An Evidence-Based Review Of Pediatric Anaphylaxis (Trauma CME)
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An Evidence-Based Review Of Pediatric Anaphylaxis (Trauma CME)

October 2010

Abstract

Anaphylaxis is a diagnosis that all pediatricians and emergency medicine clinicians must be comfortable treating. Common teaching is that patients should immediately be treated with epinephrine, H1 and H2 receptor blocking antihistamines, and corticosteroids. This treatment regimen is so ingrained that few question the evidence behind these treatments.

The more common clinical question is who to treat for anaphylaxis. We all know to aggressively treat the hypotensive, stridulous patient with diffuse urticaria or the child with a known serious peanut allergy who presents with symptoms after accidental exposure. What about the asthmatic child who looks well with diffuse urticaria and wheezing? Or the child with food allergies who presents with abdominal cramping, diarrhea, and wheezing after eating away from home? Since all the signs and symptoms of anaphylaxis are commonly seen in other disease processes, atypical presentations of anaphylaxis can easily be missed and undertreated.

This issue of Pediatric Emergency Medicine Practicewill focus on the identification of patients with anaphylaxis including those with atypical presentations. A recent collaboration between the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network developed consensus guidelines for the clinical diagnosis of anaphylaxis.1 (See Table 1.) We use those criteria for the diagnosis of anaphylaxis. This issue will also review the literature behind the treatment of anaphylaxis and review recent guidelines on the topic (See Table 2).




Keywords: anaphylaxis, epinephrine, steroids

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