First Aid: Allergic Reactions/Anaphylaxis in Children

What is an Allergic Reaction?

Allergic reactions can be triggered by many different things such as certain foods (like peanut, tree nuts, milk, eggs, shellfish, and fish [see my blog Understanding Food Allergies to learn more]), insect stings, drugs (like certain antibiotics), and more. These triggers are referred to as “allergens.” An allergic reaction can be a serious and potentially life-threatening condition that occurs when your body’s immune system (that is usually responsible for detecting germs and fighting infections) accidentally mistakes a harmless allergen as an invader—and attacks. This overreaction of the body’s immune system releases histamines and other chemicals that can result in your child experiencing mild to severe symptoms such as hives, itching, vomiting, diarrhea, difficulty breathing, and more.

What Are the Signs and Symptoms of an Allergic Reaction?

Symptoms of an allergic reaction may develop within minutes to several hours after exposure to an allergen. Symptoms may affect one or several areas of the body and can range from mild to severe and, in some cases, life-threatening. Anaphylaxis is a severe and potentially fatal allergic reaction that occurs suddenly and requires immediate administration of epinephrine. Therefore, it is important to understand the different types of symptoms of allergic reactions so that appropriate and prompt intervention and treatment can be initiated.

Mild Symptoms May Include:

1. Itchy/runny nose

2. Sneezing

3. Itchy mouth

4. Hives

5. Itchy skin

6. Mild nausea or discomfort

Severe Symptoms May Include:

1. Shortness of breath/difficulty breathing

2. Wheezing

3. Cough

4. Throat tightness/hoarseness/difficulty swallowing

5. Swelling of the tongue or lips

6. Hives, widespread skin redness

7. Vomiting

8. Diarrhea

9. Feeling of impending doom, anxiety, or confusion

10. Lightheadedness

11. Loss of consciousness

Children may experience a mild reaction or a severe reaction when exposed to an allergen. A mild reaction is when one mild symptom is present that affects one area of the body. A severe reaction is when any severe symptom is present, OR when mild symptoms affect more than one area of the body (such as hives with nausea). Sometimes, a severe reaction can progress rapidly to anaphylaxis.

What Should I Do If My Child Has an Allergic Reaction?

Mild Allergic Reaction Treatment:

1. Give an oral antihistamine (such as Benadryl or generic form)

2. Continue to monitor your child for any new or worsening symptoms

3. If mild symptoms persist, contact your child’s provider

Severe Allergic Reaction Treatment:

1. If you have an epinephrine auto-injector, use it as directed immediately

2. Once epinephrine has been injected or if you don’t have an epinephrine auto-injector, call 911

3. Place your child on their back and elevate their legs and feet—If vomiting or in respiratory distress, place them on their side or in a position of comfort

4. If severe symptoms persist, give a second dose of epinephrine 5-15 minutes after the first while waiting for EMS to arrive

5. Take your child to the emergency department (preferably via ambulance) for further assessment and monitoring—Additional interventions such as supplemental oxygen and IV fluids may be necessary

What Should I Know About Epinephrine?

Epinephrine is the first-line treatment for severe allergic reactions and anaphylaxis. It is considered a safe drug with adverse effects similar to those experienced during a person’s “fight or flight” response such as pallor, tremor, anxiety, and palpitations. The benefits of epinephrine far outweigh the risks of not using it promptly during a severe allergic reaction. Delayed administration of epinephrine is associated with poor patient outcomes. It is important that you use the epinephrine auto-injector at the first sign of a severe reaction, even if you are unsure.

Oral antihistamines (such as Benadryl) and bronchodilators (such as Albuterol) are not replacements for epinephrine during a severe allergic reaction. The use of oral antihistamines may relieve itching and hives, but it will not reverse swelling of the airway or low blood pressure. Always give epinephrine first in the event of a severe allergic reaction. Your child should always have two epinephrine auto-injectors within easy reach at all times in case one does not work or a second dose is required.

Key Points to Remember

Being a parent to a child with allergies can feel scary and overwhelming. Even with proper education and prevention strategies to avoid the allergen, accidents can happen. That is why it’s important to always be prepared: Your child’s allergy emergency action plan and two epinephrine auto-injectors should be within reach at all times. During a mild reaction, oral antihistamines may be used with continued monitoring for any new or worsening symptoms. During a severe reaction, immediate use of the epinephrine auto-injector is always recommended. Remember, the benefits of prompt administration of epinephrine during a severe reaction outweigh the risks of giving it for a mistaken severe reaction

FARE Food Allergy and Anaphylaxis Emergency Care Plan

Image obtained from Food Allergy Research and Education website.

References