An expert panel has reached consensus on treatment of anaphylaxis in infants. The report in the Journal of Allergy and Clinical Immunology in Practice points out that infant anaphylaxis is an emerging risk, with food allergy the most common cause. However, there are challenges in treating it.

“Although the presentation of anaphylaxis involves the same systems as in older children and adults, there are real-world challenges to identifying symptoms of an allergic emergency in nonverbal children, as well as implementing optimal treatment,” writes the expert panel, led by researchers from Children’s Hospital Colorado and the University of Colorado School of Medicine.

One challenge is that allergic symptoms and certain normal infant behaviors might overlap, making recognition of anaphylaxis in infants difficult, the study team notes.

The guidance suggests that intramuscular epinephrine is the treatment of choice for infants, as it is for older children and adults. It advises that an epinephrine autoinjector approved by the FDA is now available for infants weighing between 7.5 and 15 kg.

A French study published earlier this year in the European Journal of Pediatrics identified an additional issue: Despite multiple recommendations, intramuscular epinephrine is poorly prescribed in (EDs) treating pediatric anaphylaxis. The study confirms that intramuscular epinephrine is underused in pediatric anaphylaxis—about one case in 10 before admission and one in five in pediatric EDs.
“A panel of experts sought to develop guiding principles for the recognition, diagnosis, and management of anaphylaxis in infants, and provide a framework for the development of new guidelines and future research,” the European Journal of Pediatrics article states. “Accordingly, anaphylaxis emergency action planning for infants was addressed by the panel. In considering formation of future infant anaphylaxis guidelines, health care providers should be aware of the needs to improve the recognition, diagnosis, and management of infants with anaphylaxis.”

The authors call for future research to identify and validate clinical criteria for the diagnosis of anaphylaxis in infants, as well as risk factors for the most severe reactions.

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