Anaphylaxis - Paediatric



Management Algorithm

Adrenaline dosing
Age (yrs) Wt Vol. Adrenaline
1 : 1000
Adrenaline
autoinjectors
<1 5-10 0.05 - 0.1 mL
1-2 10 0.1 mL 10-20 kg (1-5yrs) = 0.15 mg (green label) device
2-3 15 0.15 mL
4-6 20 0.2 mL
7-10 30 0.3 mL >20kg (>5y) = 0.3mg (yellow label) device
10-12 40 0.4 mL
>12 & adult >50 0.5 mL

Assessment

Skin changes without systemic features are NOT anaphylaxis

Skin (20%)

  • Erthema, Urticaria
  • Pruritis, Angioedema

CVS

  • Tachy or bradycardia (severe cases)
  • ↓ BP, cyanosis

Respiratory

  • Tongue swelling
  • Voice changes, Stridor, Wheeze

GI

  • D&V ! Abdo pain

Management

  • Assess ABC
  • High flow oxygen
  • IM Adrenaline (flow diagram for dose)
  • REPEAT IM Adrenaline @ 3-5 mins if required
  • Nebulised Adrenaline if airway obstruction
  • Treat ↓ BP with 20ml/kg fluid bolus
  • Consider Salbutamol nebs if wheeze
  • Antihistamines given for itch (not "collapse")
  • PO prednisolone for all who require Adrenaline
  • Early anaesthetic involvement if airway obstruction
  • Early paediatric involvement if requiring adrenaline
  • Early ENT involvement if possibility surgical airway required



Content by Dr Íomhar O' Sullivan 16/08/2014. Reviewed 01/08/2007. Last review Dr IOS/Dr Rory O'Brien 31/05/19