A hub-and-spoke network organizational model in Liguria (Italy) for managing anaphylaxis in pediatric age: a retrospective analysis

Abstract Background : Anaphylaxis represents one of the most severe and potentially life-threatening emergencies in children. However, significant gaps persist in real-world recognition, management, and long-term follow-up of affected patients despite established diagnostic criteria and treatment guidelines. This study provides a comprehensive overview of the epidemiology, pathogenesis, and management of pediatric anaphylaxis, contextualized by a multicenter, retrospective observational study conducted within the "Gaslini Diffuso" Hub-and-Spoke Allergology Network in the Liguria region of Italy. Methods The study cohort included children aged 0 to 16 years who met the 2006 NIAID/FAAN diagnostic criteria for anaphylaxis. Data were retrospectively collected from the Hub center, IRCCS G. Gaslini in Genoa, covering the period from 2013 to 2023, and from five satellite spoke centers, covering the period from 2022 to 2023. The primary objective was to evaluate and compare diagnostic and therapeutic management practices across these Hospital Pediatric Units. Results The results demonstrate critical disparities in clinical practice across the network, specifically regarding the frequency of epinephrine administration, the utilization of tryptase measurement, the duration of clinical observation, and the rates of epinephrine autoinjector prescription upon discharge. These variations highlight significant differences in adherence to standardized protocols between the Hub center and the Spoke centers. Conclusions : These findings underscore the urgent need to implement unified, standardized clinical protocols across a regional network. The study emphasizes that structured clinical education and improved resource allocation are essential to ensure consistent, high-quality care for pediatric patients experiencing anaphylactic episodes across both Hub and Spoke clinical settings.