UMEM Educational Pearls

Title: What about Anaphylaxis in kids? (submitted by Yitschok Applebaum, MD)

Keywords: allergic reaction, anaphylaxis, auto-injector, epi-pen (PubMed Search)

Posted: 1/27/2017 by Mimi Lu, MD (Updated: 8/25/2017)
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What if you were out in public and a 1 year old child (est 10 kg) suddenly develops anaphylaxis but you only have an epinephrine auto-injector with the “adult” dose of 0.3 mg. Is it safe to give?

Anaphylaxis is a life threatening emergency with mortality of up to 2% [1]. Early recognition is imperative and administration of timely Epinephrine is the single most important intervention [2]. While providers may be hesitant to administer epinephrine in older patients due to fear of precipitating adverse cardiovascular events, they may also hesitate in younger patients due to fear of overdose.

Iimmediate administration with any dose available is recommended because:

the risks of untreated anaphylaxis are greater than the risk of over-treating with epinephrine.
20% of Anaphylaxis patients require a second dose of Epinephrine [3].
The recommended IM dose of 0.01mg /kg was determined arbitrarily.
The vast majority of epinephrine overdoses are via IV injection at doses 100 - 1000 fold the recommended IV dose [4]

Bottom line:

There are no absolute contraindications (including age) for epinephrine in patients with anaphylaxis. Give the initial dose IM into the anterolateral thigh.

References

1- Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001 Jan. 107(1):191-3. [Medline].

2- Sheikh A, Shehata YA, Brown SG, Simons FE. Adrenaline for the treatment of anaphylaxis: cochrane systematic review. Allergy 2009; 64:204.

3- Oren E, Banerji A, Clark S, Camargo CA Jr. Food-induced anaphylaxis and repeated epinephrine treatments. Ann Allergy Asthma Immunol 2007; 99:429.

4- Wood JP, Traub SJ, Lipinski C. Safety of epinephrine for anaphylaxis in the emergency setting. World Journal of Emergency Medicine. 2013;4(4):245-251. doi:10.5847/wjem.j.issn.1920-8642.2013.04.001.