title: Anaphylaxis in children and adolescents: The European Anaphylaxis Registry.
abstract: BACKGROUND
  Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description.
  
  
  OBJECTIVE
  We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents.
  
  
  METHODS
  The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form.
  
  
  RESULTS
  Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom- and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions.
  
  
  CONCLUSIONS
  The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Linus B
authors.initials: LB
authors.lastname: Grabenhenrich
authors.affiliation: Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Dölle
authors.affiliation: Allergy Vigilance Network, University Hospital Nancy, Nancy, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Moneret-Vautrin
authors.affiliation: Division of Allergology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Alice
authors.initials: A
authors.lastname: Köhli
authors.affiliation: Department of Pediatrics, St Marien-Hospital, Bonn, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Lange
authors.affiliation: Pediatric Pneumology and Allergology, Lungenzentrum Süd-West, Wangen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Spindler
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian-Universität, Munich, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Ruëff
authors.affiliation: Pediatric Pneumology and Allergology, Kinderzentrum Dresden-Friedrichstadt, Dresden, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Nemat
authors.affiliation: Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: Ioana
authors.initials: I
authors.lastname: Maris
authors.affiliation: Allergy Department, University of Athens, Athens, Greece.
authors.forename: Eirini
authors.initials: E
authors.lastname: Roumpedaki
authors.affiliation: Department of Dermatology, University Hospital Basel, Basel, Switzerland.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Scherer
authors.affiliation: Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Ott
authors.affiliation: Rheine Kinderklinik, Mathias-Spital, Rheine, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reese
authors.affiliation: Clinical Centre of Allergology, University Hospital Alexandrovska/Medical University Sofia, Sofia, Bulgaria.
authors.forename: Tihomir
authors.initials: T
authors.lastname: Mustakov
authors.affiliation: Department of Dermatology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria.
authors.forename: Roland
authors.initials: R
authors.lastname: Lang
authors.affiliation: Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fernandez-Rivas
authors.affiliation: Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland.
authors.forename: Marek L
authors.initials: ML
authors.lastname: Kowalski
authors.affiliation: Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Bilò
authors.affiliation: Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: Jonathan O'B
authors.initials: JO
authors.lastname: Hourihane
authors.affiliation: Allergy Department, University of Athens, Athens, Greece.
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Papadopoulos
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Beyer
authors.affiliation: Department of Mother and Child Health, Padua General University Hospital, Padua, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Muraro
authors.affiliation: Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: margitta.worm@charite.de.
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment; D005060:Europe / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D012189:Retrospective Studies
keywords: Anaphylaxis; arthropod venoms; drug hypersensitivity; epinephrine; food hypersensitivity; registries