From the Guidelines
Managing allergies in babies requires a careful approach that includes identifying triggers, seeking medical advice, and implementing appropriate treatments, with the most recent guidelines suggesting introduction of allergenic solid foods, including peanut butter, cooked egg, and dairy and wheat products, in the first year of life, as recommended by the 2019 study 1. To manage allergies in babies, it is essential to consult a pediatrician if you suspect your baby has allergies, as they can recommend appropriate testing and treatments based on your baby's specific symptoms and age. For food allergies, introduce potential allergens gradually and one at a time, particularly common allergens like dairy, eggs, peanuts, and wheat, as suggested by 1. Keep a food diary to track reactions. For environmental allergies, reduce exposure by keeping your home clean, using air purifiers, washing bedding regularly in hot water, and limiting outdoor time during high pollen seasons. Medication options may include infant-appropriate antihistamines like cetirizine (Zyrtec) or diphenhydramine (Benadryl) at doses prescribed by your doctor, as mentioned in the example answer. Never give medication without medical guidance, as dosing for infants is weight-based and some medications aren't suitable for babies under certain ages. For severe allergic reactions, your doctor might prescribe an epinephrine auto-injector and teach you how to use it, with the 2017 study 1 emphasizing the importance of prompt intramuscular epinephrine injection in the mid-outer thigh to reduce hospitalizations, morbidity, and mortality. Allergies occur when a baby's immune system overreacts to normally harmless substances, and early management can help prevent complications and improve quality of life. Some key points to consider include:
- Exclusive breast-feeding until 4 to 6 months of age, unless contraindicated for medical reasons, as recommended by 1
- Introduction of solid food should not be delayed beyond 4 to 6 months, with potentially allergenic foods introduced at this time as well, as suggested by 1
- Restriction of maternal diet during pregnancy or lactation is not recommended as a strategy for preventing the development of food allergy, as mentioned in 1
- Effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations, as emphasized by 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.
1 INDICATIONS & USAGE
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.
To manage an allergy in a baby, epinephrine (IM) can be used for emergency treatment of allergic reactions, including anaphylaxis. The dosage should be weight-based. It is essential to note that while epinephrine can be used in pediatric patients, including babies, for the treatment of anaphylaxis, the decision to administer epinephrine should be made with caution and under the guidance of a healthcare professional, considering the potential risks and benefits 2 2.
From the Research
Managing Allergy in Babies
To manage allergy in babies, it is essential to recognize the symptoms of an allergic reaction and take prompt action.
- The most common symptoms of anaphylaxis in infants and toddlers are cutaneous and gastrointestinal 3.
- Age-specific language may be helpful for caregivers to identify and describe the symptoms of anaphylaxis in infants and toddlers 3.
- Long-term management of anaphylaxis includes allergy evaluation to guide avoidance and assess prognosis and education on allergic reaction management; this incorporates the prescription of epinephrine autoinjector and provision of an allergy emergency plan 3.
Treatment of Anaphylaxis
The treatment of choice for anaphylaxis in infants is intramuscular epinephrine, and an epinephrine autoinjector approved by the Food and Drug Administration is now available for infants weighing between 7.5 and 15 kg 4.
- Epinephrine is the drug of choice for anaphylaxis, and it has no absolute contraindication in this clinical setting 5.
- The therapeutic benefits of epinephrine exceed the risk when given in appropriate i.m. doses 5.
- Acute management of anaphylaxis involves removal of the trigger; early administration of intramuscular epinephrine; supportive care for the patient's airway, breathing, and circulation; and a period of observation for potential biphasic reactions 6.
Prevention and Education
Prevention and education are crucial in managing allergy in babies.
- Food allergen avoidance is the most effective strategy to decrease allergic reactions 7.
- Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families 7.
- Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school 7.