Underrecognized Neurologic Sequelae of Severe Pediatric Anaphylaxis

Background: Severe anaphylaxis is a rapidly progressive systemic hypersensitivity reaction that can result in airway compromise, shock, and multisystem organ dysfunction. While cardiovascular and respiratory manifestations are well described, data on neurological sequelae following severe anaphylaxis—particularly in children—remain limited. This study aimed to determine the incidence of new-onset neurological manifestations in pediatric patients following severe anaphylaxis.

We conducted a retrospective cohort study of pediatric patients (0–18 years) diagnosed with severe anaphylaxis over 10 years (2015–2025). Severe anaphylaxis was defined as airway, breathing, or circulatory compromise requiring epinephrine administration. Patients were identified using ICD-9 and ICD-10 codes. Those with pre-existing neurological disorders or incomplete clinical documentation were excluded. Demographics, clinical characteristics, hospital course, and post-discharge follow-up were reviewed. Descriptive statistics and chi-square were used for data analysis.

A total of 389 patients met the inclusion criteria. The mean age was 7.32 years (Standard Error of Mean 0.27). Most patients were male and of White ethnicity. Eighty percent required hospital admission, and 9% had neurological symptoms at presentation. During hospitalization and follow-up, the most commonly observed new neurological manifestations were speech and gross motor delays. At 3 months post-anaphylaxis, 34 patients (9%) developed new neurological symptoms. This persisted in 36 patients (9%) at 6 months and 30 patients (8%) at 12 months following discharge.

Severe anaphylaxis in children was associated with a measurable incidence of new-onset neurological manifestations that persisted for months after the acute event. These findings suggest that neurologic sequelae following severe anaphylaxis may be underrecognized and support the need for longitudinal neurological surveillance in affected pediatric patients.