxis.