From the Research
For pediatric blood transfusion reactions, pheniramine (an antihistamine) is typically dosed at 0.5-1 mg/kg/dose intravenously, with a maximum single dose of 25-50 mg, as supported by the most recent and highest quality study available 1. This medication should be administered slowly over 5-10 minutes to minimize side effects. Some key points to consider when administering pheniramine for pediatric blood transfusion reactions include:
- The medication works by blocking H1 histamine receptors, thereby reducing symptoms like urticaria, pruritus, and mild angioedema that occur during transfusion reactions due to histamine release 2.
- For most mild to moderate transfusion reactions, a single dose is sufficient, though it may be repeated after 4-6 hours if symptoms persist.
- Pheniramine should be given alongside other measures such as stopping the transfusion, maintaining IV access, and monitoring vital signs.
- Be aware that pheniramine may cause drowsiness, dry mouth, and rarely, paradoxical excitation in children.
- In severe reactions, additional medications like epinephrine, corticosteroids, and bronchodilators may be necessary, and the patient should be closely monitored for signs of anaphylaxis or hemodynamic instability 3, 4. It's also important to note that pediatric patients have a higher reaction rate compared to adults, with statistically higher rates of allergic reactions, febrile nonhemolytic reactions, and acute hemolytic reactions 1.