Emergency Department Clinical Pathway for
Evaluation/Treatment of Children with Anaphylaxis

Goals and Metrics
Patient Education
Provider Resources
Related Pathways
Child with Suspected Anaphylaxis
ED Triage
CLINICAL CRITERIA FOR DIAGNOSING ANAPHYLAXIS
 Anaphylaxis is highly likely when ONE of the following 3 criteria are fulfilled, usually within minutes to 2-3 hours following possible allergen exposure
CRITERIA 1

Acute onset of an illness with involvement of the skin, mucosal tissue, or both (e.g., generalized hives, pruritis or flushing, swollen lip-tongue-uvula)

AND AT LEAST ONE OF THE FOLLOWING

  • Respiratory compromise
  • Reduced BP or associated symptoms of end-organ dysfunction
  • Persistent GI Symptoms, Significant abdominal pain and/or significant vomiting
CRITERIA 2

Two or more of the following that occur rapidly after exposure to a LIKELY ALLERGEN for that patient:

  • Involvement of the skin-mucosal tissue
  • Respiratory compromise
  • Reduced BP or associated symptoms
  • Persistent gastrointestinal symptoms
CRITERIA 3 Reduced BP after exposure to KNOWN ALLERGEN for that patient

MD/CRNP/RN Rapid Assessment

  • Patient meets clinical criteria for Anaphylaxis listed below:
  • ADMINISTER EPINEPHRINE IM IMMEDIATELY
  • Repeat dose as clinically indicated q 5-15 minutes
  • Assess need for IV access
  • ASSESS, MANAGE ABC’S
    • Mental status abnormality
    • Upper airway obstruction
    • Lower airway symptoms
    • Circulatory abnormality
  • Respiratory Medications
  • IV Access, NS bolus as indicated
  • Vasopressors
  • Epinephrine treats all symptoms of anaphylaxis and can prevent the escalation of symptoms.
  • IM is preferred, being faster and safer.
  • Use of adjunctive medications should not delay epinephrine administration.
Epinephrine Dosing - IM
< 5 kg 0.01 mg/kg Epinephrine IM
0.1 mg/mL solution
5 - 25 kg 0.15 mg EpiPen Jr®
> 25 kg 0.3 mg EpiPen®

Risk Factors for Biphasic Reaction

  • History of biphasic or severe reactions
  • Progression of / or persistent symptoms
  • History of severe asthma
  • Hypotension
  • Requires > 1 Epinephrine dose
  • Requires fluid bolus
  • Drug trigger
Complete History and Physical
Tryptase Testing Indications
Reassess patient’s symptoms, PE, VS
Serious Symptoms Resolved with
1 dose of Epinephrine, excluding rash
Consider antihistamine for urticaria
Risk Factors for Biphasic Reactions
Determine Admitting Service
Posted: June, 2006
Last Revised: November 2024
Authors: J. Lee, MD; T. Brown-Whitehorn, MD; N. Tsarouhas, MD; J. Lamaina, RN, MSN; J. Molnar, CRNP; R. Sutton, MD; D. Davis, MD; M. Lewis, CRNP; C. Jacobstein, MD; J. Lavelle, MD; MK. Abbadessa, ACCNS-P;