Recognising potentially life-threatening presentations in children with food allergies and asthma

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Risk of anaphylaxis in children with asthma and food allergies

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GPs are well placed to educate young people and their families about recognising and managing anaphylaxis to reduce morbidity and mortality. It is particularly important that a diagnosis of anaphylaxis is considered in every child with symptoms suggestive of severe asthma who is also known to have food allergy and appropriate management commenced.

As part of a comprehensive food allergy management plan[9], for young people at risk, GPs should create an anaphylaxis action plan with parents, any regular carers and the young person. The anaphylaxis action plan lists the symptoms of anaphylaxis and has a step-by-step guide for what to do in the event of anaphylaxis, including how to use an adrenaline auto-injector.

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Asthma increases the risk of fatal food-induced anaphylaxis.[17]

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Of the reported food-related anaphylaxis fatalities between 1997 and 2013, 73% of the deceased had also been previously diagnosed with asthma. Most food allergy related fatalities occur in those with unstable or poorly-managed asthma. [11,14]

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It’s important to note that food-induced anaphylaxis can occur immediately or anywhere up to 2hrs after eating.[1] Exercise after eating allergenic foods, particularly peanuts, can induce serious anaphylaxis.[16]

Mild to moderate allergic signs (and symptoms) may but do not necessarily precede anaphylaxis. These include[7]:

  • Facial and/or lip swelling (tingling mouth)
  • Urticaria
  • Vomiting (abdominal pain)

A severe reaction (anaphylaxis) impacts the respiratory and/or cardiovascular systems. Symptoms and signs include:

  • Respiratory distress (wheeze, cough, difficulty talking)
  • Tongue and/or pharyngeal swelling (hoarse voice)
  • Collapse, young children may be pale and floppy (postural dizziness)

If there is any doubt about whether the symptoms are caused by food allergy or by asthma, use the adrenaline auto-injector first, and then use the asthma reliever puffer and call 000.

If you would like to do a short case study on this topic, you can enrol in the Recognising potentially life-threatening presentations in children with food allergies and asthma activity on gplearning. Completion of the online activity is worth 2 CPD Activity points.

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Additional resources

Patient information

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References

  1. Allergy & Anaphylaxis Australia. Signs & Symptoms.
  2. Asthma Australia. Asthma Emergency.
  3. Asthma Australia. Common concerns: Anaphylaxis.
  4. Asthma Australia. Could it be asthma?.
  5. Asthma Australia. Statistics.
  6. Australasian Society of Clinical Immunology and Allergy. Action Plans for Anaphylaxis.
  7. Australasian Society of Clinical Immunology and Allergy. Action Plan for Anaphylaxis for use with epinephrine autoinjector.
  8. Australasian Society of Clinical Immunology and Allergy. Anaphylaxis
  9. Australasian Society of Clinical Immunology and Allergy. Anaphylaxis Checklist for General Practice.
  10. Australasian Society of Clinical Immunology and Allergy. Asthma and allergy.
  11. Australasian Society of Clinical Immunology and Allergy. Asthma and anaphylaxis.
  12. Australasian Society of Clinical Immunology and Allergy. Food allergy.
  13. Coroners Court of Victoria. Finding – Inquest into the Death of Jack Glen Irvine. Finding 411712 Jack Glen Irvine. 29 April 2016.
  14. Mullins RJ, et al. Increases in anaphylaxis fatalities in Australian from 1997 to 2013. Wiley Online Library. First published 31 May 2016.
  15. National Asthma Council Australia. What is asthma?.
  16. RACGP. Anaphylaxis: Identification, management and prevention. Aust Family Physician, Volume 42, No.1, January/February 2013.
  17. RACGP. Anaphylaxis: Recognition and management. Aust Family Physician, Volume 41, No. 6, June 2012.

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