Modified criteria helping Mass General treat pediatric allergic reactions
Infants and toddlers can be challenging to evaluate partly because of their limited ability to communicate symptoms, authors say.
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A Mass General team has developed modified criteria that may help healthcare professionals more accurately identify anaphylaxis, a potentially life-threatening allergic reaction, in infants and young children.
In a study published in the Journal of Allergy and Clinical Immunology: In Practice, researchers cited an urgent need for training clinicians to recognize and manage anaphylaxis in a young patient population that is often difficult to diagnose.
Infants and toddlers younger than 3 years old can be challenging to evaluate partly because of their limited ability to communicate symptoms, said senior author Dr. Michael Pistiner, director of Food Allergy Advocacy, Education and Prevention at Mass General for Children.
"We're proposing modifications to current anaphylaxis criteria that consider age-specific symptoms and signs that are often overlooked or under-recognized," he said. "We believe our work will lead to more widespread recognition of a condition which is a true medical emergency."
WHAT'S THE IMPACT
Anaphylaxis is a serious systemic allergic reaction with a rapid onset that can result in death if not treated quickly. Among its common triggers are bee stings, peanuts, shellfish and some medications.
Over the last few decades, increasing rates of anaphylaxis have been reported worldwide, particularly in infants, authors said. In the U.S., hospitalizations among children from food-induced anaphylaxis have been on the rise.
In 2006, the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID-FAAN) proposed and adopted criteria designed to help clinicians identify patients likely to be experiencing anaphylaxis. In 2020, the World Allergy Organization (WAO) proposed modifications, though neither organization's criteria have been validated in infants and toddlers less than two years of age.
Mass General researchers set out to fill the gaps they perceived in those guidelines by identifying signs and symptoms that more precisely capture anaphylaxis in young children and incorporating them into a modified criteria. In addition to commonly recognized symptoms like hives, swelling and vomiting, their modifications include less recognized signs such as lethargy, inconsolability, coughing, diarrhea, cyanosis and rapid heart rate with no other explanation.
Based on a review of 337 cases of infants (less than 12 months), toddlers (12 to 36 months) and children (greater than 36 months) treated for suspected allergic or anaphylactic reactions in the pediatric emergency department of Mass General for Children, they evaluated their updated criteria against the current clinical standard and found that the NIAID/FAAN criteria identified 85% of all allergic/anaphylaxis encounters in the pediatric emergency department, while their expanded criteria captured 98% of such encounters.
Compared to existing standards, the modified criteria improved identification performance nearly 23% among infants, and more than 10% among toddlers.
The team also emphasized the need for enhanced training nationally of healthcare professionals – particularly clinicians without extensive pediatric experience – to recognize the unique signs of anaphylaxis presentation in infants and toddlers.
THE LARGER TREND
Over the last few decades, increasing rates of anaphylaxis have been reported worldwide, particularly in infants, the authors said. In the U.S., hospitalizations among children from food-induced anaphylaxis have been on the rise.
ON THE RECORD
"Some of our modifications are designed to accommodate the inability of infants to verbally express such symptoms as 'my tummy hurts,' 'my tongue is itchy,' or 'I'm dizzy,'" said Dr. Anna Handorf, a pediatrics specialist at Mass General for Children and co-first author. "For these cases, we've added surrogate signs such as infants pulling their legs up to their chest, and crying as a proxy for abdominal pain."
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
