Emergency Treatments for Allergic Reactions in Children

Published: June 28, 2022
Barbara Young
By Barbara Young, PharmD

Suppose your child has had a severe allergic reaction to a food, insect sting, or another substance. This severe, potentially life-threatening allergic reaction is called anaphylaxis. It is critical that a parent or caregiver understands what to do if your child is experiencing an anaphylaxis reaction. Your child’s doctor can create a written plan to communicate details for the management of anaphylaxis. This plan and any necessary medication(s) should be available to your child’s responsible adults in all settings, including home, school, sporting events, and camps. Your pharmacist is an excellent resource for answering questions about medications and training parents and caregivers to give emergency injections.

What are the symptoms of an anaphylaxis reaction?
Here are examples of adverse effects that may occur when your child comes in contact with an allergic substance. The effects may worsen rapidly, and it is difficult to predict the severity of the reaction.

  • Itching, redness, hives, or swelling of the skin, lips, and eyes
  • Hoarseness, itching or tightness of the throat, cough, wheezing, difficulty breathing, chest tightness
  • Chest pain, racing heart, dizziness, fainting, weak pulse
  • Nausea, abdominal pain, vomiting, diarrhea
  • Sense of doom, headache, changes in mental or behavioral status, confusion

If your child experiences an anaphylaxis reaction, call 911 immediately.

What medication(s) should be available? 
Epinephrine is the medication of choice for the treatment of anaphylaxis. It is available as an autoinjector (Adrenaclick, Auvi-Q, Epi-pen) and as a pre-filled syringe (Symjepi) to give a prepared dose. The medications should be easily accessible because the adverse reaction may happen suddenly. It is also vital to always have two doses of the medication available— a second dose may be necessary if there is not a quick or adequate response to the first dose.

Epinephrine products must be stored properly as the medication can degrade when exposed to extreme heat or cold. Keep it at temperatures between 68-77°F (20 to 25°C), but brief exposures to temperatures between 59-86° F (15-30° C) are allowed.

Be sure to check the expiration dates of all products periodically and refill epinephrine prescriptions promptly. However, using an expired epinephrine autoinjector in an emergency is better than delaying treatment.

For certain children, other medications may be included in the plan. Some, such as those with asthma, may require treatment with a rescue inhaler such as albuterol. Others may have first treatment with an antihistamine (diphenhydramine [Benadryl] or cetirizine [Zyrtec]) given by mouth for mild symptoms.

Additional tips for parents and caregivers
Aside from having the medication available, the most critical thing for parents and caregivers to know is how to give the injection.

Each epinephrine autoinjector product differs and has specific instructions for use. Be sure to review the instructions and practice with a “dummy” device, which works the same as the regular product but does not contain medication. Familiarity with the device is essential to save time in an actual event.

Other key points include:

  • The injection can be given through clothing into the middle part of the outer thigh.
  • After giving the medication, have the child lay down (or on their side if vomiting may occur) in case the allergic reaction lowers their blood pressure and causes dizziness and fainting.
  • Call 911 right after giving the injection. The child should be assessed by a medical professional to see if further treatment is necessary.
  • Another injection of epinephrine may be necessary 5-15 minutes later if the response is not sufficient. 

What should be described in the emergency plan?
The emergency plan should identify the child’s allergy, triggers to avoid (such as certain foods, insect stings) and symptoms to watch for in case of an exposure to the substance. The plan also details what to do if these symptoms occur and explain when and how much of the medication to give. Further information for your child’s care after giving the medication(s) should also be included.

How often should the emergency plan be reviewed? 
Annually. Remember to check your child’s weight because if it has changed, the dose of injection may need to be increased. Add any updates about your child’s medical condition, additional allergies, or other new medical information.

Summary
To care for your child’s potential allergic reactions, it is important to maintain a written emergency plan and have the necessary medications on hand for the initial emergency treatment. Your pharmacist is a great resource if you have any questions about this plan or if you would like to be trained to give the epinephrine injections. If your child experiences an anaphylaxis reaction, call 911.

 

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