J Korean Med Sci.  2019 Apr;34(13):e106. 10.3346/jkms.2019.34.e106.

Infantile Anaphylaxis in Korea: a Multicenter Retrospective Case Study

Affiliations
  • 1Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
  • 2Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea. jsjs87@ajou.ac.kr
  • 3Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 5Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Pediatrics, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 7Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
  • 8Department of Pediatrics, Seoul Medical Center, Seoul, Korea.
  • 9Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 10Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
  • 11Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Seoul, Korea.
  • 12Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea. bypyun@schmc.ac.kr

Abstract

BACKGROUND
Anaphylaxis is increasing in young children. The aim of the present study was to analyze the clinical characteristics of anaphylaxis in Korean infants, with a focus on food triggers.
METHODS
The study analyzed the medical records of infants aged 0 to 2 years old who had been diagnosed with anaphylaxis in 23 secondary or tertiary hospitals in Korea.
RESULTS
We identified 363 cases of infantile anaphylaxis (66.9% male). Cutaneous symptoms were most prevalent (98.6%), followed by respiratory (83.2%), gastrointestinal (29.8%), and neurologic (11.6%) symptoms. Cardiovascular symptoms were noted in 7.7% of the cases. Most of the cases of anaphylaxis (338; 93.1%) were induced by foods. The most common trigger food was cow's milk and cow's milk products (43.8%), followed by hen's eggs (21.9%), walnuts (8.3%), wheat (7.7%), peanuts (4.8%), other nuts (3.0%), and fish (2.1%). In cow's milk-induced anaphylaxis cases, more than half the cases had cow's milk specific immunoglobulin E (sIgE) levels that were lower than the diagnostic decision points (DDPs), which is 5 kUA/L for those under the age of 1 and 15 kUA/L for those over the age of 1. In anaphylaxis induced by hen's egg, most of the cases (91.8%) had hen's egg sIgE levels that were higher than the DDP, which is 2 kUA/L for those under the age of 2 and 7 kUA/L for those over the age of 2. Of the infantile anaphylaxis cases, 46.8% had been treated with epinephrine, and 25.1% had been prescribed an epinephrine auto-injector.
CONCLUSION
Cow's milk is the most frequent trigger food of anaphylaxis in Korean infants. However, we found no significant correlation between the sIgE level and clinical severity. Education is required regarding the importance of epinephrine as the first line therapy for anaphylaxis and on properly prescribing epinephrine for infants with a history of anaphylaxis.

Keyword

Anaphylaxis; Epinephrine; Food; Infant

MeSH Terms

Anaphylaxis*
Arachis
Child
Education
Eggs
Epinephrine
Humans
Immunoglobulin E
Immunoglobulins
Infant
Juglans
Korea*
Medical Records
Milk
Nuts
Ovum
Retrospective Studies*
Tertiary Care Centers
Triticum
Epinephrine
Immunoglobulin E
Immunoglobulins
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