Anaphylaxis: Emergent Care URL: https://www.chop.edu/clinical-pathway/anaphylaxis-emergentcare-clinical-pathway 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 Posted: June 2006, last revised January 2019 ANAPHYLAXIS Goals of Treatment Early recognition, aggressive cardiopulmonary support, and immediate treatment with IM epinephrine are essential in the evaluation and treatment of anaphylaxis CLINICAL PEARLS AND PITFALLS Anaphylaxis is a life-threatening emergency, increasing in incidence among children Rapid intervention is required for patients with stridor, hoarseness, respiratory distress, and hypotension Epinephrine should be the medication priority in patients with anaphylaxis Delayed administration of IM epinephrine may be associated with an increased risk of severe and biphasic reactions Dermatologic involvement including urticaria is common, but not required, and may be transient Hypotension and shock are uncommon among children with anaphylaxis, however absence of cardiovascular involvement does not exclude the diagnosis Antihistamines and systemic corticosteroids are considered adjunctive therapies due to lack of data regarding efficacy Current Evidence Anaphylaxis is a potentially life-threatening acute hypersensitivity reaction Reaction severity varies from mild urticaria to shock and death Anaphylaxis is a multisystem reaction involving the respiratory, cardiovascular, dermatologic, and gastrointestinal systems Anaphylactic reactions classically involve an IgE-mediated response that occurs after reexposure to an antigen to which the patient has been sensitized The term anaphylactoid reaction is sometimes used to refer to a clinically similar non–IgE-mediated reaction that doesn’t require prior antigen exposure Although the mortality rate for children 30% decline in systolic blood pressure) after exposure to a known allergen Among children with anaphylaxis, skin manifestations are usually, but not uniformly present Gastrointestinal symptoms are common and may include nausea, vomiting, diarrhea, and abdominal pain Mucosal involvement may include lip and tongue swelling which could impair swallowing and ventilation Patients with mild upper airway edema may begin with throat discomfort or pruritus which can progress to life-threatening upper airway obstruction with stridor and respiratory distress Similar to acute asthma exacerbations, children with anaphylaxis may have bronchospasm and present with chest tightness, cough, dyspnea, wheezing, and retractions Although hypotension is rare among patients with anaphylaxis (1% to 5%), children with hypotension or wide pulse pressure may be at increased risk of severe and biphasic reactions Children may present in hypotensive shock, develop life-threatening arrhythmias, or have electrocardiographic evidence of ... Although the mortality rate for children