What should parents administer if a child is having an allergic reaction?

What Parents Should Give During a Child's Allergic Reaction

For severe allergic reactions (anaphylaxis), parents must inject epinephrine immediately into the child's outer thigh—this is the single most critical intervention that can be life-saving. 1

Immediate Action for Severe Reactions (Anaphylaxis)

Inject epinephrine immediately if the child has ANY of these symptoms after allergen exposure: 1

• Difficulty breathing or shortness of breath 1
• Diffuse hives (widespread, not just a few around the mouth) 1
• Obstructive swelling of tongue and/or lips that interferes with breathing 1
• Any respiratory symptoms (wheezing, throat tightness) 1
• Circulatory symptoms (dizziness, fainting, collapse) 1
• Combination of symptoms affecting multiple body systems 2

Epinephrine Administration Steps

After injecting epinephrine: 1

1. Call 911 immediately 1
2. Position the child lying on their back with legs raised 1
3. A second dose of epinephrine can be given 5-10 minutes after the first if symptoms persist or recur 1
4. Tell emergency responders that epinephrine was administered 1

Dosing by weight: 3

• Children weighing 30 kg (66 lbs) or more: 0.3 to 0.5 mg intramuscularly 3
• Children weighing less than 30 kg: 0.01 mg/kg (up to maximum 0.3 mg) intramuscularly 3

Adjunctive Medications (Given AFTER Epinephrine)

Only after epinephrine has been administered should parents consider these additional medications: 1, 2

• Antihistamines (H1 blockers like diphenhydramine or cetirizine) for symptom relief 1
• Bronchodilator inhaler (if the child has asthma) 1

Critical caveat: Antihistamines and inhalers cannot be depended upon to treat severe reactions—epinephrine is the only definitive treatment for anaphylaxis. 1

For Mild Reactions (Non-Anaphylactic)

If the child has only mild symptoms without signs of anaphylaxis: 4

• A few hives around the mouth or face 1
• Mild itching 1
• Localized rash without breathing difficulty 4

Give oral antihistamines as first-line treatment: 4

• Non-sedating options: cetirizine or loratadine 4
• Sedating option (use cautiously, typically at bedtime): hydroxyzine 4

Apply topical hydrocortisone 2.5% cream to affected skin areas 4

Critical Pitfalls to Avoid

Never delay epinephrine administration while waiting to see if symptoms worsen—early epinephrine use is associated with better outcomes and prevents progression to life-threatening reactions. 5, 2

Do not rely on antihistamines alone for any reaction that involves multiple body systems or respiratory symptoms—this represents anaphylaxis requiring immediate epinephrine. 1

Parents must understand that even "mild" food allergies can progress to severe reactions on subsequent exposures—all food-allergic children should have epinephrine prescribed and available. 1

What Parents Should Have Available

Every food-allergic child should have an emergency kit containing: 1

• At least two doses of epinephrine (in case a second dose is needed) 1
• Antihistamines 1
• Bronchodilator inhaler (if child has asthma) 1
• Written emergency action plan 6

The emergency kit must accompany the child everywhere, including school and field trips. 1

When to Seek Emergency Care

Call 911 and transport to emergency department after ANY epinephrine administration, even if symptoms improve, because biphasic reactions (recurrence of symptoms) can occur 4-12 hours later. 2

Seek immediate emergency care if the reaction appears to involve multiple organ systems or is progressing, even before administering epinephrine. 4