{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:19:59Z","timestamp":1790813999085,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rates of anaphylaxis in early childhood are rising, yet there remains a paucity of data on age\u2010specific presentations and outcomes. While prompt treatment is essential, symptoms can differ from older children. Observation after stabilization is routinely used; however, no infant and toddler\u2010specific data guide the duration of monitoring. Identifying predictors of biphasic anaphylaxis could help guide observation times.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize symptoms of anaphylaxis in infants and toddlers, analyze predictors for biphasic anaphylaxis and get more insight into required observation times in this age group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Anaphylaxis cases aged 0\u20132\u2009years presenting to a major Emergency Department (ED) were reviewed over two 5\u2010year\u2010periods. We analyzed clinical features, allergens, and management, comparing uniphasic and biphasic presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 567,595 total ED presentations aged 0\u201316\u2009years, 243 cases of 0\u20132\u2010year\u2010olds (infants\/toddlers) presented with anaphylaxis (72\/236,217 in 2003\u20132007; 171\/331,378 in 2013\u20132017). Symptoms included urticaria (85.8%), angioedema (67.8%), wheeze\/persistent cough (57.7%), vomiting (42.3%) and flushing (21.8%). Symptoms unique to infants\/toddlers were pallor\/hypotonia (33.5%) and persistent crying (13.8%).<\/jats:p>\n                    <jats:p>\n                      Biphasic anaphylaxis occurred in 4.6%, was exclusively food\u2010induced and more common among infants (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.048). Predictors for biphasic anaphylaxis were lower systolic blood pressure (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.011), pallor\/hypotonia (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.046), use of fluids (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001), and greater severity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.014). Timeframe for recurrence of anaphylaxis was 70\u2013330\u2009min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased awareness of age\u2010specific symptoms is essential for timely recognition and optimal care of infant\/young toddler anaphylaxis. Cardiovascular signs, fluid resuscitation, and reaction severity may help predict recurrent anaphylaxis in 0\u20132\u2010year\u2010olds and identify which patients need observation beyond 4\u2009h versus those safe for earlier discharge.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/pai70438-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  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