Diagnosing Anaphylaxis in Pediatric Populations

For parents and carers of young children and adolescents with allergies, the threat of anaphylaxis from exposure to allergens is a sobering thought.

Despite this, there are a large number of recommendations for the treatment of anaphylaxis, not least emergency epinephrine injection.

In an interview with HCPLive, Ari R. Cohen, MD, FAAP, Chief of Pediatric Emergency Medicine, Massachusetts General Hospital, spoke about the benefits of epinephrine in the treatment of anaphylaxis, as well as the diagnostic criteria clinicians use to define anaphylaxis in young patients. .

The data Cohen referenced in the interview was available in his session, “Anaphylaxis Update: Be Prepared!”, which was presented at the American Academy of Pediatrics (AAP) 2021 Virtual Conference.

“We have numerous studies that have shown primary care physicians to use other treatments such as antihistamines, steroids, h2 antagonists, all in an effort to treat anaphylaxis,” Cohen said. “But the only thing that really treats the anaphylaxis and really stops this huge cascade (of events) is epinephrine, and the sooner you take the epinephrine, the better chance of a good recovery.”

While emergency medicine auto-injectors are often expensive, Cohen noted that the actual drug was “remarkably cheap” and a standard syringe was suitable for administering epinephrine.

He also talked about some diagnostic criteria for pediatric patients, especially younger patients who may not fully meet the criteria for anaphylaxis.

Children often show symptoms differently than adult patients, Cohen noted, and as such may not be diagnosed with anaphylaxis. However, they could benefit from anaphylaxis treatment, and as such, he believed these patient populations should be treated. He proposed several changes to the diagnostic criteria of anaphylaxis in young children.

“I think we have to think about it a little bit differently with the younger kids than with the older kids, who are a lot more like adults,” Cohen said. “Maybe we should loosen up our criteria a little bit or be more willing to treat a few kids who wouldn’t meet the actual definition of epinephrine anaphylaxis because there’s a slight downside…I don’t like screaming kids because I ‘ I stick them with a needle, but the actual adverse side effects of a dose of an intramuscular epinephrine are really very good, relative to the risk of not treating a child who has anaphylaxis because they don’t quite meet the criteria.

Watch the video above to hear more from Dr. Cohen on his AAP session on anaphylaxis.

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