Age- and Elicitor-Dependent Characterization of Hymenoptera Venom-Induced Anaphylaxis in Children and Adolescents

Margitta Worm; Ewa Cichocka-Jarosz; Franziska Ruëff; Thomas Spindler; Alice Köhli; Johannes Trück; Lars Lange; Karin Hartmann; Thomas Hawranek; Katja Nemat; Claudia Pföhler; Maria Beatrice Bilò; Dominique Sabouraud-Leclerc; Nicola Wagner; Nikolaos Papadopoulos; Susanne Hämmerling; Luis Felipe Ensina; Sabine Dölle-Bierke; Veronika Höfer

doi:10.1016/j.jaip.2024.08.036

Age- and Elicitor-Dependent Characterization of Hymenoptera Venom-Induced Anaphylaxis in Children and Adolescents

J Allergy Clin Immunol Pract. 2024 Aug 28:S2213-2198(24)00855-9. doi: 10.1016/j.jaip.2024.08.036. Online ahead of print.

Authors

Margitta Worm¹, Ewa Cichocka-Jarosz², Franziska Ruëff³, Thomas Spindler⁴, Alice Köhli⁵, Johannes Trück⁶, Lars Lange⁷, Karin Hartmann⁸, Thomas Hawranek⁹, Katja Nemat¹⁰, Claudia Pföhler¹¹, Maria Beatrice Bilò¹², Dominique Sabouraud-Leclerc¹³, Nicola Wagner¹⁴, Nikolaos Papadopoulos¹⁵, Susanne Hämmerling¹⁶, Luis Felipe Ensina¹⁷, Sabine Dölle-Bierke¹⁸, Veronika Höfer¹⁸

Affiliations

¹ Division of Allergy and Immunology, Department of Dermatology, Venereology, and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. Electronic address: [email protected].
² Department of Paediatrics, Jagiellonian University Medical College, Krakow, Poland.
³ Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.
⁴ Outpatient Clinic for Pediatric Allergology and Pulmonology, Medizin Campus Bodensee, Friedrichshafen, Germany.
⁵ Division of Allergology, University Children's Hospital Zurich, Zürich, Switzerland; Division of Paediatric Allergology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.
⁶ Divisions of Allergy and Immunology, University Children's Hospital and Children's Research Center, University of Zurich, Zurich, Switzerland.
⁷ Department of Paediatrics, St Marien-Hospital, Bonn, Germany.
⁸ Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.
⁹ University Clinic for Dermatology and Allergology, Paracelsus Medical Private University Salzburg, Salzburg, Austria.
¹⁰ Dresden-Friedrichstadt Children's Center, Dresden, Germany.
¹¹ Clinic for Dermatology, Venerology, and Allergology, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany.
¹² Allergy Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
¹³ Pediatrics Unit, University Hospital Reims, Reims, France.
¹⁴ Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
¹⁵ Allergy Department, Second Pediatric Clinic, University of Athens, Athens, Greece.
¹⁶ Division of Paediatric Pulmonology and Allergology, University Children`s Hospital Heidelberg, Heidelberg, Germany.
¹⁷ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
¹⁸ Division of Allergy and Immunology, Department of Dermatology, Venereology, and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

PMID: 39209067
DOI: 10.1016/j.jaip.2024.08.036

Abstract

Background: Hymenoptera venom is one of the most frequent causes of anaphylaxis. Studies from adults indicate the clinical profiles and risk factors of Hymenoptera venom-induced anaphylaxis (VIA). Much less is known about pediatric VIA.

Objective: To understand elicitor- and age-related factors determining pediatric VIA by analyzing data from the anaphylaxis registry.

Methods: We selected pediatric VIA, pediatric food-induced anaphylaxis (FIA), and adult VIA cohorts from the anaphylaxis registry and performed a comparative data analysis regarding elicitors, symptoms, and management.

Results: We identified 725 pediatric patients with VIA, 3,149 with pediatric FIA, and 5,534 with adult VIA. In pediatric VIA, boys were more frequently affected, atopy was not increased, and the onset of the reaction after exposure was fast (≤30 min; 91%) compared with pediatric FIA. Symptoms in pediatric VIA were age dependent, and although respiratory symptoms occurred most frequently besides skin symptoms in both pediatric patients with VIA and FIA, cardiovascular symptoms were more frequently reported in pediatric patients with VIA than pediatric patients with FIA. The analysis of pediatric versus adult VIA revealed clear differences in the frequency of involved organ systems (skin: 93% vs 78%; respiratory: 77% vs 64%; and cardiovascular: 61% vs 85%). For both pediatric and adult VIA, the rates of adrenaline application by a professional were low (29% vs 31%) but hospitalization rates were higher in children than in adults (61% vs 42%). Venom immunotherapy was frequently initiated regardless of age (78% each).

Conclusions: Pediatric VIA is more frequent in boys, symptoms are age dependent, and hospitalization is often required. Adrenaline should be applied according to current guidelines. Venom immunotherapy is an important treatment option in pediatric VIA and should be considered in severely affected children.

Keywords: Anaphylaxis registry; Children; Symptoms; Treatment; Venom anaphylaxis.