What is the treatment for an allergic reaction in an infant under 1 year of age?

From the Guidelines

For infants under 1 year old with allergic reactions, immediate administration of epinephrine via an auto-injector is crucial in cases of anaphylaxis, as it reduces hospitalizations, morbidity, and mortality 1. When it comes to treating allergic reactions in infants under 1 year old, it's essential to consider the severity of the reaction.

• For mild reactions, such as hives or mild swelling, it's best to consult a pediatrician before administering any medication.
• However, for moderate to severe reactions, including signs of anaphylaxis, such as breathing difficulty, swelling of the face, lips, or tongue, prompt intramuscular epinephrine injection in the mid-outer thigh is the recommended course of action, as emphasized by the American Academy of Pediatrics 1. Some key points to consider when treating allergic reactions in infants under 1 year old include:
• The importance of prompt recognition and treatment of anaphylaxis to prevent severe outcomes 1
• The need for a comprehensive approach to managing anaphylaxis in the community, involving children, families, and caregivers 1
• The importance of education on anaphylaxis recognition and first-aid treatment for children and supervising adults 1 It's also important to note that prescribing epinephrine for infants and young children weighing less than 15 kg can be challenging due to the high dose of epinephrine in available auto-injectors 1. In cases where an infant epinephrine auto-injector is prescribed, it's crucial to follow the recommended dosage and administration guidelines to ensure effective treatment and minimize potential side effects 1.

From the FDA Drug Label

8.4 Pediatric Use Clinical use data support weight-based dosing for treatment of anaphylaxis in pediatric patients, and other reported clinical experience with the use of epinephrine suggests that the adverse reactions seen in children are similar in nature and extent to those both expected and reported in adults.

The treatment for an allergic reaction in someone under 1 involves weight-based dosing of epinephrine.

• Key considerations:
  • The signs and symptoms associated with anaphylaxis include flushing, apprehension, syncope, tachycardia, thready or unobtainable pulse associated with hypotension, convulsions, vomiting, diarrhea and abdominal cramps, involuntary voiding, airway swelling, laryngospasm, bronchospasm, pruritus, urticaria or angioedema, swelling of the eyelids, lips, and tongue.
  • Pediatric use is supported by clinical use data, but the exact dosing for someone under 1 is not explicitly stated in the provided drug labels 2 2.

From the Research

Allergic Reaction Treatment in Infants Under 1

• The treatment of anaphylaxis in infants under 1 involves the administration of intramuscular epinephrine, as stated in the study 3.
• According to the study 4, long-term management of anaphylaxis in infants and toddlers includes allergy evaluation to guide avoidance and assess prognosis, and education on allergic reaction management.
• The study 3 recommends that the 0.15 mg adrenaline injector device may be prescribed for infants and children weighing 7.5-10 kg.
• It is essential to position the patient correctly before administering intramuscular adrenaline, as incorrect positioning can lead to fatal consequences, as mentioned in the study 3.
• The use of adjunct medications, such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon, may be considered after epinephrine administration, as stated in the study 5.

Administration of Epinephrine

• Intramuscular epinephrine is the immediate treatment for all patients with anaphylaxis, including infants under 1, as stated in the study 6.
• The study 3 emphasizes the importance of administering adrenaline early in the treatment of anaphylaxis.
• The correct dosage of epinephrine for infants under 1 is crucial, and the study 3 provides guidelines for the use of adrenaline injector devices in this age group.

Monitoring and Observation

• Patients with anaphylaxis, including infants under 1, should be monitored for a biphasic reaction, which can occur within 4 to 12 hours after the initial reaction, as mentioned in the study 5.
• The study 6 suggests that mandatory observation periods are not necessary, as biphasic reactions can be difficult to predict and may occur outside of typical observation periods.