What is the appropriate dosing of Diphenhydramine (Benadryl) for pediatric patients experiencing allergic reactions?

From the Guidelines

Diphenhydramine (Benadryl) dosing for pediatric allergic reactions is 1-2 mg/kg/dose every 4-6 hours as needed, with a maximum of 50 mg per dose for children. For infants under 6 months, consult a physician before administering. Children 6-12 years typically receive 12.5-25 mg per dose, while those 2-5 years should receive 6.25-12.5 mg per dose. Liquid formulations (12.5 mg/5 mL) are easier to dose accurately for young children. When treating allergic reactions, give the medication at the first sign of symptoms and have the child evaluated by a healthcare provider if symptoms are severe or don't improve. Side effects include drowsiness, dry mouth, and irritability, so monitor children closely after administration. Benadryl works by blocking histamine receptors, reducing itching, swelling, and other allergic symptoms. For severe allergic reactions with breathing difficulty, facial swelling, or vomiting, seek emergency care immediately as epinephrine (not Benadryl) is the first-line treatment for anaphylaxis. This recommendation is based on the most recent and highest quality study available, which is the 2010 guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel 1. Some key points to consider when administering diphenhydramine to pediatric patients include:

• The dosage should be adjusted based on the child's weight, with a maximum dose of 50 mg per dose.
• The medication should be administered at the first sign of symptoms, and the child should be evaluated by a healthcare provider if symptoms are severe or don't improve.
• Side effects such as drowsiness, dry mouth, and irritability should be monitored closely.
• Benadryl should not be used as a substitute for epinephrine in the treatment of anaphylaxis. It's also important to note that the use of diphenhydramine in pediatric patients should be guided by the most recent and highest quality evidence available, and that the medication should be used in conjunction with other treatments, such as epinephrine and supplemental oxygen therapy, as needed.

From the FDA Drug Label

Directions • take every 4 to 6 hours, or as directed by a physician• do not take more than 6 doses in 24 hours agedose Adults and children over 12 years of age10 mL (25 mg) to 20 mL (50 mg) Children 6 to under 12 years of age10 mL (25 mg) Children under 6 years of ageDo not use

For pediatric Benadryl dosing for allergic reactions:

• For children over 12 years, the dose is 10 mL (25 mg) to 20 mL (50 mg).
• For children 6 to under 12 years, the dose is 10 mL (25 mg).
• For children under 6 years, the label states Do not use. The dosing should not exceed 6 doses in 24 hours and should be taken every 4 to 6 hours, or as directed by a physician 2.

From the Research

Pediatric Benadryl Dosing for Allergic Reactions

• There is no direct information on pediatric Benadryl dosing for allergic reactions in the provided studies 3, 4, 5, 6, 7.
• However, the studies discuss the management of anaphylaxis and allergic reactions, emphasizing the importance of epinephrine as the first-line treatment 5, 6, 7.
• Antihistamines, such as Benadryl, are considered second-line medications and should not be given in lieu of, or prior to, epinephrine 6, 7.
• The use of antihistamines and corticosteroids in anaphylaxis management is still being researched, with some studies suggesting a beneficial effect of antihistamines 6.
• It is essential to note that the management of anaphylaxis and allergic reactions should be individualized, and treatment decisions should be made based on the specific patient's needs and medical history 3, 4, 7.

Management of Anaphylaxis and Allergic Reactions

• Epinephrine is the drug of choice for anaphylaxis and should be administered intramuscularly as soon as the diagnosis is suspected 5, 6, 7.
• Delayed epinephrine administration is a risk factor for fatal anaphylaxis 6.
• Antihistamines and corticosteroids may be considered as adjunctive therapies, but their use should not delay the administration of epinephrine 6, 7.
• Aggressive fluid resuscitation and supplemental oxygen may also be necessary to treat anaphylaxis 7.

Importance of Early Treatment

• Early recognition and treatment of anaphylaxis are critical to prevent unnecessary increases in patient morbidity and mortality 3, 4, 7.
• Delays in recognition or initiation of therapy can result in severe consequences, including death 7.
• It is essential to have a clear understanding of the management of anaphylaxis and allergic reactions to provide optimal care for patients 3, 4, 5, 6, 7.