Presence of Asthma May Not Indicate More Severe Anaphylaxis in Children

Children hospitalized for anaphylaxis who have a prior history of asthma may not be more likely than those without any asthma history to experience severe anaphylactic reactions.

A retrospective cohort study of children hospitalized for anaphylaxis between 2009 and 2016 was conducted and the results published in The Journal of Pediatrics.

Investigators sought to evaluate whether a history of asthma was linked to the severity of anaphylaxis in children who were hospitalized for an anaphylactic reaction. The primary study outcome was severe anaphylactic reactions, which were defined by findings from physical examinations (ie, respiratory distress, stridor, or hypotension) or administered treatments (ie, ≥2 doses of intramuscular epinephrine, vasopressors, continuous albuterol, or pressure ventilation). Adjustments were made for patient age, allergen, and history of atopic dermatitis or anaphylaxis in multivariable analyses.

In a total of 603 children who were hospitalized for anaphylaxis, 38.3% (231 of 603) of them had a prior history of asthma. Those children who had a history of asthma were older (median age, 6.6 years vs 4.0 years, respectively), had a higher likelihood of having a history of anaphylaxis (38.1% vs 18.0%, respectively), and were more likely to have food as the inciting allergen (68.0% vs 52.2%, respectively). However, children with a history of asthma were not more likely to experience severe anaphylactic reactions (odds ratio, 0.97; 95% CI, 0.67-1.39).

The major limitations of the current study are related primarily to its retrospective design. This may have led to symptoms, findings from physical examinations, and prior medical history not having been documented accurately in patients’ electronic medical records.

The researchers concluded that the results of the present study support the management of children with anaphylaxis according to the severity of their symptomatology. Thus, if validated, clinicians should not consider the comorbidity of asthma as a sole criterion for hospitalization of children with anaphylactic reactions.

Reference

Dribin TE, Michelson KA, Zhang Y, Schnadower D, Neuman MI. Are children with a history of asthma more likely to have severe anaphylactic reactions? A retrospective cohort study. [published online January 24, 2020]. J Pediatr. doi:10.1016/j.jpeds.2019.12.019