How to recognize and manage anaphylaxis: The key points

The most common triggers of anaphylaxis in children are foods, medications, and insect stings, although reactions may also occur in the absence of an identifiable trigger. The most common sign is a skin reaction, such as urticaria. Other manifestations include wheeze, dyspnea, throat tightness, tongue or laryngeal edema, hypotension, and a thready pulse. For immediate care, epinephrine administered intramuscularly into the thigh is the treatment of choice. Children who do not respond can be treated with repeated injections of epinephrine, antihistamines, H₂ blockers, or corticosteroids. Patients should be observed for at least 4 hours after initial symptoms, because of the possibility of a biphasic reaction. In addition, patients and family and other caregivers should be educated on avoidance of triggers, recognition of symptoms, and administration of prompt therapy with self-injectable epinephrine.