Evaluation of anaphylaxis in a pediatric emergency department In Italy.

RATIONALE: Anaphylaxis is an acute-onset, systemic allergic reaction, under-diagnosed and undertreated. Data on acute pediatric anaphylaxis presentations to the emergency department (ED) are limited. Aim is to evaluate clinics, management and outcome of anaphylaxis in children. METHODS: Retrospective, cross-sectional study was conducted on all children admitted to ED of Pediatric Dept. Padua, Italy (January 2006-December 2007). Case selection was carried out extracting from the 51000 admissions, all records specific or suggestive for anaphylaxis (ICD-based). From medical records we collected information on personal data, case history, signs and symptoms, management and outcome. Descriptive, bivariate, multivariate analysis were carried out. RESULTS: In the second phase, we identified 67 episodes of anaphylaxis occurring in 63 patients, we calculated the admission rate of 1,3/1000 children referring to ED. There were no fatalities. A cause of anaphylactic reaction was recognized in 59/67 (88%). Causes: food (84,7%), drugs (10%), hymenoptera stings (5,1%). Systems involved: skin (80%), respiratory (50%), gastrointestinal (15%), CNS (15%), cardiovascular (7,5%). 74% of episodes were treated in the ED; 26% of cases were hospitalized. Adrenaline was utilized in 26% of cases. Of the 23 patients (35%) with known past anaphylaxis, only 2 (9%) had self-injectable-adrenaline and 1 used it. CONCLUSIONS: Milk and egg are the most important triggers of anaphylaxis, although nut and peanut are frequent. Most patients present with skin or respiratory symptoms. The most severe cases of anaphylaxis present with respiratory and gastrointestinal symptoms. Adrenaline timely administration does not always occur, partly due to a lack of awareness of the diagnostic criteria.