By: Michael Pistiner, MD, MMSc, FAAP
Severe allergic reactions are unpredictable—they can happen anywhere, anytime. Symptoms can even go away with treatment and come back later. Parents of children with severe allergies to certain
foods,
insect stings, latex and medication know this all too well.
What's the plan when your child has an allergic reaction?
In an effort to best treat
anaphylaxis—a potentially life-threating, severe allergic reaction—the American Academy of Pediatrics (AAP) developed the clinical report, Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan. In the report, we explain to pediatricians and other health care providers how to create and use the AAP Allergy and Anaphylaxis Emergency Plan. This emergency care plan (ECP) is based on the most up to date and appropriate treatment of anaphylaxis.
Epinephrine: first-line treatment for anaphylaxis
The AAP plan emphasizes the important role of epinephrine, which can quickly reverse symptoms of anaphylaxis. and de-emphasizes the role of antihistamines (such as
Benadryl). It lists symptoms and clearly tells the caregiver or child when to use the epinephrine childcare facilities.
Anaphylaxis emergency care plan overview:
Includes simple criteria to identify potential allergic emergencies for use by patients, families, school staff and all caregivers
Is accessible and understandable to anyone caring for your child
Given to school, childcare, after-school programs, or any place where others care for your child
Trains others using your child's specific ECP
When creating an ECP, it is also important to customize it to the specific needs of your child, allergies, family, and your state and local regulations. (Some may have their own forms already in place; you can encourage them to use this new one.)
If in doubt, give epinephrine!
The AAP report also includes more evidence for why epinephrine is so important and safe and that delaying the use of epinephrine and relying on antihistamines is a bad idea!
Epinephrine is the first line treatment for anaphylaxis because it works quickly. The available devices are specially designed for easy use in non-medical settings. Delays in giving epinephrine for anaphylaxis can increase the risk of death, long hospitalization, and a second anaphylactic reaction called a biphasic reaction.
Anyone caring for a child with an allergy that can be life-threatening must know how to recognize anaphylaxis and know when and how to give lifesaving treatment for severe allergic reactions. The
AAP Allergy and Anaphylaxis Emergency Plan and clinical report were designed to help with this—wherever your child is and whoever is caring for him or her.
What to remember about epinephrine
Epinephrine is the first-line treatment of choice for anaphylaxis
Acts where it is needed
Will make you feel better
Fast acting
Delays in administration increase risk of death
Err on the side of caution and give if any doubt
- Safe medicine
More information
About Dr. Pistiner
Michael Pistiner, MD, MMSc, FAAP, is a pediatric allergist and the Director of Food Allergy Advocacy, Education, and Prevention at Mass General for Children, Harvard Medical School, Boston. He specializes in food allergy prevention and management in infants and toddlers, with a focus on early introduction strategies and the development of clinician support tools. Dr. Pistiner's team has proposed modified criteria for identifying anaphylaxis in young children and developed the
Food Allergy Management and Prevention Clinician Support Tool for Infants and Toddlers (FAMP-IT.org) to help primary care providers prevent and manage food allergies in this age group. Dr. Pistiner is a member of the American Academy of Pediatrics Section on Allergy and Immunology.
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