ORLANDO (FRONTLINE MEDICAL NEWS) – Food was found to be the most commonly identified trigger, with peanuts the most prevalent food cause, in what researchers say is the largest comprehensive review of anaphylaxis episodes in North America that led to pediatric intensive-care unit stays.

Researchers examined the Virtual Pediatrics Systems database, an international database of pediatric intensive care unit (PICU) information, said Carla M. Davis, MD , a pediatrician at Baylor College of Medicine, Houston. During 2010-2015, there were 1,989 pediatric anaphylaxis admissions to these units in North America, she reported at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.

Dr. Davis said the study is intended to give a much-needed broad look at what is causing the most severe cases of child anaphylaxis.

“Because anaphylaxis is one of the most severe consequences of allergic disease, we decided that this study needed to be done to see really what the landscape was in the most critically ill children,” she said.

Peanuts accounted for 45% of the food triggers, followed by tree nuts and seeds at 19%, and milk at 10%.

Common causes aside from food included drug, blood products, and venom, Dr. Davis said.

Anaphylaxis accounted for 0.3% of all PICU admissions over the 5-year period, researchers found. Dr. Davis said this was “higher than what we anticipated.”

The overall mortality rate was 1%, and researchers found that peanuts and dairy were main causes of death of all the food-induced cases.

Anaphylaxis occurred more often in children ages 6-18 years than in kids of other ages and was least common among those aged 2-5 years. Asian children were disproportionately represented among the PICU anaphylaxis patients, but the mortality rate didn’t vary by any demographic factors.

Admissions were most likely to happen in the fall and were more common in the Northeast and Western regions of the United States, Dr. Davis reported.

She said the deep look at the causes of these severe cases should help drive home the importance of counseling patients and families about prevention.

“For patients that have had a history of an allergic reaction to food or medication, but specifically food, I think really stressing avoidance measures will be something that will be very helpful, as well as counseling about epinephrine injectors and carrying them is going to help,” she said. “I think having a little more knowledge, pediatricians should be able to counsel and refer to allergists when they don’t feel they have all the necessary skills.”

Dr. Davis reports financial relationships with Aimmune Therapeutics and DBV Technologies.

SOURCE: Davis CM et al. 2018 AAAAI/WAO Joint Congress Abstract 775 .


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