Retrospective Evaluation of Patients Admitted to the Emergency Department Due to Anaphylaxis in Children: A Single-Center Study from Türkiye

TL;DR

This study finds that while acute care for pediatric anaphylaxis in emergency departments is generally good, there are significant gaps in post-discharge care, such as low rates of epinephrine auto-injector prescriptions and specialist referrals.

Contribution

The study provides a detailed retrospective analysis of pediatric anaphylaxis management in a Turkish hospital, highlighting critical gaps in post-discharge care.

Findings

Food allergy was the main cause of anaphylaxis in children, especially in infants.

Only 7.8% of patients were prescribed epinephrine auto-injectors, and 15.7% were referred to allergists.

Drug-induced anaphylaxis had the highest proportion of severe cases at 81.6%.

Abstract

What are the main findings?
Pediatric anaphylaxis management in the emergency department shows sub-stantial gaps in timely epinephrine administration and discharge planning.Prescription rates of epinephrine auto-injectors and referrals to allergy specialists remain suboptimal despite guideline recommendations.

Pediatric anaphylaxis management in the emergency department shows sub-stantial gaps in timely epinephrine administration and discharge planning.

Prescription rates of epinephrine auto-injectors and referrals to allergy specialists remain suboptimal despite guideline recommendations.

What is the implication of the main finding?
Targeted educational and system-level interventions are needed to improve adherence to anaphylaxis management guidelines in pediatric emergency settings.Standardized discharge protocols may reduce preventable morbidity and re-current anaphylaxis in children.

Targeted educational and system-level interventions are needed to improve adherence to anaphylaxis management guidelines in pediatric emergency settings.

Standardized discharge protocols may reduce preventable morbidity and re-current anaphylaxis in children.

Background: Management of pediatric anaphylaxis in the emergency department remains clinically important. The research investigated pediatric anaphylaxis medical indicators together with physician adherence to international treatment protocols at a Turkish tertiary medical center. Methods: Between September 2014 and July 2025, 166 pediatric anaphylaxis patients were retrospectively reviewed for triggering factors, clinical findings, treatment approaches, and quality indicators. Results: The mean age of the patients was 7.4 ± 5.6 years. Food allergy was the main cause with 53%, followed by drugs with 24.7%. Food allergy in infants was 85.7%, while drug reactions in adolescents reached 37.2% (p < 0.001). Skin findings were present in 93.4% of the patients, and respiratory symptoms were present in 67.5% of the patients. Epinephrine was administered to 97.6% of patients, 95.2% of whom were given intramuscularly. The rate of epinephrine administration in the first 30 min was 61.1%. Drug-induced anaphylaxis showed the highest proportion of severe cases (81.6%, p < 0.001). A biphasic reaction was seen in 6%. The auto-injector prescription rate was 7.8%, and the allergist referral rate was 15.7%. No deaths were observed. Conclusions: While acute-phase management largely adheres to international guidelines, significant gaps persist in post-discharge care with low auto-injector prescription and allergist referral rates.

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