Allergic Reaction

Guidelines:

1. Albuterol 2.5-5 mg aerosol prn bronchospasm
2. Epinephrine
   1. With adequate peripheral perfusion, use 1:1,000 (1 mg/1 mL) IM, 0.01 mg/kg IM Max single dose 0.3 mg May repeat q5 minutes prnX2
   2. For severe, life threatening reactions (hypo-perfusion, severe bronchospasm or stridor), use 1:10,000 IV (1 mg/10 mL), 0.01 mg/kg max dose of 0.1 mg IV over 5 minutes
3. Diphenhydramine (Benadryl) Pediatrics: 1.25 mg/kg IV/IM. Max 50 mg.
4. Methylprednisolone (Solu-Medrol): 1 mg/kg/dose IV over 1 minute Max 60 mg/day
5. If hypotensive, administer 0.9% NaCl
   1. 10-20 ml/kg IV bolus.
6. For severe, persistent hypotension:
   1. Epinephrine drip at 0.05-0.1 mcg/kg/min OR
   2. Norepinephrine drip at 0.05-0.1 mcg/kg/min OR
   3. Dopamine drip at 5-20 mcg/Kg/min
7. Administer H2 blocker IV:
   1. Famotidine: 0.25 mg/kg/dose max 20 mg OR
   2. Ranitidine: 2 mg/kg/dose max 50 mg

Citations/References:

1. Liberman DB, Teach SJ. Management of anaphylaxis in children. Pediatr Emerg Care. 2008;24:861–9.