Anaphylaxis%20(pediatric) Signs and Symptoms

• A serious generalized or systemic hypersensitivity reaction that is rapid in onset and potentially fatal
• Involves immunological response with IgE, high-affinity IgE receptors, mast cells, basophils, release of cytokines, chemokines, and chemical mediators of inflammation such as histamine and tryptase
• IgG-mediated anaphylaxis has been reported in humans after administration of dextran or monoclonal antibodies
• Nonimmunological mechanisms are also involved and termed as nonallergic anaphylaxis or anaphylactoid reaction
  
  • Relatively uncommon in children

• Food allergy - most common cause in the community setting
  • Eg cow’s milk, egg white, shellfish, fish, peanuts, tree nuts, wheat
• Medications (eg penicillins, beta-lactams, cephalosporins, nonsteroidal anti-inflammatory drugs [NSAIDs], muscle relaxants, anticancer chemotherapy drugs, biological modifiers and monoclonal antibodies [eg Omalizumab]) and latex - common in the hospital setting
• Insect sting
• Food-induced anaphylaxis associated with exercise - affects teenagers
  • Anaphylaxis occurs when exercise takes place within 2-4 hours of ingestion of a specific food
  • May be food-independent or food-dependent; may be encountered after ingestion of celery, shellfish, wheat
• Idiopathic anaphylaxis
  • When the trigger of the anaphylaxis is unknown or cannot be identified despite a thorough history, allergen skin tests, IgE levels and provocation tests
• Allergen immunotherapy

• The longer the symptoms develop the less severe the overall reaction
• Grading the severity of clinical symptoms as 1 to 5 based on the organ system most affected may be helpful in the diagnosis and timely administration of Epinephrine

Cutaneous

• Most frequent manifestations occurring in more than 90% of cases
• May be delayed or absent in rapidly progressive anaphylactic reaction
• Include urticaria, angioedema (including periorbital edema, conjunctival swelling), flushing, pruritus (may begin on palms and soles)

Respiratory

• Occur in up to 85% of episodes
• Include rhinorrhea, nasal congestion, throat tightness, hoarseness, sudden or ‘barky’ cough, stridor, wheeze, dyspnea, chest tightness

Gastrointestinal

• Symptoms occur in up to 45% of episodes
• Include oral pruritus, nausea, vomiting, dysphagia, diarrhea, crampy abdominal pain

Cardiovascular

• Occur in up to 45% of episodes
• Include dizziness, tachycardia, chest pain, hypotension and collapse

Neurological

• Include restlessness, withdrawal behavior, lightheadedness, sense of impending doom, confusion, loss of consciousness, headache, seizure