Pediatric Idiopathic Anaphylaxis: A Report of Three Cases with Recommendations for Evaluation and Management

Abstract

The manifestations, evaluation, treatment, and clinical course of three children with idiopathic anaphylaxis (IA) are reported. By definition, there is no identifiable antigen or physical factor responsible for episodes of IA, and there is no underlying disease in these children. Therapy is based on the frequency of episodes. Although therapy of acute episodes only is appropriate for children with infrequent episodes of IA, prophylactic therapy, including antihistamines, oral adrenergic agents, and tapering courses of prednisone, is indicated when IA episodes are frequent. As in adults, prednisone will induce remissions of IA in children, and such remissions may persist when prednisone is tapered and discontinued. As described in one child in this report, there are cases of corticosteroid-dependent IA in children in whom episodes of IA occur whenever prednisone is tapered below a threshold dose, but a treatment regimen, including maintenance alternate-day prednisone, is preferable to a potential fatality and a markedly restricted life due to fear of episodes of IA.