What is the treatment for a moderate allergic reaction in an 11-month-old infant?

From the Guidelines

For a moderate allergic reaction in an 11-month-old, administer epinephrine via an auto-injector if available, and if not, seek immediate medical attention, as the benefits of prompt epinephrine administration outweigh the risks, especially considering the potential for anaphylaxis 1.

Key Considerations

• The American Academy of Pediatrics emphasizes the importance of prompt intramuscular epinephrine injection in the mid-outer thigh to reduce hospitalizations, morbidity, and mortality in cases of anaphylaxis 1.
• However, for infants and young children weighing less than 15 kg, the lowest dose available in epinephrine auto-injectors (0.15 mg) may be a high dose, presenting a dilemma in treatment 1.
• In the absence of an epinephrine auto-injector or if the reaction is not severe enough to warrant its use, antihistamines like diphenhydramine can be considered, but with caution and close monitoring, as they are not a substitute for epinephrine in anaphylaxis 1.

Management Approach

• Monitor the child closely for signs of worsening symptoms, such as difficulty breathing, swelling of the lips or tongue, persistent vomiting, lethargy, or failure of symptoms to improve within 30-60 minutes of medication.
• Keep the child well-hydrated and apply cool compresses to itchy areas for additional relief.
• Avoid the suspected allergen and consult a pediatrician for follow-up care, which may include allergy testing or prescription of additional medications if needed.

Prioritizing Safety

• Given the potential severity of allergic reactions and the importance of prompt treatment, it is crucial to err on the side of caution and seek medical attention immediately if there is any doubt about the severity of the reaction or the appropriate treatment.

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.

1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.

For the treatment of a moderate allergic reaction in an 11-month-old, epinephrine (IM) can be considered.

• The dosage should be weight-based.
• Epinephrine is used for emergency treatment of allergic reactions (Type I), including anaphylaxis.
• It is essential to follow the recommended weight-based dosing for pediatric patients, as stated in the drug label 2.
• Always consult a healthcare professional for proper diagnosis and treatment.

From the Research

Treatment of Moderate Allergic Reaction in 11-Month-Old

• The treatment of moderate allergic reactions in infants, including 11-month-olds, typically involves the administration of epinephrine, antihistamines, and corticosteroids 3.
• However, it is essential to note that corticosteroids can also induce hypersensitivity reactions, including anaphylaxis, in some individuals 4, 5, 6, 7.
• The use of epinephrine and antihistamines in the treatment of anaphylaxis has been well-established, with epinephrine being the first-line treatment 3.
• Corticosteroids, on the other hand, are often used to treat allergic reactions, but their use in anaphylaxis should be revisited, as they may not be as effective as previously thought 3.
• In cases where corticosteroids are necessary, careful challenge testing is recommended to select a safe alternative preparation, as some individuals may be sensitized to one or more corticosteroids 5, 6, 7.
• The diagnosis of hypersensitivity reactions to corticosteroids is based primarily on medical history and can be confirmed by challenge testing, skin tests, or other diagnostic methods 6, 7.

Hypersensitivity Reactions to Corticosteroids

• Hypersensitivity reactions to corticosteroids are rare but can occur in high-risk groups, such as patients who receive repeated doses of corticosteroids 6.
• Immediate hypersensitivity reactions to corticosteroids can manifest as anaphylaxis, urticaria, and/or angioedema, and can occur through any route of exposure, including intravenous, oral, and intra-articular 7.
• The most commonly implicated corticosteroids in hypersensitivity reactions are methylprednisolone and prednisolone, although other preparations can also cause reactions 7.
• Pharmacologically-inactive ingredients in corticosteroid preparations can also be implicated in hypersensitivity reactions 7.