Health inequities in pediatric anaphylaxis: A policy framework and call to action for equitable care from SIAIP allergy prevention commission

Pediatric anaphylaxis is a rapidly evolving and potentially fatal allergic reaction whose incidence is increasing worldwide, particularly among young children. Despite international guidelines identifying intramuscular epinephrine as the first-line, life-saving treatment, significant health inequities persist in the prevention, recognition, and management of pediatric anaphylaxis. This manuscript, developed by the Primary and Secondary Prevention of Allergic Diseases Committee of the Italian Society of Pediatric Allergy and Immunology (SIAIP), moves beyond a traditional narrative review by integrating current evidence with a structured policy-oriented framework. Evidence highlights pronounced socioeconomic, racial, cultural, biological, and geographic inequities influencing disease burden, access to specialist care, prescription and availability of epinephrine autoinjectors (EAIs), training of caregivers and healthcare professionals, and timely epinephrine use in emergency settings. Building on this evidence, we propose a SIAIP-driven call to action and outline a preliminary national policy framework aimed at reducing inequities through coordinated interventions. Key priorities include equitable access to EAIs, standardized and repeated practical training, school-based preparedness programs, public awareness initiatives, integration of psychological support, and the development of national monitoring systems. By translating evidence into actionable strategies, this work provides a national perspective that complements existing international recommendations and offers a model for other countries seeking to address disparities in pediatric anaphylaxis care.