A severe allergic reaction in an infant is a frightening experience for any parent, but new research offers reassuring insights into how these emergencies unfold and respond to treatment. According to a study published in Pediatric Emergency Care, anaphylaxis in babies and toddlers is most often triggered by food, and most children treated with epinephrine require only one dose. However, some need additional treatment, reinforcing the importance of having two doses readily available.
Led by Dr Colleen M Shannon and researchers from the Children’s Hospital of Philadelphia, the study examined emergency department visits involving children up to two years old between June 2019 and June 2022. Among 155 confirmed cases of anaphylaxis, the median age was approximately 11 months. Food was responsible for an overwhelming 96.1% of reactions, highlighting its role as the leading trigger of anaphylaxis among the young children studied.
Recognizing anaphylaxis in babies can be especially difficult because they cannot explain what they are feeling. Nearly every child in the study (99.4%) experienced symptoms affecting the skin or mucous membranes, including hives, swelling, or redness. Digestive symptoms, such as vomiting, occurred in 74.2% of cases, while breathing symptoms, including coughing or wheezing, affected 57.4%. Symptoms involving the heart or circulation were much less common, occurring in just 5.8% of patients.
When it came to emergency care, most children responded to treatment without requiring repeated doses of epinephrine. Intramuscular epinephrine was administered to 87.1% of patients, and among those who received it, 90.4% were given only a single dose. Overall, 88.4% of the children were discharged directly home from the emergency department. None of those admitted to the hospital required additional epinephrine after admission. The report does not establish whether every epinephrine dose was administered in the emergency department or before arrival.
The researchers concluded that anaphylaxis in this age group was overwhelmingly food-triggered, most often causing skin symptoms accompanied by digestive problems or breathing difficulties. Severe heart, circulation, or respiratory complications were uncommon, and most children recovered without requiring repeated epinephrine doses or extended hospital care. However, because the study examined children treated in a pediatric emergency department, its findings may not represent every case of anaphylaxis in infants and toddlers.
Despite epinephrine’s effectiveness, recognizing anaphylaxis in infants remains a major challenge. In an earlier clinical discussion referenced by the report, Dr Jay Lieberman, a professor at the University of Tennessee Health Science Center, explained how easily symptoms can be overlooked or mistaken for ordinary infant behavior. Inconsolable crying, unusual fussiness, sticking fingers into the mouth, or repeatedly tugging at the ears may indicate itching in the mouth, throat, or ears. Sudden vomiting can also be mistaken for a stomach bug rather than a sign of a serious allergic reaction, especially when other symptoms are subtle.
For parents and caregivers, the message is encouraging but also a reminder to remain vigilant. Most infants in the study recovered after receiving a single dose of epinephrine, but some required more than one dose. Epinephrine remains the first-line treatment for anaphylaxis at any age, and treatment should never be delayed when anaphylaxis is suspected. As Dr Lieberman emphasized: “Infants shouldn’t be treated any differently. If we think they’re having anaphylaxis, they should get epinephrine.”
- Infant Anaphylaxis Often Resolves After a Single Epinephrine Dose — HCPLive
- Anaphylaxis in Infants and Toddlers Presenting to a Pediatric Emergency Department — Pediatric Emergency Care
