Background: Several factors that increase the risk of severe food-induced
anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced
anaphylaxis in early childhood and also any other factors associated with severe
anaphylaxis. Methods: We carried out a medical chart review of
anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced
anaphylaxis episodes were included in the study. The median (interquartile range) age of the first
anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The
anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food
allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%).
Epinephrine was administered in only 98 (36.8%) of these
anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe
anaphylaxis: the presence of
angioedema and
hoarseness during the anaphylactic episode.
Urticaria was observed less frequently in patients who developed
hypotension. In addition,
confusion and
syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant
hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe
anaphylaxis episodes. The presence of
angioedema and
hoarseness in any patient who presents with a history of food-induced
anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of
confusion,
syncope, or
stridor probably indicates concomitant
hypotension.