Rethinking how anaphylaxis presents

In the August 2019 issue of Contemporary Pediatrics, Dr. Todd A. Mahr, president of the American College of Allergy, Asthma, and Immunology, discusses anaphylaxis and when to have your patient seek specialty care. Anaphylaxis is typically thought of as severe, acute and visibly evident. However, as Dr. Mahr points out, anaphylaxis can present differently in infants and young children.

Avoiding food allergens in society

As Dr. Mahr discusses, food allergies in young children have increased in the past decade, resulting in more emergency department visits for anaphylaxis due to food allergies. It is not uncommon to have at least 1 child with a severe allergy in a classroom or a group of friends. Certain pockets of society have attempted to keep abreast of these changes in our demographics. For instance, a parent can now seek out a peanut-free daycare or school, an entity that was unheard of a generation ago. Since 2006, the US Food and Drug Administration has required food labelling to specify ingredient information related to 8 common food allergens. During Halloween, houses and businesses can display notices that they have non-food items for trick-or-treaters with food allergies. These are positive examples of society acknowledging and accommodating the increasing frequency of severe allergies in our children.

Anaphylaxis recognition

When I was taught about anaphylaxis in school, it was presented as a very serious but obvious diagnosis. The scene from the movie Hitch comes to mind, when Will Smith’s character had progressively swelling eyes, lips, and tongue after shellfish contact. This, portrayed as a comedic reaction in the movie, is what most people think of when they hear the term anaphylaxis. However, the definition from the National Institute of Allergy and Infectious Disease does not require this typical facial swelling and respiratory distress. After exposure to an antigen, symptoms from 2 different systems, for example vomiting and hypotension, can meet the criteria for anaphylaxis. Both adult and pediatric providers need to be able to recognize these less typical anaphylactic presentations and treat them appropriately.

Being prepared for patients with allergies

As more trials and evidence-based research are compiled, recommendations for the introduction of high-risk foods and therapy options for patients with severe allergies have evolved. As Dr. Mahr discusses, all children who have had anaphylaxis should be evaluated by an allergist and be provided with appropriate education for future events. As epinephrine is a life-saving therapy, every pediatric office and urgent care center should have epinephrine readily available for urgent use. As pediatric providers, it is our responsibility to remain current with allergy and anaphylaxis guidelines, and guide our patients’ families through the introduction of foods, navigating an allergen-filled world, and managing any allergies that do occur.