Anaphylaxis in Pediatric Patients: Early Recognition and Treatment Are Critical for Best Outcomes

Points and Pearls Excerpt

• Anaphylaxis is an acute, systemic allergic reaction that can lead to life-threatening symptoms within minutes to hours. Treatment with intramuscular (IM) epinephrine should be initiated early, even in uncertain cases, as it may prevent progression to respiratory failure or cardiac arrest.
• Most patients have mucocutaneous symptoms (urticaria, flushing, angioedema) and respiratory complaints. Diagnosis can be challenging in patients who lack cutaneous findings. Subjective symptoms of dyspnea should not be discounted, especially in patients with a history of severe anaphylaxis.
• Anaphylaxis in infants can present with nonspecific symptoms such as facial flushing, vomiting, and loose stool. Concurrent tachycardia or hypotension should raise suspicion for possible anaphylaxis.

Most Important References

• * Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report--second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. Ann Emerg Med. 2006;47(4):373-380. (Consensus statement)
• Simons FE, Ardusso LR, Bilo MB, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9. (Literature review) 
• * Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. (Practice parameter) 
• * Campbell RL, Li JT, Nicklas RA, et al. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014;113(6):599-608. (Practice parameter) 
• * Soar J, Pumphrey R, Cant A, et al. Emergency treatment of anaphylactic reactions--guidelines for healthcare providers. Resuscitation. 2008;77(2):157-169. (Expert guideline)