Anaphylaxis in Chinese Children: Different Clinical Profile Between Children with and without a History of Asthma/Recurrent Wheezing

Figures & data

Table 1 Characteristics of 264 Children with Anaphylaxis

Characteristics	Total, n=264, n (%)	AS/RW^a, n=119, n (%)	Non-AS/RW, n=145, n(%)	P value (AS/RW vs Non-AS/RW)^d
Onset age
0–2y	141 (53.4)	65 (54.6)	76 (52.4)	0.804
3–6y	55 (20.8)	27 (22.7)	28 (19.3)	0.544
7–12y	53 (20.1)	21 (17.6)	32 (22.1)	0.441
13–17y	15 (5.7)	6 (5.0)	9 (6.2)	0.793
Gender
Male	176 (66.7)	82 (68.9)	94 (64.8)	0.514
Allergic comorbidities
AR/AC^b	185 (70.1)	91 (76.5)	94 (64.8)	0.044^e
AD^c	95 (36.0)	44 (37.0)	51 (35.2)	0.797
Multiple food allergy (not anaphylaxis)	79 (30.0)	32 (27.9)	47 (32.4)	0.347
Chronic urticaria	15 (5.7)	5 (4.2)	10 (6.9)	0.429
Family history	102 (38.6)	58 (48.7)	44 (30.3)	0.003^f
Allergen sensitization
At least 1 areoallergen sIgE positive	163 (61.7)	80 (67.2)	83 (57.2)	0.097
Mold	65 (24.6)	33 (27.7)	32 (22.1)	0.288
Dust mite	51 (19.3)	30 (25.2)	21 (14.5)	0.028^g
Cat dander	54 (20.5)	26 (21.8)	28 (19.3)	0.611
Dog dander	65 (24.6)	35 (29.4)	30 (20.7)	0.102
Mugwort	101 (38.3)	47 (39.5)	54 (37.2)	0.708
Ragweed	74 (28.0)	40 (33.6)	34 (23.4)	0.067
Birch	44 (16.7)	16 (13.4)	28 (19.3)	0.203
Cockroach	6 (2.3)	5 (4.2)	1 (0.7)	0.057

Notes: ^dComparison between AS/RW group and non-AS/RW group was performed using the Pearson’s chi squared test, or Fisher’s exact test; ^echildren with asthma/RW were more likely to have a history of allergic rhinitis/allergic conjunctivitis (76.5% vs 64.8%, p = 0.044); ^fchildren with asthma/RW were more likely to have a family history of allergic disease (48.7% vs 30.3%, p = 0.003); ^gsensitization to dust mites was more common in the asthma/RW group (25.2% vs 14.5%, p = 0.028).

Abbreviations: ^aAS, asthma; RW, recurrent wheezing; ^bAR, allergic rhinitis; AC, allergic conjunctivitis; ^cAD, atopic dermatitis.

Table 2 Triggers of 399 Anaphylactic Reactions

Suspected Triggers	Total n= 399, n (%)^g	AS/RW, n=191, n (%)	Non-AS/RW, n=208, n (%)	P value (AS/RW vs Non-AS/RW)^h
Foods	341 (85.5)	163 (85.3)	178 (85.6)	1
Milk	65 (16.3)	28 (14.7)	37 (17.8)	0.418
Egg	43 (10.8)	23 (12.0)	20 (9.6)	0.519
Wheat	49 (12.3)	27 (14.1)	22 (10.6)	0.29
Buckwheat	19 (4.8)	18 (9.4)	1 (0.5)	0.00 ^i
Corn	1 (0.3)	0 (0)	1 (0.5)	1.00
Peanut	8 (2)	2 (1.0)	6 (2.9)	0.288
Nuts/seeds	33 (8.3)	15 (7.9)	18 (7.7)	0.856
Walnut	14 (3.5)	7 (3.7)	7 (3.4)	0.661
Cashew nut	7 (1.8)	2 (1.0)	5 (2.4)	0.302
Other nuts/seeds^a	13 (3.3)	6 (3.1)	7 (2.4)	0.900
Soybean	6 (1.5)	3 (1.6)	3 (1.4)	1
Fruit /vegetable	61 (15.3)	26 (13.6)	35 (16.8)	0.221
Peach	12 (3.0)	6 (3.1)	6 (2.9)	0.881
Mango	9 (2.3)	3 (1.6)	6 (2.9)	0.377
Pitaya	8 (2.0)	0 (0)	8 (3.8)	0.006
Lychee	8 (2.0)	3 (1.6)	5 (2.4)	0.302
Other fruit/vegetable^b	24 (6.3)	14 (7.9)	10 (4.8)	0.531
Seafoods	16 (4.0)	9 (4.7)	7 (3.4)	0.612
Spices	6 (1.5)	4 (2.1)	2 (1.0)	0.432
Mix foods^c	19 (4.8)	8 (4.2)	11 (5.3)	0.501
Foods unclear^d	15 (3.8)	3 (1.6)	12 (5.8)	0.021
Foods+exercise /exercise	33 (8.3)	16 (8.4)	17 (8.2)	1
Drug^e	14 (3.5)	9 (4.7)	5 (2.4)	0.278
Idiopathic	10 (2.5)	3 (1.6)	7 (3.4)	0.342
Other trigger^f	1 (0.3)	0 (0)	1 (0.5)	1

Notes: ^aOther nuts/seeds include: pistachio nut (n = 2), almond (n = 2), hazelnut (n = 2), sesame (n = 1), sunflower seed (n = 1), not specified (n = 4); ^bother fruits and vegetables include: pear (n = 4), physalis peruviana L (n = 3), longan (n = 2), kiwifruit (n = 2), apple (n = 2), rambutan (n = 2), pineapple (n = 1), cauliflower (n = 1), melon (n = 1), blueberry (n = 1), orange (n = 1), grape (n = 1), seabuckthorn (n = 1), watermelon (n = 1), cherry (n = 1); ^cmix foods represented that the offending foods may contain multiple potential allergens several food allergens, such as cake, cookies, pizza. ^dFood unclear represented the food triggers were not determined during chart review, such as the reactions occur just after a meal that may ingest several foods; ^eDrug triggers included: vaccines [n = 5, comprising DTaP (n = 2), group A+C meningococcal polysaccharide vaccine (n = 1), Sabin vaccine (n = 1), and not specified (n = 1)], propofol (n = 1) antibiotics (n = 4), probiotics (n = 2), methylprednisolone (n = 1), lacidophilin tablets (n = 1); ^fOther trigger: one episode triggered by cat dander exposure. ^gA total of 399 anaphylactic reactions in 264 patients were analyzed; ^hcomparison between AS/RW group and non-AS/RW group was performed using the Pearson’s chi squared test or Fisher’s exact test. ⁱBuckwheat-induced anaphylaxis was more common in the asthma/RW group 9.4% vs 0.5%, p < 0.001).

Figure 1 Food triggers in AS/RW and non-AS/RW group. A total of 399 anaphylactic reactions in 264 patients were analyzed and comparison between AS/RW group and non-AS/RW group was performed using the Pearson’s chi squared test, or Fisher’s exact test. ***Buckwheat-induced anaphylaxis was more common in the asthma/RW group (9.4% vs 0.5%, p < 0.001).

Table 3 Symptoms of 399 Anaphylactic Reactions

Symptoms, n (%)	Total, n=399, n (%)^a	AS/RW, n=191, n (%)	Non-AS/RW, n=208, n (%)	P value (AS/RW vs Non-AS/RW)^b
Skin and mucocutaneous (any)	342 (85.7)	158 (82.7)	184 (88.5)	0.116
Hives	247 (61.9)	113 (59.2)	134 (64.4)	0.303
Itching	41 (10.3)	23 (12)	18 (8.7)	0.322
Redness/rash	8 (2.0)	6 (3.1)	2 (1.0)	0.16
Angioedema	109 (27.3)	48 (25.1)	61 (29.3)	0.37
Oropharyngeal (any)	51 (12.8)	33 (17.3)	18 (8.6)	0.011^c
Throat closing or swelling	38 (9.5)	23 (12.0)	15 (7.2)	0.124
Difficulty swallowing	5 (1.3)	5 (2.6)	0 (0)	0.024
Throat tingling or itching	7 (1.8)	6 (3.1)	1 (0.5)	0.058
Hoarseness	7 (1.8)	5 (2.6)	2 (1.0)	0.267
Respiratory(any)	266 (66.7)	131 (68.6)	135 (64.9)	0.458
Wheezing	99 (24.8)	66 (34.5)	33 (15.9)	0.00^d
Shortness of breath	58 (14.5)	34 (17.8)	24 (11.5)	0.088
Breathing difficulty	128 (32.1)	62 (32.5)	66 (31.7)	0.915
Cough	68 (17.0)	29 (15.2)	39 (18.8)	0.355
Cyanosis	22 (5.5)	5 (2.6)	17 (8.2)	0.016^e
Gastrointestinal (any)	92 (23.1)	48 (25.1)	44 (21.2)	0.405
Nausea	2 (0.5)	1 (0.5)	1 (0.5)	1
Pain	29 (7.3)	15 (7.9)	14 (6.7)	0.703
Vomiting	59 (14.8)	31 (16.2)	28 (13.5)	0.481
Diarrhea	9 (2.3)	3 (1.6)	6 (2.9)	0.506
Cardiovascular (any)	34 (8.5)	13 (6.8)	21 (10.1)	0.16
Hypotension	5 (1.3)	1 (0.5)	4 (1.9)	0.374
Loss of consciousness/Confusion	31 (7.8)	13 (6.8)	18 (8.7)	0.576
Incontinence	1 (0.3)	0 (0)	1 (0.5)	1
Neuologic (any)	36 (9.0)	9 (4.7)	27 (13.0)	0.005^f
Persistent crying or restlessness	17 (4.3)	4 (2.1)	13 (6.3)	0.048
Drowsiness	10 (2.5)	0	10 (4.8)	0.002
Faintness	4 (1.0)	1 (0.5)	3 (1.4)	0.624
Amaurosis	3 (0.8)	1 (0.5)	2 (1.0)	1
Seizure	2 (0.5)	2 (1.0)	0 (0)	0.229
Severe anaphylaxis ^g	91 (22.8)	37 (19.4)	54 (25.9)	0.122

Notes: ^aA total of 399 anaphylactic reactions in 264 patients were analyzed; ^bcomparison between AS/RW group and non-AS/RW group was performed using the Pearson’s chi squared test or Fisher’s exact test. ^cPatients with asthma/RW had higher rates of oropharyngeal symptoms (17.3% vs 8.6%, p = 0.011); ^dpatients with asthma/RW had higher rates of wheezing (34.5% vs 15.9%, p < 0.001); ^ecyanosis was more common in non-AS/RW patients (8.2% vs 2.6%, p = 0.016); ^fneurologic involvement was more common in non-AS/RW children (13.0% vs.4.7%, p = 0.005). ^gThe frequency of severe anaphylaxis was no difference between AS/RW group and non-AS/RW group (19.4% vs 25.9%, p = 0.122).

Figure 2 Systems involvement in AS/RW and non-AS/RW group. A total of 399 anaphylactic reactions in 264 patients were analyzed and comparison between AS/RW group and non-AS/RW group was performed using the Pearson’s chi squared test, or Fisher’s exact test. **Patients with asthma/RW had higher rates of oropharyngeal symptoms (17.3% vs 8.6%, p = 0.011); Neurologic involvement was more common in non-AS/RW children (13.0% vs.4.7%, p = 0.005).

Table 4 Treatment of Anaphylactic Reactions

Treatment	Total n=306, n (%)^a	AS/RW, n=144, n (%)	Non-AS/RW, n=162, n (%)	P value (AS/RW vs Non-AS/RW)^b
Treatment at home	110 (35.9)	57 (39.6)	53 (32.7)	0.37
Self-relief	37 (12.1)	14 (9.7)	23 (14.2)	0.229
Oral antihistamines	67 (21.9)	39 (27.1)	28 (17.3)	0.081
Nebulized β-agonist	7 (2.3)	6 (4.2)	1 (0.6)	0.058
Oral montelukast	2 (0.7)	1 (0.7)	1 (0.6)	1.00
Treatment in ED	186 (60.8)	80 (55.6)	106 (65.4)	0.072
Epinephrine	29 (9.5)	10 (6.9)	19 (11.7)	0.176
Systemic corticosteroid	85 (27.8)	39 (27.1)	46 (28.4)	0.715
Antihistamines	55 (18.0)	21 (14.6)	34 (21.0)	0.146
Nebulized β-agonist	21 (6.9)	17 (11.8)	4 (2.5)	0.003^c
Oxygen supplement	3 (1.0)	0 (0)	3 (1.9)	0.249
Unclear	28 (9.2)	8 (5.6)	20 (12.3)	0.048
Hospitalization	7 (2.3)	4 (2.8)	3 (1.9)	0.714

Notes: ^aAcute management was not accessible for 93 anaphylactic events and a total of 306 anaphylactic events with detailed management records were analyzed; ^bcomparison between AS/RW group and non-AS/RW group was performed using the Pearson’s chi squared test or Fisher’s exact test; ^cchildren with asthma were more likely to receive nebulized β–agonists during emergency treatment than children without asthma/RW (11.8% vs 2.5%, p = 0.003).

Table 5 Comparison of FeNO and Pulmonary Function Test Results Between Severe and Mild-Moderate Anaphylaxis

	Severe Anaphylaxis in AS/RW Patients	Mild-Moderate Anaphylaxis in AS/RW Patients	P-value (Severe Anaphylaxis vs Mild-Moderate)^a
FENO (ppb)	48.6±35.3	45.2±31.9	0.778
FVC% predicted value (%, x±s)	101.8±12.3	96.8±11.5	0.188
FEV1%predicted value (%, x±s)	98.3±14.7	93.0±14.1	0.254
FEV1/FVC (%, x±s)	94.8±7.8	93.5±9.5	0.654
PEF%predicted value (%, x±s)	86.0±11.1	84.0±14.9	0.656
FEF 25 (%, x±s)	82.1±13.0	78.5±20.0	0.546
FEF 50 (%, x±s)	75.0±18.1	66.7±22.0	0.228
FEF75 (%, x±s)	59.5±23.4	53.8±21.2	0.416
MMEF 75/25 (%, x±s)	71.7±19.7	65.2±22.2	0.355

Notes: ^aComparison between AS/RW group and non-AS/RW group was performed using the two tailed, unpaired t-test.

Abbreviations: FENO, fractional exhaled nitric oxide; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; FEV1/FVC, the ratio of the FEV ₁ to the FVC; PEF, peak expiratory flow; FEF, forced expiratory flow; MMEF, the average mid-maximal expiratory flow.