From the Guidelines
An anaphylactic reaction in infants typically occurs within minutes to 2 hours after exposure to a new allergen, with most severe reactions happening within 30 minutes, as indicated by the most recent and highest quality study 1. When introducing new allergens to a baby, it is crucial to be aware of the potential for anaphylaxis. The signs to watch for include:
- Hives or welts
- Swelling of the face (especially lips, eyes, or tongue)
- Difficulty breathing or wheezing
- Persistent coughing
- Hoarse voice or cry
- Difficulty swallowing
- Pale and floppy appearance (particularly in infants)
- Vomiting
- Diarrhea It is essential to introduce one new allergenic food at a time, preferably early in the day when medical facilities are readily accessible, and start with a small amount, gradually increasing if no reaction occurs, as suggested by 1. If you notice any signs of a severe allergic reaction, call emergency services (911) immediately and administer epinephrine via an auto-injector if prescribed and available, as emphasized by 1 and 1. Do not delay seeking emergency care even if symptoms initially improve after epinephrine. Anaphylaxis occurs when the immune system overreacts to a substance, releasing chemicals that cause blood pressure to drop and airways to narrow, potentially becoming life-threatening without prompt treatment. The American Academy of Pediatrics and other organizations recommend introducing allergenic foods, such as peanut butter, cooked egg, and dairy and wheat products, in the first year of life, including infants at high risk of allergy, as stated in 1. It is also recommended that all infants be exclusively breast-fed until 4 to 6 months of age, unless contraindicated for medical reasons, and that introduction of solid food should not be delayed beyond 4 to 6 months, as indicated by 1. In the event of an anaphylactic reaction, it is vital to prioritize the infant's airway, breathing, and circulation (ABCs) and provide prompt medical attention, as highlighted by 1 and 1.
From the FDA Drug Label
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. The timeframe for an anaphylactic reaction to occur is not specified in the drug label. The signs to look for include:
- Flushing
- Apprehension
- Syncope
- Tachycardia
- Thready or unobtainable pulse
- Hypotension
- Convulsions
- Vomiting
- Diarrhea
- Abdominal cramps
- Involuntary voiding
- Airway swelling
- Laryngospasm
- Bronchospasm
- Pruritus
- Urticaria
- Angioedema
- Swelling of the eyelids, lips, and tongue 2
From the Research
Timeframe for Anaphylactic Reaction
- The timeframe for an anaphylactic reaction to occur when introducing new allergens to an infant is not explicitly stated in the provided studies.
- However, studies suggest that introducing allergenic foods between 4 to 6 months of age may help prevent food allergy in high-risk infants 3, 4.
- It is recommended that commonly allergenic solids be introduced at around 6 months of age, but not before 4 months of age, and guided by the infant's developmental readiness for food 3.
Signs of Anaphylactic Reaction
- Anaphylaxis in the pediatric population is both serious and potentially lethal, and the incidence of allergic and anaphylactic reactions has been increasing 5.
- Symptoms consistent with anaphylaxis include severe allergic reactions, and indications for epinephrine administration 5.
- Signs of anaphylaxis may not always be immediately apparent, and EMS personnel may not always treat anaphylaxis appropriately with epinephrine 5.
Introduction of Allergenic Foods
- Current recommendations suggest introducing common food allergens by the age of 12 months 6.
- Emerging evidence suggests that early food introduction, between 4 and 6 months of age, may have a role in preventing food allergy, particularly for egg and peanut, in high-risk infants 3, 4.
- Commercial baby foods often lack major allergens, namely nuts and peanuts, eggs, and shellfish, highlighting the need for healthy, age-appropriate, minimally processed products that incorporate rather than exclude major food allergens 6.