Food-induced anaphylaxis in infants and children

Background: Recent recommendations to introduce peanut products to infants for peanut allergy prevention requires a focused assessment of infant anaphylaxis. Objective: This study describes the symptomatology of food-induced anaphylaxis (FIA) in infants (<12 months) compared with older pediatric cohorts. Methods: Retrospective review between June 2015 and June 2017 of children presenting with FIA at a large urban children's hospital emergency department (ED). Results: A total of 357 cases of FIA were evaluated: 47 in infants (<12 months), 43 in toddlers (12-24 months), 96 in young children (2-6 years), and 171 in school-aged children (>6 years). Infants presented with gastrointestinal (GI) involvement more frequently than any other age group (89% vs 63% [P =.003], 60% [P <.001], and 58% [P <.001]). Additionally, infants and young children presented with skin involvement more frequently than school-aged children (94% and 91% vs 62% [P <.001]). Respiratory symptoms were more common in older cohorts (17% in infants vs 44% in young children [P <.001] and 54% in school-aged children [P <.001]). Egg and cow's milk were more common causes of FIA in infants compared with school-aged children (egg, 38% vs 1% [P <.001]; milk, 17% vs 7% [P =.03]). Only 21% of infants with FIA had eczema, and 36% had a history of food allergy. Conclusion: Infants with FIA primarily presented with GI and skin manifestations. Egg was the most common food trigger in infants. Most infants with FIA did not have eczema or a history of food allergy.