CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

CHILDHOOD ANAPHYLAXIS: INCIDENCE AND EPIDEMIOLOGY

Dilek Kacar1 Özlem Cavkaytar2

1İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Immunology and Allergic Diseases, İstanbul, Türkiye
2İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Immunology and Allergic Diseases, İstanbul, Türkiye

Kacar D, Cavkaytar Ö. Childhood Anaphylaxis: Incidence and Epidemiology. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.11-22.

ABSTRACT

Anaphylaxis is rarely observed in children and constitutes a severe, life-threatening systemic allergic reaction. Although its exact incidence remains unclear, recent data indicate a growing trend in anaphylaxis incidence worldwide. According to current literature, the annual incidence of anaphylaxis in the general population ranges from 50 to 112 cases per 100,000 individuals. In children, anaphylaxis occurs more frequently than in adults, with a notably pronounced increase among younger age cohorts. However, variations in diagnostic criteria and the diversity of regional health record systems lead to a wide range of reported incidence rates for childhood anaphylaxis ranging from 1 to 761 cases per 100,000 children. An increasing number of pediatric anaphylaxis cases has also been noted in Türkiye. A regional study conducted in Istanbul reported an annual incidence of approximately 1.95 per 100,000 children, whereas a national analysis covering 2015-2021 indicated a 1.23-fold rise in incidence. During childhood, anaphylaxis is seen more often in males, whereas in adolescence and adulthood, it becomes more common in females. The etiology in pediatric populations varies by age; nevertheless, food allergens, medications, and insect venoms-particularly from bees-are the most frequently implicated triggers. In infancy, anaphylaxis is rare and nearly always triggered by food. Although food allergies remain the primary cause in preschool-aged children, medications begin to appear as occasional contributors. From school age onward, a marked increase in venom-induced anaphylaxis is observed, which continues into adolescence, where it can become as common as food-induced episodes. Despite the potential fatality of anaphylaxis at any age, mortality rates in pediatric patients remain notably low. Current evidence suggests that, although the incidence of anaphylaxis is on the rise, mortality has stayed at a relatively low level, underscoring the lifesaving value of early recognition and prompt treatment. Enhancing the education of healthcare professionals and the general public, alongside strengthening rapid response systems, is essential for effectively reducing the overall burden of anaphylaxis.

Keywords: Childhood anaphylaxis; Epidemiology; Incidence; Trigger; Etiology

Referanslar

  1. Cardona V, Ansoteguib IJ, Ebisawac M, El-Gamald Y, Rivase MF, Finemanf, S et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472. [Crossref]  [PubMed]  [PMC]
  2. Kemp SF, Lockey RF. Anaphylaxis: A review of causes and mechanisms. Journal of Allergy and Clinical Immunology. 2002;110(3):341-348. [Crossref]  [PubMed]
  3. Tsujimura Y, Obata K, Mukai K, Shindou H, Yoshida M, Nishikado H, et al. Basophils play a pivotal role in immunoglobulin-G-mediated but not immunoglobulin-E-mediated systemic anaphylaxis. Immunity. 2008;28(4):581-589. [Crossref]  [PubMed]
  4. Muraro A, Worm M, Alviani C, Cardona V, DunnGalvin A, Garvey LH, et al. EAACI guidelines: Anaphylaxis (2021 update). Allergy: European Journal of Allergy and Clinical Immunology. 2022;77(2):357-377. [Crossref]  [PubMed]
  5. Tejedor Alonso MA, Moro Moro M, Múgica García M V. Epidemiology of anaphylaxis. Clinical and Experimental Allergy. 2015;45(6):1027-1039. [Crossref]  [PubMed]
  6. Decker WW, Campbell RL, Manivannan V, Anuradha Luke A, Sauver JL, Weaver A, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol. 2008;122(6):1161-1165. [Crossref]  [PubMed]  [PMC]
  7. Shen Y, Li L, Grant J, Grant J, Rubio A, Zhao Z, Zhang X, et al. Anaphylactic deaths in Maryland (United States) and Shanghai (China): a review of forensic autopsy cases from 2004 to 2006. Forensic Sci Int. 2009;186(1-3):1-5. [Crossref]  [PubMed]
  8. Celiksoy MH, Ulas S, Turan I, Yıldırım I, Ucar OT, Al S. Characteristics of childhood anaphylaxis in different age Kacar, Cavkaytar Childhood Anaphylaxis: Incidence and Epidemiology groups. Allergol Immunopathol (Madr). 2024;52(5):1-5. [Crossref]  [PubMed]
  9. Bilò MB, Corsi A, Martini M, Penza E, Grippo F, Bignardi D. Fatal anaphylaxis in Italy: Analysis of cause-of-death national data, 2004-2016. Allergy. 2020;75(10):2644-2652. [Crossref]  [PubMed]
  10. Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015;135(4):956-963.e1. [Crossref]  [PubMed]  [PMC]
  11. Soyak Aytekin E, Şirin S, Kıratlı Nalbant E, Ata N, Sertçelik A, Ülgü MA, et al. Changes in anaphylaxis trends and characteristics in emergency department admissions in Türkiye: From 2015 to 2021 based on the Ministry of Health database. World Allergy Organ J. 2024;18(1):101019. [Crossref]  [PubMed]  [PMC]
  12. Shaker MS, Wallace DV., Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. [Crossref]  [PubMed]
  13. Grabenhenrich LB, Dölle S, Moneret-Vautrin A, Kohli A, Lange L, Spindler T, et al. Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. J Allergy Clin Immunol. 2016;137(4):1128-1137.e1. [Crossref]  [PubMed]
  14. Orhan F, Canitez Y, Bakirtas A, Yilmaz O, Boz AB, Can D, et al. Anaphylaxis in Turkish children: a multi-centre, retrospective, case study. Clin Exp Allergy. 2011;41(12):17671776. [Crossref]  [PubMed]
  15. Cetinkaya F, Incioglu A, Birinci S, Karaman BE, Dokucu AI, Sheikh A. Hospital admissions for anaphylaxis in Istanbul, Turkey. Allergy. 2013;68(1):128-130. [Crossref]  [PubMed]
  16. Cambaz Kurt N, An overview of anaphylaxis in children. REVIEW Zeynep Kamil Med J. 2021;52(3):116-120. [Crossref]
  17. Aydogan M, Topal E, Yakici N, Acar HC, Demirkale ZH, Arga M, et al. Food-induced anaphylaxis in early childhood and factors associated with its severity. Allergy Asthma Proc. 2021;42(5):E135-E144. [Crossref]  [PubMed]
  18. Civelek E, Erkoçoğlu M, Akan A, Özcan C, Kaya A, Vezir E, et al. The Etiology and Clinical Features of Anaphylaxis in a developing country: A nationwide survey in Turkey. Asian Pac J Allergy Immunol. 2017;35(4):212-219.
  19. Comberiati P, Spahn J, Peroni DG. Anaphylaxis in adolescents. Curr Opin Allergy Clin Immunol. 2019;19(5):425-431. [Crossref]  [PubMed]
  20. Panesar SS, Javad S, De Silva D, Nwaru BI, Hickstein L, Muraro A, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68(11):1353-1361. [Crossref]  [PubMed]
  21. Perez-Codesido S, Rosado-Ingelmo A, Privitera-Torres M, Pérez Fernández E, Nieto-Nieto A, Gonzalez-Moreno A, et al. Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies. J Investig Allergol Clin Immunol. 2022;32(4):245-260. [Crossref]  [PubMed]
  22. Höfer V, Dölle-Bierke S, Francuzik W, Wedi B, Cardona V, Worm M, et al. Fatal and Near-Fatal Anaphylaxis: Data From the European Anaphylaxis Registry and National Health Statistics. J Allergy Clin Immunol Pract. 2024;12(1):96-105.e8. [Crossref]  [PubMed]
  23. Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL. Increasing Emergency Department Visits for Anaphylaxis, 2005-2014. J Allergy Clin Immunol Pract. 2017;5(1):171-175.e3. [Crossref]  [PubMed]
  24. Chaaban MR, Warren Z, Baillargeon JG, Baillargeon G, Resto V, Kuo YF. Epidemiology and trends of anaphylaxis in the United States, 2004-2016. Int Forum Allergy Rhinol. 2019;9(6):607-614. [Crossref]  [PubMed]
  25. Lieberman P. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2008;8(4):316-320. [Crossref]  [PubMed]
  26. Yu JE, Lin RY. The Epidemiology of Anaphylaxis. Clin Rev Allergy Immunol. 2018;54(3):366-374. [Crossref]  [PubMed]
  27. Turner PJ, Campbell DE, Motosue MS, Campbell RL. Global Trends in Anaphylaxis Epidemiology and Clinical Implications. J Allergy Clin Immunol Pract. 2020;8(4):1169-1176. [Crossref]  [PubMed]  [PMC]
  28. Jeong K, Lee JD, Kang DR, Lee S. A population-based epidemiological study of anaphylaxis using national big data in Korea: trends in age-specific prevalence and epinephrine use in 2010-2014. Allergy Asthma Clin Immunol. 2018;14(1). [Crossref]  [PubMed]  [PMC]
  29. Lee MH, Roh EJ, Jung YM, Ahn Y, Chung EH. Characteristics of anaphylaxis patients who visited emergency departments in Korea: Results from a national emergency department information system. PLoS One. 2022;17(4). [Crossref]  [PubMed]  [PMC]
  30. Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy. 2019;74(6):1063-1080. [Crossref]  [PubMed]
  31. Liu FC, Chiou HJ, Kuo CF, Chung TT, Yu HP. Epidemiology of Anaphylactic Shock and its Related Mortality in Hospital Patients in Taiwan: A Nationwide Population-Based Study. Shock. 2017;48(5):525-531. [Crossref]  [PubMed]
  32. Wang Y, Koplin JJ, Ho MHK, Wong WHS, Allen KJ. Increasing hospital presentations for anaphylaxis in the pediatric population in Hong Kong. J Allergy Clin Immunol Kacar, Cavkaytar Childhood Anaphylaxis: Incidence and Epidemiology Pract. 2018;6(3):1050-1052.e2. [Crossref]  [PubMed]
  33. Ikegawa K, Morikawa E, Nigo A, Hataya H, Akasawa A. Epidemiology of anaphylaxis and biphasic reaction in Japanese children. Acute medicine & surgery. 2021;8(1). [Crossref]  [PubMed]  [PMC]
  34. Su Y, Wen J, Zhang H, Zou Z, Cai Y, Zhang C. Clinical Characteristics of Anaphylaxis in Children Aged 0-16 Years in Xi'an, China. Int Arch Allergy Immunol. 2023;184(3):220-227. [Crossref]  [PubMed]  [PMC]
  35. Tanno LK, Briand Y, Mary M, Khan DA, Sublett JL, Corbett ML, et al. Optimization of the allergen classification of the International Classification Of Diseases, 11th Revision (ICD-11). J Allergy Clin Immunol. 2023;151(6):1655-1659. e3. [Crossref]  [PubMed]
  36. Mullins RJ, Dear KBG, Tang MLK. Changes in Australian food anaphylaxis admission rates following introduction of updated allergy prevention guidelines. J Allergy Clin Immunol. 2022;150(1):140-145.e1. [Crossref]  [PubMed]
  37. Lee AYM, Enarson P, Clarke AE, Vieille SL, Eisman H, Chan ES, et al. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities. J Asthma Allergy. 2016;10:1-7. [Crossref]  [PubMed]  [PMC]
  38. Mullins RJ, Camargo CA. Latitude, sunlight, vitamin D, and childhood food allergy/anaphylaxis. Curr Allergy Asthma Rep. 2012;12(1):64-71. [Crossref]  [PubMed]
  39. Losol P, Sokolowska M, Hwang YK, Ogulur I, Mitamura Y, Yazici D, et al. Epithelial Barrier Theory: The Role of Ex posome, Microbiome, and Barrier Function in Allergic Diseases. Allergy Asthma Immunol Res. 2023;15(6):705-724. [Crossref]  [PubMed]  [PMC]
  40. Celebi Sozener Z, Ozdel Ozturk B, Cerci P, Turk M, Akin BG, Akdis M, et al. Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease. Allergy. 2022;77(5):1418-1449. [Crossref]  [PubMed]  [PMC]
  41. Brough HA, Lanser BJ, Sindher SB, Teng JMC, Leung DYM, Venter C, et al. Early intervention and prevention of allergic diseases. Allergy. 2022;77(2):416-441. [Crossref]  [PubMed]
  42. Celebi Sözener Z, Cevhertas L, Nadeau K, Akdis M, Akdis CA. Environmental factors in epithelial barrier dysfunction. J Allergy Clin Immunol. 2020;145(6):1517-1528. [Crossref]  [PubMed]
  43. Kim S, Damialis A, Charalampopoulos A, Voelker DH, Rorie AC. The Effect of Climate Change on Allergen and Irritant Exposure. J Allergy Clin Immunol Pract. 2025;13(2). [Crossref]  [PubMed]
  44. Pacheco SE, Guidos-Fogelbach G, Annesi-Maesano I, Pawankar R, Amato GD, Latour-Staffeld P, et al. Climate change and global issues in allergy and immunology. J Allergy Clin Immunol. 2021;148(6):1366-1377. [Crossref]  [PubMed]
  45. Tarczoń I, Cichocka-Jarosz E, Knapp A, Kwinta P. The 2020 update on anaphylaxis in paediatric population. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2021;39(1):13. [Crossref]  [PubMed]  [PMC]