Anaphylaxis Treatment in Infants

First-Line Treatment and Adjunctive Therapies

The American Academy of Allergy, Asthma, and Immunology recommends intramuscular epinephrine 0.15 mg via autoinjector as the first-line treatment for anaphylaxis in infants, with adjunctive therapies including diphenhydramine and albuterol for specific symptoms 1, 2, 3
For a 7-month-old infant weighing 15 pounds (6.8 kg), diphenhydramine 1.25 mg/kg/dose orally (approximately 8.5 mg) is recommended for mild reactions 1, 2, 4
Albuterol nebulization 0.15 mg/kg every 20 minutes × 3 doses (minimum 2.5 mg per dose) over 5-15 minutes is recommended for bronchospasm 1, 2
Oxygen 8-10 L/min via face mask is recommended if available 1, 2
Normal saline 20 mL/kg/dose (approximately 136 mL) over 5 minutes intravenously is recommended for hypotension 1, 2
Corticosteroids, such as prednisolone 1 mg/kg orally (approximately 6.8 mg) or Solumedrol 1 mg/kg intravenously, may be used to prevent biphasic reactions 1, 2, 5, 7, 4

The American Academy of Pediatrics recommends placing the infant in a recumbent position if tolerated, and observing for 3-4 hours minimum in an emergency department setting 3, 5, 6
Prescribing an epinephrine autoinjector 0.15 mg for home use, and providing two autoinjectors in case a second dose is needed before emergency services arrive, is recommended 3, 5, 6, 4
Training caregivers on recognition of anaphylaxis symptoms and proper autoinjector technique is crucial 4