Treatment Summary
ÎThe management of food-induced anaphylaxis should focus on the following: (A-III)
> Dosing with IM epinephrine followed by transfer to an emergency facility for observation and possible further treatment
> Observation for 4-6 hours or longer based on severity of the reaction > Education for patient and family on:
> Epinephrine auto-injector prescription and training provided at the time of discharge
▶ Allergen avoidance ▶ Early recognition of signs and symptoms of anaphylaxis ▶ Anaphylaxis emergency action plan implementation ▶ Appropriate IM epinephrine administration ▶ Medical identification jewelry or an anaphylaxis wallet card
> Continuation of adjunctive treatment after patient discharge: ▶ H1
▶ H2
> Follow-up appointment with primary health care professional (after a food- induced anaphylactic reaction), with consideration for additional follow-up with a clinical specialist such as an allergist/immunologist
Table 2. Summary of the Pharmacologic Management of Anaphylaxis
Note: These treatments often occur concomitantly and are not meant to be sequential, with the exception of epinephrine as first-line treatment. In the Outpatient Setting
ÎFirst-line treatment: > Epinephrine, IM; auto-injector or 1:1000 solution ▶ Weight 10-25 kg: 0.15-mg epinephrine auto-injector, IM (anterior-lateral thigh) ▶ Weight > 25 kg: 0.3-mg epinephrine auto-injector, IM (anterior-lateral thigh) ▶ Epinephrine (1:1000 solution) (IM), 0.01 mg/kg per dose; maximum dose, 0.5 mg per dose (anterior-lateral thigh) Note: Epinephrine doses may need to be repeated every 5-15 minutes
ÎAdjunctive treatment: > Bronchodilator (β2
> H1
▶ Metered-dose inhaler (MDI) (child: 4-8 puffs; adult: 8 puffs) or ▶ Nebulized solution (child: 1.5 mL; adult: 3 mL) every 20 minutes or continuously as needed
-agonist): albuterol
▶ 1-2 mg/kg per dose ▶ Maximum dose, 50 mg IV or oral (oral liquid is more readily absorbed than tablets)
antihistamine: diphenhydramine
> Supplemental oxygen therapy > IV fluids in large volumes if patient presents with orthostasis, hypotension, or incomplete response to IM epinephrine
8 ▶ Alternative dosing may be with a less-sedating second generation antihistamine > Place the patient in recumbent position if tolerated, with the lower extremities elevated
antihistamine: diphenhydramine every 6 hours for 2-3 days; alternative dosing with a nonsedating second generation antihistamine antihistamine: ranitidine twice daily for 2-3 days ▶ Corticosteroid: prednisone daily for 2-3 days
