Similar to the care of children with asthma, it is reasonable to administer inhaled β2 -agonists and glucocorticoids for children with wheezing as long as administration does not delay treatment with IM epinephrine Although the role of glucocorticoids in preventing severe and biphasic reactions is unclear, they are frequently recommended because of known efficacy for other allergic diseases For patients who can tolerate enteral medications prednisone (0.5 to mg per kg by mouth, maximum 60 mg) and dexamethasone (0.6 mg/kg, maximum 16 mg) are reasonable options whereas methylprednisolone (1 to mg per kg IV; maximum 60 mg) can be administered for critically ill patients Stress-dose hydrocortisone should be considered for those with adrenal insufficiency or lifethreatening anaphylaxis In summary, there is no data supporting the use of antihistamines or glucocorticoids to treat anaphylaxis, and, administration of these medications should never precede treatment with IM epinephrine Disposition The recommended period of observation after anaphylaxis should be individualized and based upon initial reaction severity, risk factors for biphasic reactions, and access to care An observation period of to hours may be appropriate for patients with mild to moderate episodes that resolve promptly with therapy Patients with severe reactions including upper airway obstruction, refractory wheezing or respiratory distress, and shock should be hospitalized The reported incidence of biphasic reactions varies widely from 1% to 15%; potential risk factors include delayed administered of IM epinephrine, respiratory involvement (e.g., wheezing), history of asthma, and hypotension Discharge Considerations Patients who are asymptomatic and fulfill discharge criteria after a period of ED observation should be educated about allergen avoidance, anaphylaxis action plans, and indications for out-of-hospital epinephrine administration These patients should be discharged with prescriptions for epinephrine autoinjectors, or ideally the medication in hand Providing hands-on instruction on proper use of autoinjectors increases the likelihood of patients and families correctly administering epinephrine during subsequent reactions It is critical that families receive specific instructions on different autoinjectors approved by the Food and Drug Administration (FDA) Multiple online educational resources are available for parents and patients with food allergies, some of which have been validated through federal funding and are available free of charge