Anaphylaxis / Allergic Reaction

Quick patient

— · — kg

Age

Weight

Pediatric · Routine allergic reaction

Urticaria · pruritus · mild angioedema (no airway / CV / GI)

Management
  • Remove trigger if identifiable; reassess for any anaphylaxis criteria.
  • Vitals on arrival; recheck q15–30 min while symptomatic.
  • PO antihistamines + steroid are first-line for isolated skin/mucosal symptoms.
  • Escalate to anaphylaxis pathway immediately if airway swelling, wheeze, hypotension, syncope, or vomiting/diarrhea develop — give IM epinephrine 0.01 mg/kg.
First-line pediatric dosing (enter weight to see live dose)
  • () 1 mg/kg PO/IV/IM (max 50 mg) q6h.
  • () PO: 2.5 mg (6 mo–2 y) · 2.5–5 mg (2–5 y) · 5–10 mg (≥6 y) once daily.
  • () 0.25 mg/kg IV (max 20 mg) or 0.5 mg/kg PO (max 40 mg) BID.
  • () 1–2 mg/kg IV (max 125 mg).
  • 1–2 mg/kg PO (max 60 mg) daily × 3–5 days.
  • nebulized 0.15 mg/kg (min 2.5 mg, max 5 mg) for wheeze/bronchospasm.

Disposition: observe until symptoms improving; discharge with 3-day H1 + H2 + steroid course and EpiPen Jr. (15–30 kg) or EpiPen 0.3 mg (≥30 kg) if any concerning features.

Note: IV bolus dosing is no longer recommended to treat anaphylaxis

Epinephrine Infusion

  • 4 mg/250 mL = 16 mcg/mL
  • 8 mg/250 mL = 32 mcg/mL
  • 16 mg/250 mL = 64 mcg/mL
  • Weight-Based Infusion Range: 0.05-1 mcg/kg/min
4 mg / 250 mL 0.05 mL/min
Range start (0.05 mcg/kg/min × 16 kg)0 mL
8 mg / 250 mL 0.03 mL/min
Range start (0.05 mcg/kg/min × 16 kg)0 mL
16 mg / 250 mL 0.01 mL/min
Range start (0.05 mcg/kg/min × 16 kg)0 mL
Fluid bolus (refractory shock)
20 mL/kg
— mL

Repeat × 2-3 PRN