Position paper: Management of anaphylaxis in childhood

The European academy of allergology and clinical immunology (EAACI) has published a position paper on management of anaphylaxis in childhood.

First-line therapy for anaphylaxis is epineprhrine (adrenaline) administered I.M. and it should be given as soon as the condition is recognized. Supplementary therapies include IVF, nebulized bronchodilators, antihistamines and corticosteroids.

Allergy assessment is mandatory in all children with a history of anaphylaxis to identify and avoid the allergen to prevent its recurrence.

Self-injectable epinephrine (adrenaline) should be prescribed in most children with a history of anaphylaxis. The position paper lists the absolute and relative indications for prescribing self-injectable epinephrine.

A recent study in the Annals of Allergy, Asthma and Immunology reported on development of the acronym SAFE, a mnemonic to remind physicians of the 4 action steps for anaphylaxis treatment: (1) Seek support, (2) Allergen identification and avoidance, (3) Follow-up for specialty care, and (4) Epinephrine for emergencies.

Drugs used for management of anaphylaxis are remembered by the mnemonic EASI:

Epinephrine IM
Antihistamines PO, IM
Steroids PO, IM, IV
Inhaled b2-agonists, if wheezing

References:
The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, Moneret-Vautrin A, Niggemann B, Rancé F; EAACI Task Force on Anaphylaxis in Children. Allergy. 2007 Jun 21.
SAFE: a multidisciplinary approach to anaphylaxis education in the emergency department. Annals of Allergy, Asthma and Immunology, 2007, vol. 98, no. 6, pp. 519 - 523.
Epinephrine Labels May Promote Overdoses for Children. MedPage Today, 01/2008.
Anaphylaxis guidelines by World Allergy Organization. JACI, 2011.
Image source: EpiPen, Wikipedia, GNU Free Documentation License.

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