Anaphylaxis

AAP Updates Recommendations on Epinephrine for Anaphylaxis

The American Academy of Pediatrics (AAP) has updated its recommendations on the use of epinephrine for the treatment of anaphylaxis, and has offered a universal and customizable emergency action plan for patients and caregivers.
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The clinical report updates the AAP’s 2007 report on the same topic. Key points of the report include the following:

  • In a health care setting, epinephrine by intramuscular injection in the mid-outer thigh is recommended.
  • Prescription of epinephrine autoinjectors (EAs) for patients with a history of anaphylaxis and for some high-risk patients who have not experienced anaphylaxis facilitates timely epinephrine injection in the community setting.
  • Prescribing epinephrine for infants and young children is troublesome, due to the lowest available dosage of EA (0.15 mg) being a high dose for many infants and young children.
  • Prevention of anaphylaxis requires confirmation of the trigger, discussion of allergen avoidance, immunotherapy, and a customized anaphylaxis emergency action plan.
  • The management of anaphylaxis should include education of children and supervising adults about recognition and first-aid treatment.  

“Even physicians with years of experience in diagnosing and treating anaphylaxis cannot determine, at the onset of an episode, whether that episode will remain mild or escalate over minutes to become life-threatening,” the authors wrote.

“In community settings, patients experiencing anaphylaxis or caregivers without medical training may be so anxious that they cannot assess the situation accurately and remember what to do. It is therefore important that physicians instruct patients and caregivers to err on the side of prompt epinephrine injection.”

—Michael Potts

Reference:

Sicherer SH, Simons ER. Epinephrine for first-aid management of anaphylaxis [published online February 13, 2017]. Pediatrics. doi:10.1542/peds.2016-4006.