Management of Anaphylaxis

Classification and Treatment

The American Academy of Pediatrics recommends epinephrine as the first-line treatment for anaphylaxis, which should be administered promptly at the onset of symptoms, as delayed administration has been implicated in contributing to fatalities 1, 2
Allergic reactions can be classified based on severity, with Grade I being skin and mucosal signs only, Grade II being moderate multi-organ involvement, Grade III being life-threatening involvement, and Grade IV being cardiac or respiratory arrest 3
The American Academy of Allergy, Asthma, and Immunology recommends administering epinephrine intramuscularly into the anterolateral thigh, with dosages of 0.3-0.5 mg for adults and children ≥30 kg, and 0.01 mg/kg for children <30 kg 1, 2

Positioning the patient in a recumbent position with lower extremities elevated, if tolerated, is recommended by the American Academy of Pediatrics 1, 2
Oxygen therapy should be administered as needed, according to the American Academy of Allergy, Asthma, and Immunology 1, 4
IV fluids should be provided in large volumes for hypotension or incomplete response to IM epinephrine, as recommended by the American Academy of Pediatrics 1, 2
Bronchodilator (albuterol) should be administered for bronchospasm, with dosages of 4-8 puffs for children and 8 puffs for adults, or 1.5 mL for children and 3 mL for adults via nebulized solution 1
H1 antihistamine (diphenhydramine) should be administered at a dosage of 1-2 mg/kg per dose, with a maximum of 50 mg IV or oral, as recommended by the American Academy of Pediatrics 1

The American Academy of Pediatrics recommends observing patients who receive epinephrine for 4-6 hours in a medical facility 1, 2
Patients should be discharged with an anaphylaxis emergency action plan, epinephrine auto-injector prescription, and a plan for monitoring auto-injector expiration dates, as recommended by the American Academy of Allergy, Asthma, and Immunology 1, 2
Continuation of adjunctive treatment, including H1 antihistamine, H2 antihistamine, and corticosteroid, should be considered, according to the American Academy of Allergy, Asthma, and Immunology 2, 5

The American Academy of Pediatrics identifies adolescents and young adults, individuals with known food allergy and previous history of anaphylaxis, and those with asthma as being at higher risk for severe reactions 1
Patients with cardiovascular disease, taking monoamine oxidase inhibitors or tricyclic antidepressants, or with conditions like recent intracranial surgery or uncontrolled hyperthyroidism require careful consideration when administering epinephrine, according to the American Academy of Allergy, Asthma, and Immunology 2, 5