Anaphylaxis : a 7 - Year Follow - up Survey of 46 Children

symptoms, or hypotension. The reaction was considered mild if the symptoms were primarily limited to generalized urticaria and did not require treatment in an emergency department; the reaction was considered to be moderate if a hospital or emergency department visit was initiated for treatment and the symptoms were treated with epinephrine; and the event was considered to be severe if there was hypotension. Results. A total of 898 patients were identified, and a random sample of 70 (9%) cases with a coded diagnosis and 50 (43%) cases with a comment diagnosis underwent additional evaluation. Relevant information on the diagnosis was available for 90% of these cases. Criteria for anaphylaxis was met in 87 of the 120 cases, so that an estimated 675 cases of the total 783 were estimated to have confirmed anaphylaxis, resulting in an incidence of 8.4 cases per 100 000 person-years. Insect stings were responsible for 32% and medications for 30% of cases. Food was implicated in 22% of cases, and more than half of these were due to a tree nut or peanut. Severity of the cases was as follows: mild, 29%; moderate, 45%; severe, 9%; indeterminate, 17%. One death was identified. Conclusions. In the United Kingdom, the estimated incidence rate of anaphylaxis was 8.4 cases per 100 000 person-years, and 10% of these cases were life threatening. Reviewer’s Comments. Although anaphylaxis is a relatively uncommon event, 10% of cases are characterized by hypotension. The estimated percentage of severe, lifethreatening events would have been even higher if lowerairway symptoms were considered as a manifestation of severe anaphylaxis. Physicians evaluating patients with suspected allergic reactions should be prepared to treat life-threatening symptoms.