Pediatric anaphylaxis

What are the signs and symptoms of pediatric anaphylaxis?

Anaphylactic shock may be life-threatening, so it requires immediate treatment. It is important to administer life-saving epinephrine and get your child to an emergency room right away. 

During an anaphylactic reaction, the body’s immune system releases a flood of chemicals. This can cause anaphylactic shock, which may include symptoms such as narrowing of breathing airways an/or a drop in blood pressure.

The rapidly developing symptoms include:

• Abdominal pain
• Abnormal breathing sounds
• Chest discomfort or tightness
• Cough
• Diarrhea
• Difficulty breathing or swallowing
• Dizziness
• Nasal congestion
• Nausea or vomiting
• Swelling of the face, eyes or tongue
• Unconsciousness

Prevention

To prevent anaphylaxis, parents are advised to keep children away from foods and medications that caused past allergic reactions. If your child is allergic to certain foods, be careful when the family is eating out. Ask detailed questions about the ingredients in a menu serving. At the grocery store, carefully examine ingredient labels. 

Treatment

When you take your child for medical treatment, a physician’s first priority is a physical examination. This will assess the child’s airway, breathing and circulation. Your doctor will also assess alertness and orientation. During the clinical diagnosis for anaphylaxis, the physician will ask parents about their children’s allergies or previous allergic reactions.

Medication

Epinephrine (epi·​neph·​rine), or epi, is the most effective immediate treatment. It reverses the most serious symptoms (breathing and dangerous blood-pressure drop).

How is pediatric anaphylaxis diagnosed?

When you take your child for medical treatment, a physician’s first step is a physical examination. This will assess the child’s airway, breathing and circulation. Your doctor will also assess alertness and orientation.

Examination findings may include:

• Restlessness and anxiety
• Severe angioedema, or rapid swelling of the tongue and lips
• Tachypnea, or rapid breathing
• Stridor, an abnormal, high-pitched breathing sound caused by a blockage in the throat or the larynx
• Loss of voice, hoarseness, wheezing or dysphonia (difficulty speaking due to spasms of the muscles that control the vocal cords)
• Neurologic issues such as altered mental activity and depressed level of consciousness
• Hives anywhere on the body
• Gastrointestinal disorders such as vomiting, diarrhea and abdominal distention

During the clinical diagnosis for anaphylaxis, the physician will ask parents about their child’s allergies or previous allergic reactions.

Typical questions include:

• Do any particular foods seem to cause a reaction?
• Is your child taking any medications? Do any seemed linked to symptoms?
• Has exposure to latex triggered allergy symptoms?
• Have stings or bites from any particular insect seemed to have caused symptoms?

Your doctor also may test your child for:

• Food allergies
• Medication allergies
• Causes of IgE-independent reactions

Blood tests for tryptase might be helpful in diagnosing anaphylaxis due to insect stings or medications. This test has only limited use if the cause is food.

The physician may order lab tests such as:

• Serum tryptase assessment, to help confirm diagnosis of anaphylaxis
• Skin testing, in vitro immunoglobulin E (IgE) tests or both to determine the stimulus for the anaphylactic reaction

What are the causes of pediatric anaphylaxis?

• Common causes include drug allergies, food allergies and insect bites or stings. After being exposed to a substance such as bee sting venom, a person’s immune system becomes sensitized to it. Anaphylaxis can occur in response to any allergen.
• Less common causes of anaphylaxis include latex, medications used in anesthesia and exercise.

How is pediatric anaphylaxis treated?

Waste no time! Call 911! 

Treatment for anaphylaxis begins at home with the parent. An anaphylactic reaction is an emergency situation that requires immediate medical attention.

While awaiting the arrival of paramedics

• Check your child’s airway breathing and circulation. Dangerous throat swelling could be occurring, and a hoarse or whispered voice is an indicator. If necessary, start rescue breathing and CPR. Stay calm to reassure your child.
• If the reaction results from a bee sting, scrape the stinger off with a firm object. Don’t use tweezers; squeezing the stinger results in more venom release.
• To prevent shock, have your child lie flat. Raise their feet about 12 inches, and then cover your child with a blanket.

What the paramedics will do

Paramedics may perform endotracheal intubation (placing of a tube through the nose or mouth into the airways), or they may perform a tracheostomy (placing a tube into the trachea).

After lifesaving measures and epinephrine are administered, your child may receive antihistamines, such as diphenhydramine, and corticosteroids, such as prednisone. This will further improve symptoms, reducing inflammation of air passages and improving breathing.

The emergency professionals might also administer a beta-agonist, such as albuterol, to relieve breathing symptoms or oxygen to improve restricted breathing.

Helpful medication

Epinephrine is the most effective immediate treatment. If administered in time, it can reverse the life-threatening symptoms of anaphylactic shock, which include serious breathing problems and a dangerous drop in blood pressure.

Following epinephrine, antihistamines and steroid drugs like prednisone and methylprednisolone can help reduce hives and itching, as well as forestall the return of acute symptoms.

For allergic reactions related to insect stings or foods, your doctor can provide you with an epinephrine injection kit. If your child’s anaphylactic reaction is caused by stings, a series of allergy shots may reduce his body's allergic response and prevent a severe reaction in the future.