Anaphylaxis — Discharge Criteria, Medication, Teaching, Follow-up — Clinical Pathway: Emergency

Anaphylaxis Clinical Pathway — Emergency Department

Discharge Medication, Teaching, Follow-up

Discharge Criteria

  1. Complete clinical resolution of all serious symptoms (rash may persist)
  2. If epinephrine was administered, observe 4 hours from time of epinephrine administration
  3. Parental comfort with discharge with good access to ED if symptoms recur
  4. Epinephrine auto-injector physically available to family
  5. Counseling regarding use of medic alert tag
  6. Counseling regarding allergen avoidance
  7. Completion of anaphylaxis discharge instructions

Allergy referral to be seen within 1 month

Discharge Medications

All patients diagnosed with anaphylaxis will be discharged with an epinephrine auto-injector for home use.

Epinephrine auto-injector < 25 kg Epi-pen® Jr
≥ 25 kg Epi-pen®
Ensure patient is leaving ED with Epi auto-injector in hand

During CHOP Retail Pharmacy hours
Monday - Friday:
Saturday - Sunday:		 8:00 a.m. – 12 a.m.
8:30 a.m. – 6 p.m.
Give prescription to parent during the observation period to fill prior to discharge

  • During non-CHOP Retail Pharmacy hours
    • ED Pharmacy will provide patient with auto-injector
    • Use ED Anaphylaxis Order Set
Antihistamine Consider Diphenhydramine or Cetirizine for 1-3 days as needed for persistent non-severe symptoms
Prednisone Consider 1 additional dose of Prednisone (1 mg/kg, max 30 mg) as needed for persistent non-severe symptoms

Discharge Teaching

Review the following the time of discharge:

  • Have patient/family watch Epi-Pen video (including video on use of Epi-Pen  )
  • Discharge instructions (including allergen avoidance)
  • Dosing of medications
  • Review proper epinephrine auto-injection technique
  • Anaphylaxis care plan
  • Signs and symptoms that require a return to the Emergency Department
  • Advise need for medic alert tag

Discharge Follow-up

Refer to Allergy within 1 month