Anaphylaxis Discharge Medications
Essential Discharge Prescription: Epinephrine Auto-Injector
- The American Academy of Pediatrics recommends prescribing two doses of epinephrine auto-injector at discharge 2, 3
- The dosing for epinephrine auto-injector is 0.15 mg for patients weighing 10-25 kg and 0.3 mg for patients weighing more than 25 kg 1, 2, 3
- Patients must receive hands-on training in proper auto-injector use before discharge 1, 2
- A plan for monitoring expiration dates of epinephrine auto-injectors must be established 2, 3
Adjunctive Discharge Medications (2-3 Day Course)
- The NIAID expert panel recommends a 2-3 day course of H1 antihistamines, such as diphenhydramine every 6 hours 1
- The dosing for diphenhydramine is 1-2 mg/kg per dose, with a maximum of 50 mg 1, 2
- The NIAID expert panel also recommends a 2-3 day course of H2 antihistamines, such as ranitidine twice daily 1
- The dosing for ranitidine is 1-2 mg/kg per dose 2
- The NIAID expert panel recommends a 2-3 day course of corticosteroids, such as prednisone daily 1
- The dosing for prednisone is 0.5 mg/kg for less critical episodes 7
Important Caveats About Adjunctive Medications
- The evidence supporting corticosteroids and antihistamines for preventing biphasic anaphylaxis is weak and contradictory 6, 4
- The 2020 JTFPP analysis found no clear evidence that glucocorticoids or antihistamines prevent biphasic reactions 6, 4
Additional Critical Discharge Components
- The American Academy of Pediatrics recommends a written anaphylaxis emergency action plan detailing trigger avoidance and early symptom recognition 1, 2
- Medical identification jewelry or an anaphylaxis wallet card is recommended 1
- Referral to an allergist/immunologist for comprehensive evaluation and long-term management is recommended 1, 7, 2, 4
- Education on biphasic reactions, which can occur up to 72 hours later, typically around 8 hours, is essential 2, 3, 4
- A follow-up appointment with a primary care provider is necessary 1