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Management of Anaphylaxis in Children

Liberman, Danica B. MD; Teach, Stephen J. MD, MPH

doi: 10.1097/PEC.0b013e31818ea116
CME Review Article

Anaphylaxis is a severe, life-threatening immunoglobulin E (IgE)-mediated hypersensitivity reaction. The key to successful management of anaphylaxis involves rapid diagnosis, assessment, and early initiation of therapy. Epinephrine is the undisputed initial therapy for anaphylaxis, and its administration should never be delayed. In most cases, additional interventions such as oxygen therapy, fluid resuscitation, β-agonists, antihistamines, and corticosteroids should be strongly considered. Although hospital course must be individualized to meet each patient's needs, a minimum of 4 to 6 hours of observation period after complete symptom resolution may be reasonable to monitor for recurrence of symptoms and biphasic reaction. Before discharge, every patient should receive patient education about anaphylaxis, a prescription for self-injectable epinephrine, and instructions for follow-up care.

Fellow (Liberman), Associate Chief (Teach), Division of Emergency Medicine, Children's National Medical Center, Washington, DC.

Both authors have disclosed that epinephrine, diphenhydramine, and predinisone are all FDA approved for anaphylaxis while ranitidine, albuterol, glucagon, and vasopressors were not approved.

Dr Liberman has disclosed that she has no significant relationship with or financial interests in any commercial companies that pertain to this educational activity.

Dr Teach has disclosed that he is/was at speakers bureau of AstraZeneca Corporation.

All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott CME Institute, Inc. has identified and resolved all faculty and staff conflicts of interest regarding this educational activity.

Address correspondence and reprint requests to Danica B. Liberman, MD, Children's National Medical Center, 111 Michigan Ave, Northwest, Washington, DC 20010. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.