Anaphylaxis Management in Children
Clinical Recognition and First-Line Treatment
- The American Academy of Pediatrics recommends that adrenaline (epinephrine) must be administered immediately as the first-line treatment for a child presenting with anaphylaxis 1, 2, 3
- A child meets diagnostic criteria for anaphylaxis with acute onset after allergen exposure, multi-system involvement, and life-threatening presentation requiring immediate intervention 1, 2
- The American Academy of Pediatrics and the Journal of Allergy and Clinical Immunology state that epinephrine is the only first-line medication for anaphylaxis and must be administered immediately upon recognition 1, 2, 3
Dosing and Administration
- For a 7-year-old child, the dose of epinephrine is 0.01 mg/kg of 1:1000 solution, with a maximum of 0.3 mg for prepubertal children, administered via intramuscular injection in the mid-outer thigh (vastus lateralis) 1, 2, 3
- If the child's weight is >25 kg, a 0.3 mg epinephrine autoinjector should be used, and if the weight is 10-25 kg, a 0.15 mg epinephrine autoinjector should be used 2, 3
Adjunctive Therapies
- The Journal of Allergy and Clinical Immunology recommends supplemental oxygen for hypoxia, IV fluid bolus (10-20 mL/kg) for persistent hypotension, albuterol nebulizer (1.5 mL for child) for bronchospasm, H1 antihistamine (diphenhydramine 1-2 mg/kg, max 50 mg) for urticaria/pruritus, and H2 antihistamine (ranitidine 1-2 mg/kg) in combination with H1 blocker 2, 3, 4, 5
- Corticosteroids (prednisone 1 mg/kg, max 60-80 mg or methylprednisolone IV) may be given for potential biphasic reaction 2, 4