CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

TYPICAL AND ATYPICAL SYMPTOMS OF ANAPHYLAXIS IN CHILDREN

Yusuf Ziya Varlı

Kocaeli University, Faculty of Medicine, Department of Pediatric Immunology and Allergic Diseases, Kocaeli, Türkiye

Varlı YZ. Typical and Atypical Symptoms of Anaphylaxis in Children. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.191-199.

ABSTRACT

Anaphylaxis in children is a rapidly evolving, life-threatening hypersensitivity reaction that affects multiple organ systems and can be fatal if not promptly recognized. The clinical course in pediatric patients markedly differs from that in adults due to age-related differences in immune responses and the distribution of triggers.

Typical symptoms often involve cutaneous and mucosal manifestations, such as urticaria, angioedema, flushing, and pruritus, although 10-20% of cases may present without these skin findings. The respiratory system is commonly involved, with signs like cough, dyspnea, wheezing, and bronchospasm; in severe cases, “silent lung” may be observed. Gastrointestinal symptoms, particularly in food-related anaphylaxis, such as sudden abdominal pain, nausea, vomiting, and diarrhea, are also considered typical. Cardiovascular involvement, marked by systemic vasodilation and volume loss, presents with hypotension, weak pulses, pallor, and prolonged capillary refill time; bradycardia, syncope, or cardiac arrest may occur in severe cases. Neuropsychiatric signs such as a “sense of impending doom” or anxiety are typically reported by older children and adolescents.

Atypical manifestations may include isolated gastrointestinal symptoms, hoarseness, throat itching or tightness, dysphonia, behavioral changes (e.g., unexplained quietness, clinginess, or irritability), or lethargy in young children. Recognition of these atypical features can be particularly challenging in infants, who cannot verbalize their symptoms, or in individuals with developmental delay, cognitive impairment, or speech disabilities.

In conclusion, the diagnosis of anaphylaxis in children requires a comprehensive evaluation of both typical and atypical presentations. Enhancing clinical awareness is crucial to ensure early recognition and prompt intervention, as the absence of cutaneous signs does not rule out anaphylaxis, and delays in treatment can have serious prognostic implications.

Keywords: Anaphylaxis; Atypical presentation; Children; Diagnosis; Symptoms

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