Anaphylaxis in children: a 5-year experience.

OBJECTIVES To identify the causative agents, presenting signs and symptoms, and course of disease in children diagnosed with anaphylaxis. Design. Five-year retrospective chart review. SETTING Urban children's hospital pediatric emergency department, operating suite, and inpatient units. PARTICIPANTS Fifty-five cases of anaphylaxis in 50 patients 1 to 19 years of age. INTERVENTIONS None. RESULTS The most common inciting agents in this population were latex (27%), food (25%), drugs (16%), and venoms (15%). Thirty-two cases (58%) occurred outside of the hospital, including 3 of 11 severe cases. Nineteen (35%) had histories of prior allergy to the causative agent. Most agent exposures were intravenous (38%), oral (27%), or dermal (20%). The most common systems involved were respiratory (93%), skin (93%), cardiovascular (26%), and neurologic (26%). Features distinguishing the 11 patients requiring intensive care included latex agents (45%), nonenteral route of exposure (91%), and presence of cardiovascular symptoms (45%). Of the 17 patients with known past anaphylaxis, only 5 had epinephrine self-administration devices available, and 3 had used them. CONCLUSIONS (1) Most patients with anaphylaxis present with skin or respiratory symptoms. (2) Severely ill children more commonly have nonenteral and/or latex exposures that occur in the hospital. (3) Most children with anaphylaxis have no stated histories of prior reaction to the causative agent. (4) Those patients who have had past episodes of anaphylaxis infrequently have epinephrine self-administration devices available for use.