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This tool helps clinicians recognize and treat anaphylaxis in children, with epinephrine and supportive doses calculated by weight. It covers first-line treatment, refractory reactions and discharge planning.
It starts by confirming anaphylaxis: sudden skin or mucosal signs plus breathing difficulty, low blood pressure, collapse or severe gut symptoms, or sudden low blood pressure, bronchospasm or throat involvement after a likely allergen, even without skin signs. Hives alone are managed with an antihistamine and observation. For anaphylaxis, IM epinephrine 1 mg/mL is given at 0.01 mg/kg, maximum 0.5 mg, in the mid-anterolateral thigh and repeated every 5 to 15 minutes, with autoinjector sizes of 0.1, 0.15 or 0.3 mg by weight. Severity and the response after 2 IM doses decide the next step.
Results add saline boluses of 20 mL/kg and nebulized albuterol for bronchospasm. Refractory anaphylaxis leads to an epinephrine infusion of 0.1 to 1 mcg/kg/min, and glucagon for patients on a beta-blocker. Observation is at least 4 to 6 hours after symptoms resolve, with discharge on 2 autoinjectors and an action plan. Sources are the 2023 anaphylaxis practice parameter update (Ann Allergy Asthma Immunol 2024) and the World Allergy Organization anaphylaxis guidance 2020.
Epinephrine 1 mg/mL (1:1,000) is given IM at 0.01 mg/kg (0.01 mL/kg), maximum 0.5 mg, into the mid-anterolateral thigh. Repeat every 5–15 minutes if needed. Never delay it for antihistamines or steroids.
This tool uses 0.1 mg for 7.5 to under 15 kg, 0.15 mg for 15 to under 30 kg, and 0.3 mg for 30 kg or more. Below 7.5 kg, draw up 0.01 mg/kg. Discharge with 2 autoinjectors and a written action plan.
Observe at least 4–6 hours after symptoms resolve, and longer or admit if 2 or more epinephrine doses were needed or the reaction was severe. Glucocorticoids are not recommended routinely to prevent biphasic reactions.
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