Infant and toddler anaphylaxis: Identifying diagnostic and management challenges in early life

Background:

Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It can occur at any age, but specific challenges are present for preschool anaphylaxis.

Objective:

This mini review aims to highlight diagnostic and management challenges in infant and toddler anaphylaxis.

Methods:

Key publications on infant and toddler anaphylaxis were reviewed.

Results:

The diagnosis of preschool anaphylaxis is clinical, based on a combination of history, symptoms, and signs. Infants are nonverbal and cannot clearly express subjective symptoms; certain symptoms and signs may be difficult to interpret because they can be common in healthy infants and are nonspecific for anaphylaxis. There are currently published anaphylaxis criteria and multiple allergy society documents to guide health-care professionals in the often challenging diagnosis of anaphylaxis. The most common trigger is food, and the most common symptoms involve the skin and the gastrointestinal system. Epinephrine is reportedly underused in this age group.

Conclusion:

Infant and toddler anaphylaxis currently represents an area of intense focus and interest due to recent changes in prevention strategies, which encourage early allergenic food introduction as well as novel therapeutic strategies that target those of an early age. Multiple challenges exist in identifying and treating preschool anaphylaxis that may be mitigated with better education and consistent training of families and health-care professionals.