Inpatient Pathway for Evaluation/Treatment
of Children with Anaphylaxis
  • On admission, order Epinephrine Auto-injector if:
  • Documented IgE-mediated food allergy AND
  • History of severe reaction or anaphylaxis
Clinical Criteria for Diagnosing Anaphylaxis
Anaphylaxis is highly likely when ONE of the following 3 criteria are fulfilled 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, pruritus 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
  • Anaphylaxis Red Flag

  • Hx of biphasic/severe reaction
  • Progression/persistent symptoms
  • Hx of severe asthma
  • Current asthma flare
  • Hypotension
  • Needs > 1 epinephrine dose
  • Needs fluid bolus
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 station, code cart
Rapid Assessment, Manage ABCs
Mental status abnormality Oxygen
Upper airway obstruction Racemic epinephrine
Consider intubation
Lower airway symptoms Albuterol
Circulatory abnormality Rapid infusion NS Epinephrine
Epinephrine Dosing - IM Administration
< 5 kg 0.01 mg/kg Epinephrine IM
(0.1 mg/mL solution)
5 - 25 kg 0.15 mg Epipen®
> 25 kg 0.3 mg Epipen
Racemic Epinephrine – Nebulization
2.25% solution, 0.5 mL in 3 mL NS
Albuterol Weight Based Dosing, 0.5% Solution
5-10 kg 2.5 mg 0.5 mL
> 10 - 20 kg 3.75 mg 0.75 mL
> 20 kg 5 mg 1.0 mL
Posted: February 2016
Revised: November 2016, February 2019
Authors: T. Brown-Whitehorn, MD; J. Spergel, MD, PhD; J. Lavelle, MD; S. O’Neill, PharmD; J. Lamaina, RN, MSN; R. Sutton, MD; D. Davis, MD