anaphylaxis%20(pediatric)
ANAPHYLAXIS (PEDIATRIC)

Anaphylaxis is a serious generalized or systemic hypersensitivity reaction that is rapid in onset and potentially fatal.

Diagnosis can be made if it is acute in onset of minute to several hour duration that involves the skin, mucosal tissue or both plus having signs & symptoms either respiratory or cardiovascular compromise.

It involves immunological response with IgE, IgG or immune complexes. Non-immunological mechanisms are also involved and termed as nonallergic anaphylaxis that is relatively uncommon in children.

Protracted, severe anaphylaxis are reactions occurring up to 32 hours despite aggressive management.

 

Supportive Therapy

  • Establish and maintain airway
    • Endotracheal tube, cricothyrotomy or needle cricothyrotomy may be performed if indicated

Oxygen

  • High flow O2 (6-8 L/min) via non-rebreathing mask or endotracheal tube in patients experiencing respiratory symptoms, hypoxemia, or hypotension related to anaphylaxis
  • Continuous pulse oximetry and arterial blood gas determination should guide oxygen therapy

Fluid Support

  • Maintain an IV access using wide bore needles or cannulas (14-16 gauge)
  • Rapid administration of 1-2 liters of isotonic (0.9%) saline solution may be indicated
    • Children: 10 mL/kg for the first 5-10 minutes
  • For hypotensive patients or those with cardiovascular collapse, IV administration of normal saline at 20 mL/kg is recommended
    • If IV access is delayed or impossible, intraosseous route can be used
  • Inotropic support with Dopamine or Epinephrine infusion should be started if >40 mL/kg is needed
    • Invasive BP monitoring may be required
  • Monitor patient for signs of overtreatment eg hypertension or pulmonary edema

Additional Intervention for Cardiopulmonary Arrest Occurring During Anaphylaxis

  • Cardiopulmonary resuscitation and advanced cardiac life support measures
    • Prolonged resuscitation efforts are encouraged
  • High dose Epinephrine (IV)
  • Rapid volume expansion
  • Consider extracorporeal membrane oxygenation (ECMO) if available
  • Transport to ICU, as setting dictates
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