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

Hymenoptera venom is a frequent cause of anaphylaxis-related morbidity and mortality. Adult studies have described clinical profiles and risk factors for Hymenoptera venom–induced anaphylaxis (VIA). Less is known about pediatric VIA. The current study analyzed data from an anaphylaxis registry to understand elicitor- and age-related factors associated with pediatric VIA.Tertiary allergy centers from 11 European countries and Brazil participated in an anaphylaxis registry. Patients who had experienced anaphylaxis within the 12 months prior to presenting to a participating allergy center were included in the current study. The diagnosis of VIA or food-induced anaphylaxis (FIA) for a comparator group was made by allergists based on medical history and diagnostic testing. Of 15 748 cases in the anaphylaxis registry, 725 children and 5534 adults had VIA and 3149 children had FIA.Pediatric VIA, pediatric FIA, and adult VIA cohorts were selected for comparative data analysis regarding elicitors, symptoms, and management.Compared with pediatric FIA, in pediatric VIA, boys were more frequently affected, atopy was not increased, and the onset of the reaction after exposure was rapid (≤30 minutes; 91%). Cardiovascular symptoms were more frequently reported in pediatric patients with VIA than FIA. Analysis of pediatric vs adult VIA revealed differences in the frequency of involved organ systems (skin: 93% vs 78%; respiratory: 77% vs 64%; and cardiovascular: 61% vs 85%). Pediatric VIA incidence peaks at age 10 years and affects boys more than girls. For both pediatric and adult VIA, the rates of epinephrine administration by a medical 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% in both pediatric and adult VIA groups).Epinephrine should be administered for treatment of VIA. Venom immunotherapy is an important treatment option in VIA and should be considered in impacted children, regardless of age.Previous studies on pediatric VIA have not consistently demonstrated sex-specific differences in incidence. Demographic data regarding peak age of incidence and increased risk for boys in the current study are interesting and may aid in surveillance for and improved recognition and treatment of pediatric VIA.