ED Pathway for Evaluation/Treatment of Children with Anaphylaxis
Clinical Criteria For Diagnosing Anaphylaxis
Anaphylaxis is highly likely when ONE of the following 3 criteria are fulfilled, usually within minutes to 2-3 hours following possible allergen exposure
CRITERIA 1

Acute onset of an illness with involvement of the skin, mucosal tissue, or both
(e.g., generalized hives, pruritis or flushing, swollen lip-tongue-uvula)

AND AT LEAST ONE OF THE FOLLOWING

  • Respiratory compromise
  • Reduced BP or associated symptoms of end-organ dysfunction
  • Persistent GI Symptoms, Significant abdominal pain and/or significant vomiting
CRITERIA 2

Two or more of the following that occur rapidly after exposure to a LIKELY ALLERGEN for that patient:

  • Involvement of the skin-mucosal tissue
  • Respiratory compromise
  • Reduced BP or associated symptoms
  • Persistent gastrointestinal symptoms
CRITERIA 3 Reduced BP after exposure to KNOWN ALLERGEN for that patient

MD/CRNP/RN Rapid Assessment

  • Patient meets clinical criteria for Anaphylaxis listed below:
  • ADMINISTER EPINEPHRINE IM IMMEDIATELY
  • Repeat dose as clinically indicated q 5-15 minutes
  • Assess need for IV access
  • ASSESS, MANAGE ABC’S
    • Mental status abnormality
    • Upper airway obstruction
    • Lower airway symptoms
    • Circulatory abnormality
  • ADDITIONAL ANAPHYLAXIS MEDICATIONS (Dosing)
  • Consider the use of the following adjunctive medications:
    • Antihistamines
    • Corticosteroids
EPINEPHRINE DOSING
< 5 kg 0.01 mg/kg Epinephrine IM
(0.1 mg/mL solution)
5 - 25 kg 0.15 mg Epipen® Jr
> 25 kg 0.3 mg Epipen

Anaphylaxis Red Flags

  • History of biphasic or severe reactions
  • Progression of / or persistent symptoms
  • History of severe asthma
    • Patient with 1 ICU admission and/or 3 IP admissions per year
  • Current asthma flare
  • Hypotension during ED stay
  • Requires >1 Epinephrine dose
  • Requires fluid bolus
  • Upper airway obstruction i.e. stridor
Reassess patient’s symptoms, PE, VS
Serious Symptoms Resolved with 1 dose of Epinephrine (excluding rash)
Severe or recurrent symptoms
or Anaphylaxis Red Flags
Posted: June, 2006
Revised: September 2011, October 2014, November 2016, January 2019
Authors: J. Lee, MD; T. Brown-Whitehorn, MD; N. Tsarouhas, MD; B. Rodio, RN; L. Zielinski, RN; J. Molnar, CRNP;
M. Lewis, CRNP; C. Jacobstein, MD; J. Lavelle, MD