Suspected Pediatric Anaphylaxis
Acute onset multisystem allergic reaction
All Pathways
PediatricsEmergency
Pediatric Anaphylaxis (EAACI/GA²LEN 2024)
Pediatric Anaphylaxis (EAACI/GA²LEN 2024): Suspected Pediatric Anaphylaxis → Recognize Anaphylaxis → EPINEPHRINE IM - First Line → Response to Epinephri...
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Action Recognize Anaphylaxis
Clinical criteria
- ACUTE ONSET (minutes to hours) with:
- • Skin/mucosal involvement (hives, swelling, pruritus, flushing)
- + Respiratory compromise (dyspnea, wheeze, stridor, hypoxia)
- OR + Cardiovascular (hypotension, syncope, incontinence)
- OR exposure to known allergen with rapid onset of:
- • Hypotension (SBP <70 + [2×age] or >30% decrease)
03Action EPINEPHRINE IM - First Line
Give immediately - do not delay
- DOSE: 0.01 mg/kg IM (1:1000) - max 0.5 mg
- AUTOINJECTOR DOSES:
- • <15 kg: 0.15 mg (Epipen Jr or equivalent)
- • 15-25 kg: 0.15 mg or consider 0.3 mg
- • ≥25 kg: 0.3 mg
- SITE: Anterolateral thigh (through clothing if needed)
- May repeat every 5-15 minutes if no response
- Up to 3 doses usually sufficient
04Decision Response to Epinephrine?
Reassess after 5-15 minutes
05Outcome Observation Period
Monitor for biphasic reaction
- Observe 4-6 hours minimum
- High-risk (severe, refractory): observe 12-24 hours
- Prescribe epinephrine autoinjector
- Provide anaphylaxis action plan
- Refer to allergist for testing
06Action Repeat Epinephrine
Same dose IM if persistent symptoms
- Repeat 0.01 mg/kg IM (max 0.5 mg)
- Consider IV epinephrine if refractory:
- • 0.01 mg/kg (1:10,000) slow IV
- • Or infusion: 0.1-1 mcg/kg/min
07Action Adjunctive Therapies
Secondary treatments (do NOT delay epinephrine)
- FLUIDS: NS 20 mL/kg bolus if hypotensive
- ANTIHISTAMINES (do not replace epi):
- • Diphenhydramine 1-1.25 mg/kg IV/IM (max 50 mg)
- • Cetirizine 2.5-10 mg PO if tolerated
- CORTICOSTEROIDS (prevent biphasic):
- • Methylprednisolone 1-2 mg/kg IV (max 125 mg)
- • Or Prednisone 1-2 mg/kg PO (max 60 mg)
- BRONCHODILATORS: Albuterol neb for wheeze
08Warning Refractory Anaphylaxis
Persistent hypotension despite epinephrine
- Continue IV fluid boluses
- Epinephrine infusion: 0.1-1 mcg/kg/min
- Consider glucagon if on beta-blocker:
- • 20-30 mcg/kg (max 1 mg) IV over 5 min
- Vasopressin may be considered
- Prepare for intubation if airway compromise
- Path rejoins step 05Shared downstream outcome
- Path rejoins step 05Shared downstream outcome
09Action Position + Monitoring
Supportive measures
- Position supine with legs elevated (if tolerated)
- If respiratory distress: allow to sit up
- If vomiting/unconscious: recovery position
- Apply high-flow O2
- Monitor vitals continuously
- Obtain IV access
Guideline Source
EAACI Anaphylaxis Guidelines 2021 + GA²LEN 2024 Consensus
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Epinephrine dosing by weight preferred over autoinjector when possible
- Beta-blocker use may blunt epinephrine response
Applicable Regions
USEU
Version 1Next review: 2027-01-11
Next steps
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Related Resources
Frequently Asked Questions
What is the Pediatric Anaphylaxis (EAACI/GA²LEN 2024)?
The Pediatric Anaphylaxis (EAACI/GA²LEN 2024) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on EAACI Anaphylaxis Guidelines 2021 + GA²LEN 2024 Consensus.
What guideline is the Pediatric Anaphylaxis (EAACI/GA²LEN 2024) based on?
This algorithm is based on EAACI Anaphylaxis Guidelines 2021 + GA²LEN 2024 Consensus (DOI: 10.1111/all.15032).
What are the limitations of the Pediatric Anaphylaxis (EAACI/GA²LEN 2024)?
Known limitations include: Epinephrine dosing by weight preferred over autoinjector when possible; Beta-blocker use may blunt epinephrine response. Individual patient factors may require deviation from these recommendations.
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