Anaphylaxis in Chinese Children with Pollen Sensitization: Triggers, Clinical Presentation, and Acute Management

Abstract

Purpose

Pollen sensitization is increasing in children. However, there is little evidence regarding the characteristics of anaphylaxis in individuals with pollen sensitization.

Patients and Methods

We conducted a retrospective study of patients with anaphylaxis combined with pollen sensitization who attended an allergy department in a tertiary children’s hospital from 2014 to 2021.

Results

A total of 157 anaphylaxis events in 108 patients were analyzed; the mean age at the reaction was 5.8 ± 4.17 years. A total of 99.1% (107/108) of the patients came from northern China. The most common sensitizing pollen was mugwort (93.5%,101/108), followed by ragweed (68.5%, 74/108) and birch (40.7%, 44/108). A total of 76.9% (83/108) of the patients showed polysensitization to pollen. Allergic rhinitis/conjunctivitis was the most common comorbidity (87.0%, 94/108). Children with severe anaphylaxis were more likely to have a history of recurrent urticaria (16.1% vs 3.9%, p = 0.028). The most frequently implicated foods were fruits/vegetables (22.3%, 35/157), followed by wheat (8.9%, 14/157) and milk (8.3%, 13/157), and the most common fruit allergen was peach (n = 7). Of 14% (22/157) exercise-induced reactions, 63.6% (14/22) occurred in pollen season. Skin symptoms were the most frequent (86.0%, 135/157) symptoms, followed by respiratory (73.9%, 116/157) and gastrointestinal (21%, 33/157) symptoms. Regarding acute management, only 7.4% of the patients were treated with epinephrine.

Conclusion

Our findings revealed the characteristics of anaphylaxis in children with pollen sensitization. Fruits/vegetables accounted for a substantial percentage of anaphylaxis triggers. The suboptimal use of epinephrine highlights the need for educational programs promoting the use of epinephrine.

Keywords:

• anaphylaxis
• pollen
• exercise
• epinephrine

Abbreviations

FDEIA, food-dependent exercise-induced anaphylaxis; LTP, lipid transfer proteins; EAI, epinephrine auto-injector; PFAS, pollen-food allergy syndrome; IgE, immunoglobulin E.

Data Sharing Statement

The data and materials are available from the corresponding authors based on reasonable requirement.

Ethics Approval and Informed Consent

This study has been performed in accordance with the principles stated in the Declaration of Helsinki, and the study protocol was approved by the Research and Ethics Board of Beijing Children’s Hospital. (Approval number:2022-E-023-R) Because this study was based on the retrospective analysis of medical electronic record, the informed consent was deemed exempt by the Research and Ethics Board.

Consent for Publication

All authors have approved the manuscript and agree with its submission to the Journal of Asthma and Allergy.

Acknowledgments

We appreciated all the patients and investigators who participated in this study.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by Beijing Hospitals Authority Youth Programme, (code: QML20201203), and Respiatory Research Project of National Clinical Research Center for Respiratory Diseases (code. HXZX-20210203, HXZX-20210204, HXZX-202107).