Available online 20 May 2024

What is already known about this topic?

Prior publications, including the recently published Anaphylaxis Practice Parameter Updates, have identified knowledge gaps in the recognition of anaphylaxis in infants and toddlers.

What does the article add to our knowledge?

We developed modified clinical criteria for likely anaphylaxis that incorporated symptoms/signs specific to infants and young children.

How does the study impact current management guidelines?

Utilization of modified criteria may enhance identification of anaphylaxis in infants and potentially toddlers compared to the existing clinical criteria.

Current clinical criteria for identifying anaphylaxis do not account for unique aspects of infant anaphylaxis presentation and have not been validated in patients less than two years of age. This may contribute to under recognition and is thus an unmet need.

To demonstrate age-specific signs and symptoms that more accurately identify anaphylaxis in young children and to develop and compare modified criteria for “likely anaphylaxis” against the widely used 2006 National Institute of Allergy and Infectious Diseases / Food Allergy and Anaphylaxis Network criteria.

Retrospective chart review of 175 clinical encounters presenting with suspected allergic or anaphylactic reactions to a pediatric emergency department. Modified criteria for likely anaphylaxis were developed and evaluated against the NIAID/FAAN criteria.

The study population included 33% infants (ages < 12 months), 39% toddlers (ages 12 months to < 36 months), and 29% children (ages ≥ 36 months). The NIAID/FAAN criteria captured 85% of all patient encounters in the study while the modified criteria captured 98% (p < 0.001). Compared to NIAID/FAAN criteria, modified criteria had 22.8% improved performance among infants (p < 0.001) and 10.3% improved performance among toddlers (p = 0.04).

We developed modified anaphylaxis clinical criteria that incorporated symptoms specific to infants and young children. The modified criteria increased identification of anaphylaxis in infants and potentially toddlers. Future research is needed to validate our findings on a larger cohort.

© 2024 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology