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Pediatric Anaphylaxis

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Summary

Anaphylaxis is a type of allergic reaction. Specifically, it is a whole-body reaction to a chemical that becomes an allergen.

Anaphylaxis is severe; indeed, physicians consider it life-threatening. It occurs rapidly after exposure and involves a child’s entire body.

It can occur within seconds or minutes of exposure to something the child is allergic to, such as a peanut or the venom from a bee sting. For instance, after suffering a bee sting, your child’s immune system becomes sensitized to the venom. That means that when your child is again exposed to the allergen, he may suffer an allergic reaction.

Besides insect bites and stings, common causes include drug and food allergies. About 3 million youngsters have a food allergy.

Eight foods account for most of the reactions:

  • Milk
  • Eggs
  • Peanuts
  • Tree nuts
  • Wheat
  • Soy
  • Fish
  • Shellfish

Due to its life-threatening nature and its rapidity, anaphylaxis is an emergency condition that will require a 911 call. Your child needs immediate medical attention. Prompt treatment and appropriate therapy will lessen the symptoms and save your child’s life.

Symptoms

Symptoms

During an anaphylactic reaction, the body’s immune system releases a flood of chemicals. This can cause anaphylactic shock, when blood pressure suddenly drops and breathing airways narrow. Breathing and heartbeat can both stop. That’s why it is critical to get your child to an emergency room right away.

The rapidly developing symptoms include:

  • Abdominal pain
  • Abnormal breathing sounds
  • Chest discomfort or tightness
  • Cough
  • Diarrhea
  • Difficulty breathing or swallowing
  • Dizziness
  • Nasal congestion
  • Nausea or vomiting
  • Swelling of the face, eyes or tongue
  • Unconsciousness

To prevent anaphylaxis, parents are advised to keep children away from foods and medications that caused past allergic reactions. If your child is allergic to certain foods, be careful when the family is eating out. Ask detailed questions about the ingredients in a menu serving. At the grocery store, carefully examine ingredient labels. At home, introduce your child to one new food at a time, and only in small amounts. That way, you will better be able to recognize an allergic reaction.

When you take your child for medical treatment, a physician’s first priority is a physical examination. This will assess the child’s airway, breathing and circulation. Your doctor will also assess alertness and orientation. During the clinical diagnosis for anaphylaxis, the physician will ask parents about their children’s allergies or previous allergic reactions.

Epinephrine is the most effective immediate treatment. It reverses the most serious symptoms (breathing and dangerous blood-pressure drop).

Test & Diagnosis

Test & Diagnosis

When you take your child for medical treatment, a physician’s first step is a physical examination. This will assess the child’s airway, breathing and circulation. Your doctor will also assess alertness and orientation.

Examination findings may include:

  • Restlessness and anxiety
  • Severe angioedema, or rapid swelling of the tongue and lips
  • Tachypnea, or rapid breathing
  • Stridor, an abnormal, high-pitched breathing sound caused by a blockage in the throat or the larynx
  • Loss of voice, hoarseness, wheezing or dysphonia (difficulty speaking due to spasms of the muscles that control the vocal cords)
  • Neurologic issues such as altered mental activity and depressed level of consciousness
  • Hives anywhere on the body
  • Gastrointestinal disorders such as vomiting, diarrhea and abdominal distention

During the clinical diagnosis for anaphylaxis, the physician will ask parents about their child’s allergies or previous allergic reactions. Typical questions include:

  • Do any particular foods seem to cause a reaction?
  • Is your child taking any medications? Do any seemed linked to symptoms?
  • Has exposure to latex triggered allergy symptoms?
  • Have stings or bites from any particular insect seemed to have caused symptoms?

Your doctor also may test your child for:

  • Food allergies
  • Medication allergies
  • Causes of IgE-independent reactions

Blood tests for tryptase or histamine might be helpful in diagnosing anaphylaxis due to insect stings or medications. These tests have only limited use if the cause is food.

Lab studies are not usually required and are rarely helpful. But if the diagnosis is unclear, or if other diseases need to be ruled out, the physician may order:

  • Plasma/urinary histamine and serum tryptase assessment, to help confirm diagnosis of anaphylaxis
  • Urinary 24-hour 5-hydroxyindoleacetic acid levels, if carcinoid syndrome is a consideration
  • Skin testing, in vitro immunoglobulin E (IgE) tests or both to determine the stimulus for the anaphylactic reaction
Treatments

Treatments

Treatment for anaphylaxis begins at home with the parent. An anaphylactic reaction is an emergency situation that requires immediate medical attention. Waste no time. Call 911.

While awaiting the arrival of paramedics:

  • Check your child’s airway breathing and circulation. Dangerous throat swelling could be occurring, and a hoarse or whispered voice is an indicator. If necessary, start rescue breathing and CPR. Stay calm to reassure your child.
  • If the reaction results from a bee sting, scrape the stinger off with a firm object. Don’t use tweezers; squeezing the stinger results in more venom release.
  • To prevent shock, have your child lie flat. Raise her feet about 12 inches, and then cover her with a blanket.

What the paramedics will do

Paramedics may perform endotracheal intubation (placing of a tube through the nose or mouth into the airways), or they may perform a tracheostomy (placing a tube into the trachea).

After lifesaving measures and epinephrine are administered, your child may receive antihistamines, such as diphenhydramine, and corticosteroids, such as prednisone. This will further improve symptoms, reducing inflammation of air passages and improving breathing.

The emergency professionals might also administer a beta-agonist, such as albuterol, to relieve breathing symptoms or oxygen to improve restricted breathing.

Helpful Medication

Epinephrine is the most effective immediate treatment. If administered in time, it can reverse the life-threatening symptoms of anaphylactic shock, which include serious breathing problems and a dangerous drop in blood pressure.

Following epinephrine, antihistamines and steroid drugs like prednisone and methylprednisolone can help reduce hives and itching, as well as forestall the return of acute symptoms.

For allergic reactions related to insect stings or foods, your doctor can provide you with an epinephrine injection kit. If your child’s anaphylactic reaction is caused by stings, a series of allergy shots may reduce his body's allergic response and prevent a severe reaction in the future

 

Resources

Resources

For more information about anaphylaxis, please visit the following sites:

For general information about causes, symptoms, treatment and prevention:
U.S. National Library of Medicine

Here’s a brief explanation of anaphylaxis in children, and what might trigger it.
Medscape

This page has more information about causes, symptoms, and how to prepare for an emergency.
KidsWithFoodAllergies.org

This page has specific information about anaphylaxis in infants.
BabyCenter

FAQs

FAQs

What causes anaphylaxis?

Common causes include drug allergies, food allergies and insect bites or stings. After being exposed to a substance such as bee sting venom, a person’s immune system becomes sensitized to it. Anaphylaxis can occur in response to any allergen. Less common causes of anaphylaxis include latex, medications used in anesthesia and exercise.

What are the symptoms of anaphylaxis?

Typical symptoms include itchy red skin, coughing, vomiting, sneezing and watery, red eyes. Such symptoms indicate that the body is trying to rid itself of the allergen. Symptoms such as difficulty in breathing or low blood pressure are life-threatening.

How soon do symptoms appear?

Symptoms can occur within minutes of exposure to an allergen. However, anaphylaxis also can occur a half-hour or longer from exposure.

What are the most common food allergies?

The most common food allergy before 4 years of age is milk allergy. More than 170 foods can cause food allergies, but more than 90 % of food allergies are caused by milk, wheat, soy, egg, tree nuts, peanuts, shellfish and fish.

How can you prevent an anaphylactic response?

The standard treatment is strict avoidance of the allergen and carrying two epinephrine injectors with you or with your child at all times. For food allergies, learn to read food labels to protect against accidental exposure to an allergen. Food labels are required to clearly identify if the food contains any of eight specific food allergy sources (milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soy.)

Why is anaphylaxis life-threatening?

Possible complications include airway blockage, cardiac arrest (when the heart stops,) respiratory arrest (when breathing stops) and shock.

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