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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Ewa Cichocka-Jarosz - , Jagiellonian University in Kraków (Author)
  • Sabine Dölle-Bierke - , Charité – Universitätsmedizin Berlin (Author)
  • Urszula Jedynak-Wąsowicz - , Jagiellonian University in Kraków (Author)
  • Dominique Sabouraud-Leclerc - , CHU de Reims (Author)
  • Alice Köhli - , University of Zurich (Author)
  • Lars Lange - , GFO Hospitals Bonn (Author)
  • Nikolaos G. Papadopoulos - , National and Kapodistrian University of Athens, University of Manchester (Author)
  • Jonathan Hourihane - , Royal College of Surgeons in Ireland (Author)
  • Katja Nemat - , Municipal Hospital Dresden (Author)
  • Kathrin Scherer Hofmeier - , University of Basel (Author)
  • Stephanie Hompes - , University of Hamburg (Author)
  • Hagen Ott - , Children's Hospital Auf der Bult (Author)
  • Lucila Lopes de Oliveira - , Federal University of São Paulo (Author)
  • Thomas Spindler - (Author)
  • Christian Vogelberg - , Department of Paediatrics, TUD Dresden University of Technology (Author)
  • Margitta Worm - , Charité – Universitätsmedizin Berlin (Author)

Abstract

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 < 0.001). 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.

Details

Original languageEnglish
Article numbere12228
JournalClinical and translational allergy : CTA
Volume13
Issue number3
Publication statusPublished - Mar 2023
Peer-reviewedYes

Keywords

Keywords

  • children, cow's milk anaphylaxis, European Anaphylaxis Registry, hen's egg anaphylaxis

Library keywords