Food-induced anaphylaxis in children less than 2 years of age

Introduction:
Anaphylaxis is an acute, life-threatening condition representing a systemic hypersensitivity reaction, particularly triggered by food in young children. Its rising prevalence in the paediatric population has made it a critical topic in clinical practice, with epinephrine as the recommended treatment.

Aim:
This study aimed to characterize severe allergic reactions in children aged 0–2 years, focusing on gender, age, allergens, symptoms, and treatments applied.

Material and methods:
A retrospective study was conducted using the hospital database to review anaphylaxis cases in children under 2 years of age hospitalized in a paediatric allergy department.

Results:
Between 2014 and 2023, 87 patients (54 boys; mean age: 12.3 months, median age: 10 months, range: 4–24 months) with anaphylaxis were admitted to our department, comprising approximately 1% of all annual paediatric hospitalizations. The average onset time for symptoms was 17 min. Cow’s milk and hen’s egg were the most frequent triggers. Mucocutaneous symptoms (urticaria, angioedema; 81 patients; 93.1%) often appeared with respiratory symptoms. Asthma and hen’s egg protein allergy were identified as risk factors for more severe reactions. Grade 4 anaphylaxis was observed in 38 cases (approximately 43% of all cases), though only 8 patients (10.5% of patients who received medication administered by professional staff) received epinephrine. Glucocorticosteroids were the most common treatment administered by medical staff.

Conclusions:
Anaphylaxis is a multifaceted, life-threatening condition in infants, with significant diagnostic challenges. Our findings confirm insufficient use of epinephrine in managing severe allergic reactions in this age group.