Asia Pac Allergy.  2013 Jan;3(1):29-34. 10.5415/apallergy.2013.3.1.29.

Paediatric anaphylaxis in a Singaporean children cohort: changing food allergy triggers over time

Affiliations
  • 1Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore. woei_kang@yahoo.com.sg
  • 2Respiratory Medicine Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
  • 3General and Ambulatory Paediatrics Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
  • 4Allergy and Immunology Unit, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.

Abstract

BACKGROUND
We have noticed changes in paediatric anaphylaxis triggers locally in Singapore.
OBJECTIVE
We aimed to describe the demographic characteristics, clinical features, causative agents and management of children presenting with anaphylaxis.
METHODS
This is a retrospective study of Singaporean children presenting with anaphylaxis between January 2005 and December 2009 to a tertiary paediatric hospital.
RESULTS
One hundred and eight cases of anaphylaxis in 98 children were included. Food was the commonest trigger (63%), followed by drugs (30%), whilst 7% were idiopathic. Peanut was the top food trigger (19%), followed by egg (12%), shellfish (10%) and bird's nest (10%). Ibuprofen was the commonest cause of drug induced anaphylaxis (50%), followed by paracetamol (15%) and other nonsteroidal anti-inflammatory drugs (NSAIDs, 12%). The median age of presentation for all anaphylaxis cases was 7.9 years old (interquartile range 3.6 to 10.8 years), but food triggers occurred significantly earlier compared to drugs (median 4.9 years vs. 10.5 years, p < 0.05). Mucocutaneous (91%) and respiratory features (88%) were the principal presenting symptoms. Drug anaphylaxis was more likely to result in hypotension compared to food anaphylaxis (21.9% vs. 2.7%, Fisher's exact probability < 0.01). There were 4 reported cases (3.6%) of biphasic reaction occurring within 24 h of anaphylaxis.
CONCLUSION
Food anaphylaxis patterns have changed over time in our study cohort of Singaporean children. Peanuts allergy, almost absent a decade ago, is currently the top food trigger, whilst seafood and bird's nest continue to be an important cause of food anaphylaxis locally. NSAIDs and paracetamol hypersensitivity are unique causes of drug induced anaphylaxis locally.

Keyword

Anaphylaxis; Drug allergy; Food allergy; Paediatrics

MeSH Terms

Acetaminophen
Anaphylaxis*
Anti-Inflammatory Agents, Non-Steroidal
Arachis
Child*
Cohort Studies*
Drug Hypersensitivity
Food Hypersensitivity*
Humans
Hypersensitivity
Hypotension
Ibuprofen
Ovum
Retrospective Studies
Seafood
Shellfish
Singapore
Acetaminophen
Anti-Inflammatory Agents, Non-Steroidal
Ibuprofen
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