Emergency Treatment for Anaphylaxis in Children

Immediate Assessment and Risk Stratification

The American Academy of Pediatrics recommends rapidly evaluating for signs of anaphylaxis beyond isolated hives, including respiratory symptoms such as wheezing, stridor, dyspnea, throat tightness, difficulty swallowing, and persistent cough, in a child presenting with spreading hives from an unknown allergen 1, 3
The American Academy of Pediatrics also recommends evaluating for cardiovascular symptoms such as hypotension, tachycardia, syncope, dizziness, and pallor, as well as gastrointestinal symptoms like persistent crampy abdominal pain, vomiting, and diarrhea, in a child with spreading hives 1, 3
The American Academy of Pediatrics notes that neurological symptoms such as confusion and sense of impending doom can also be indicative of anaphylaxis in a child with spreading hives 3

The American Academy of Pediatrics recommends administering intramuscular epinephrine 0.01 mg/kg (0.12 mg or 0.12 mL of 1:1000 solution for a 12 kg child) immediately if there are any additional symptoms beyond skin involvement or if the hives are rapidly progressive 1, 2
The American Academy of Pediatrics advises that epinephrine should be given immediately if there are any signs of respiratory compromise, cardiovascular symptoms, persistent gastrointestinal symptoms, or rapidly spreading hives 1, 3

The Mayo Clinic recommends calling for additional help and activating emergency response after epinephrine administration, as well as positioning the child supine with legs elevated unless respiratory distress is present 4, 5
The Mayo Clinic advises monitoring the child's vital signs every 5 minutes and administering supplemental oxygen as needed 1, 4
The Mayo Clinic recommends establishing IV access and giving a fluid bolus if the child is hypotensive 1

The Mayo Clinic recommends administering H1-antihistamine (diphenhydramine) and H2-antihistamine (ranitidine) as adjunctive medications after epinephrine, as well as inhaled albuterol if wheezing is present 4, 5, 6

The American Academy of Pediatrics warns against waiting for respiratory or cardiovascular symptoms to develop before giving epinephrine, as isolated hives can rapidly progress to life-threatening anaphylaxis 1, 2, 3
The American Academy of Pediatrics advises against relying on antihistamines alone, as they are ineffective for treating anaphylaxis and have a dangerously slow onset 2, 3, 6