Differences between multi-triggered and single-triggered food anaphylaxis in children: a real life study

Background. Food-induced anaphylaxis (FIA) is a severe form of food allergy, and literature data about multi-triggered FIA is scarce. This study aimed to evaluate the differences between multi-triggered and single-triggered food anaphylaxis in children. Methods. The study included pediatric patients (age <18 years) who were diagnosed with FIA between January 1, 2015 and February 28, 2023. Demographic data, clinical features, laboratory findings, and allergological work-up results were evaluated from the patients’ records. Results. A total of 459 patients (64.1% male) were evaluated. The median age at onset (first anaphylactic reaction) was 12 months (interquartile range [IQR]: 6-24 months). Food anaphylaxis with multiple foods was reported in 114 of the 459 children (24.8%). Multi-triggered FIA was most commonly associated with combinations of milk and egg (n=21) and tree nut and tree nut (n=21). Atopic disease, asthma, higher total IgE level, and higher eosinophil count were more frequent in patients with multi-triggered FIA. In multivariate regression analysis, total IgE >100 IU/mL was identified as a predictive factor for multi-triggered FIA (Odds ratio [95% confidence interval]: 2.46 [1.40-4.30], p=0.001). Conclusions. FIA with multiple trigger foods was detected in approximately a quarter of the children with FIA. Multi-triggered FIA was associated with higher rates of atopic disease, asthma, eosinophilia, and increased total IgE levels. A total IgE level higher than 100 IU/mL was a risk factor for multi-triggered FIA. This suggests that high IgE levels may be a warning sign for clinicians to be vigilant for multiple food triggers in the screening and follow-up of FIA patients.