Baseline characteristics and reaction circumstances of severe anaphylaxis patients treated by emergency physicians.

<p>Reported by emergency physicians in Berlin, Germany vs. self report in anaphylaxis registry.</p>*<p>comparable catchment areas, # only those initally treated by emergency physician.</p

First time receiving prophylactic first aid drugs following severe anaphylaxis.

<p>First time receiving prophylactic first aid drugs following severe anaphylaxis.</p

Drugs used for emergency treatment of anaphylaxis, by age.

<p>Dashed lines indicate proportion of patients having received inhalation (adrenaline) or oral (antihistamine, corticoid) treatment only, error bars indicate 95% confidence intervals.</p

Patient instruction and specific immunotherapy after severe anaphylaxis, stratified by general characteristics and reaction circumstances.

<p>SIT: Specific immunotherapy, ENT: Ear, nose and throat/Otolaryngology.</p

Patients in anaphylaxis registry, first aid treatment stratified by general characteristics and reaction circumstances.

<p>Patients in anaphylaxis registry, first aid treatment stratified by general characteristics and reaction circumstances.</p

Drugs used by emergency physicians for initial treatment of anaphylaxis.

<p>Firsthand report (EPs) vs. self report (anaphylaxis registry). Parenteral application routes only. * Weighted for age, cause and severity distribution in anaphylaxis registry, Berlin catchment area.</p

Drugs used for emergency treatment of anaphylaxis, by cause.

<p>Only assured cases. All application routes, error bars indicate 95% confidence intervals.</p

Cow's milk and hen's egg anaphylaxis: a comprehensive data analysis from the European Anaphylaxis Registry

Background: Cow's milk (CM) and hen's egg (HE) are leading triggers of anaphylaxis in early childhood. The aim of this study was to identify clinical phenotypes and therapeutic measures for CM anaphylaxis (CMA) compared to HE anaphylaxis (HEA) in children up to 12 years of age, based on a large pan-European dataset from the European Anaphylaxis Registry. Methods: Data from 2007 to 2020 on clinical phenotypes and treatment from 10 European countries, as well as Brazil, were analysed. The two-step cluster analysis was used to identify the most frequent phenotypes. For each trigger, three clusters were extracted based on sex, age, and existence of symptoms in four vitally important systems. Results: Altogether 284 children with CMA and 200 children with HEA were identified. They were characterised as male (69% vs. 64%), infants (65% vs. 61%), with a most frequent grade III of Ring&Messmer classification (62% vs. 64%), in CMA versus HEA, respectively. Respiratory symptoms occurred more often in CMA (91% vs. 83%, p = 0.010), especially in infants (89% vs. 79%, p = 0.008). Cardiovascular symptoms were less frequent in CMA (30% vs. 44%, p = 0.002), in both infants (33% vs. 46%, p = 0.027), and older children (25% vs. 42%, p = 0.021). The clusters extracted in the CMA group were characterised as: (1) mild dermal infants with severe GI (40%), 2. severe dermal (35%), 3. respiratory (25%). While in HEA group: 1. infants with severe GI and/or reduction of alertness (40%), (2) conjunctival (16%), (3) mild GI without conjunctivitis (44%). The severity of the reaction was independent from the amount of ingested allergen protein, regardless of trigger. The first-line adrenaline application differed between the countries (0%-92%, as well as the reasons for not administering adrenaline, p Conclusions: Despite the similarity of their age, sex, and severity grade, the clinical profiles differed between the CMA and HEA children. Adrenaline was underused, and its administration was country dependent. Further studies are needed to assess to what extent the differences in the clinical profiles are related to matrix and/or absorption effects, and/or the allergen itself.</p