Inpatient Clinical Pathway for Evaluation/Treatment
of Children with Anaphylaxis
Related Pathways
- Order epinephrine auto-injector on admission if:
- Documented IgE-mediated food allergy and
- History of severe reaction or anaphylaxis
Anaphylaxis is highly likely when ONE of the following 3 criteria are fulfilled within minutes to 2-3 hours following possible allergen exposure. | |
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Criteria 1 |
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Criteria 2 |
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Criteria 3 | Reduced BP after exposure to known allergen for that patient |
Risk Factors for Biphasic Reaction
- History of biphasic or severe reactions
- Progression of/or persistent symptoms
- History of severe asthma
- Hypotension
- Requires > 1 epinephrine dose
- Requires fluid bolus
- Drug trigger
Patient meets one of the criteria listed above
- Administer Epinephrine IM Immediately, Call Code Blue
- Repeat dose as clinically indicated q 5-15 minutes
- Additional auto-injectors are available at Pyxis™ MedStation™, code cart
Mental Status Abnormality | Oxygen |
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Upper Airway Obstruction | Racemic epinephrine Consider intubation |
Lower Airway Symptoms | Albuterol |
Circulatory Abnormality | Rapid infusion NS Epinephrine |
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Epinephrine Dosing - IM | ||
< 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® |
Posted: February 2016
Revised: June 2022
Authors: J. Lee, MD; T. Brown-Whitehorn, MD; N. Tsarouhas, MD; J. Lamaina, RN, MSN; J. Molnar, CRNP; R. Sutton, MD; D. Davis, MD; M. Lewis, CRNP; C. Jacobstein, MD; J. Lavelle, MD; MK. Abbadessa, ACCNS-P
Revised: June 2022
Authors: J. Lee, MD; T. Brown-Whitehorn, MD; N. Tsarouhas, MD; J. Lamaina, RN, MSN; J. Molnar, CRNP; R. Sutton, MD; D. Davis, MD; M. Lewis, CRNP; C. Jacobstein, MD; J. Lavelle, MD; MK. Abbadessa, ACCNS-P
Evidence
- Biphasic Anaphylaxis: Review of Incidence, Clinical Predictors, and Observation Recommendations
- International Consensus on (ICON) Anaphylaxis
- 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
- Anaphylaxis — a practice parameter: 2015 Update
- Anaphylaxis - A 2020 Practice Parameter Update, Systematic Review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Analysis