Antonella Muraro

FE Simons

G Roberts

English

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An infant with anaphylaxis

Roberts Graham

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Clinical and Translational Allergy

Graham Roberts

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INVITED SPEAKER PRESENTATION Open Access
An infant with anaphylaxis
Graham Roberts
From Food Allergy and Anaphylaxis Meeting 2011
Venice, Italy. 17-19 February 2011
A 4 month old infant presents to your hospital with a
history of becoming unwell with difficulty in breathing
after being given a different cows milk formula. She had
previous devevloped urticaria with some porriage.
This case incorporates a few common clinical chal-
lenges: how to recognise anaphylaxis in infants, identify-
ing the responsible allergen and determining the most
appropriate anaphylaxis management plan.
Recognition of anaphylaxis in infancy: anaphylaxis can
be difficult to recognise in infants and readily confused
with other presentations (Simons 2007).
Finding the responsible allergen: in this case, there is
seemingly no contact with a new food. The challenge is
that food manufacturers use multiple ingrediates in pro-
cessed food so that a cows milk formula will not only
include cows milk (Roberts 2008). Additionally other
non food allergens should be considered, examples are
latex and insect stings. Some food may only behave as
allergens with a co-factor such as exercise. Skin prick
testing and specific IgE may be helpful in clarifying the
allergen although care is required when interpreting
results with a recent anaphylactic reaction or in a young
infant (Roberts 2007). Lastly, there are other conditions
that have a similar presentation to anaphylaxis (Muraro
2007).
Prescribing an appropriate anaphylaxis management
plan: the smallest available autoinjector contains 0.15mg
adrenaline and is licenced only from 15kg. But we know
that parents take a longtime to draw up adrenaline from
ampoule and are unable to accurately draw up the cor-
rect volume. Furthermore we know anecdotely that
when parents try to treat reactions themselves, they
delay calling the emergency services. We therefore have
a dilema as to what is the best anaphylaxis management
plan for a small infant: an addrenaline autoinjector
which will deliver an overdose, a syringe and ampoule
of adrenaline which we know parents find difficult to
use or a plan that asks parent to call very early for the
emergency services. Difference plans may be most
appropriate for different infants and the best plan may
change as they grow.
Finally a young infant with food allergy needs regular
follow to provide parents with advise about their diet,
monitor the infant’s growth, alter the anaphylaxis manage-
ment plan as required and retesting to determine whether
or not the infant the has outgrown their food allergy.
Published: 12 August 2011
References
1. Muraro Antonella, Roberts Graham, Clark Andrew, Eigenmann Philippe A,
Halken Susanne, Lack Gideon, Moneret-Vautrin Anne, Niggemann Bodo,
Rancé Fabienne: The Management of Anaphylaxis in Childhood: Position
paper of the European Academy of Allergy and Clinical Immunology.
Allergy 2007, 62:857-871.
2. Roberts G: Anaphylaxis to foods. Pediatr Allergy Immunol 2007, 18:543-548.
3. Roberts G: Anaphylaxis: Preventive management. In Symposia Proceedings:
Food allergy in infancy and childhood, 2008. SPS Verlagsgesellschaft mbH,
Heilbronn, Germany;U Wahn and K Beyer 2008:.
4. Simons FE: Anaphylaxis in infants: can recognition and management be
improved? J Allergy Clin Immunol 2007, 120(3):537-40.
doi:10.1186/2045-7022-1-S1-S16
Cite this article as: Roberts: An infant with anaphylaxis. Clinical and
Translational Allergy 2011 1(Suppl 1):S16.
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Submit your manuscript at 
www.biomedcentral.com/submitSouthampton University Hospital NHS Trust, Paediatric Allergy and
Respiratory Medicine, University Child Health, Southampton, UK
Roberts Clinical and Translational Allergy 2011, 1(Suppl 1):S16
http://www.ctajournal.com/content/1/S1/S16
© 2011 Roberts; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


Anaphylaxis: Preventive management. In Symposia Proceedings: Food allergy in infancy and childhood,

FE: Anaphylaxis in infants: can recognition and management be improved? J Allergy Clin Immunol

G: Anaphylaxis to foods. Pediatr Allergy Immunol

Moneret-Vautrin Anne, Niggemann Bodo, Rancé Fabienne: The Management of Anaphylaxis in Childhood: Position paper of the European Academy of Allergy and Clinical Immunology. Allergy

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3354242

An infant with anaphylaxis

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