Pediatric anaphylaxis: age-related symptom trends and the limited role of allergen molecules: a retrospective analysis

Background Emerging evidence suggests that specific allergen molecules may influence the clinical phenotype of anaphylaxis in children, but robust data are scarce. This study aimed to rigorously test the molecule-phenotype association in a large pediatric cohort and to determine the relative influence of the sensitizing molecule versus patient age on symptom presentation. Methods A retrospective analysis was conducted on 184 pediatric patients (0–18 years) hospitalized for anaphylaxis. Molecular allergen-specific immunoglobulin E (IgE) profiles were determined using the ALEX 2 test. Symptom frequencies across different organ systems were analyzed in relation to allergen molecules and age groups using Cochran’s Q and Pearson’s χ2 tests. Results The most frequent molecular triggers were Ara h 2 (18.79%), Gal d 1 (9.09%), and Ana o 3 (9.09%). While significant differences in symptom distribution were observed within individual allergen molecules ( p < 0.05), no molecule-specific symptom pattern was identified. In contrast, age significantly influenced respiratory symptom prevalence, with a higher frequency in older children compared to infants ( p = 0.003). A similar trend was observed for gastrointestinal symptoms ( p = 0.051). Conclusions In pediatric anaphylaxis, patient age is a more significant determinant of clinical presentation, particularly for respiratory symptoms, than the specific sensitizing allergen molecule. This suggests that clinical risk stratification and management strategies in children should prioritize age-related factors over specific molecular sensitization profiles.