Paediatric Anaphylaxis
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define anaphylaxis and distinguish it from mild and moderate allergic reactions.
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Recognize the common triggers and risk factors for anaphylaxis.
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Identify the clinical signs of mild, moderate, and life-threatening reactions.
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Apply the ABCDE approach in the urgent management of anaphylaxis.
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Know the emergency medications and dosages for paediatric anaphylaxis.
Description
Anaphylaxis is a severe, life-threatening allergic reaction caused by immune-mediated hypersensitivity.
It can lead to airway compromise and circulatory shock.
Common triggers include:
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Antibiotics
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Vaccines
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Blood transfusion
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Certain foods (e.g., nuts)
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Medications
Risk factors / associations:
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Asthma
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Eczema
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Family history of allergies
Note: Not all allergic reactions progress to anaphylaxis.
Symptoms and Signs
| Mild Allergic Reaction | Moderate Allergic Reaction |
|---|---|
| Mouth itching | All mild symptoms plus: |
| Nausea | Red throat |
| Urticaria | Cough |
| Conjunctivitis | Wheeze |
| Nasal congestion | Diarrhoea |
| Sweating | |
| Tachycardia | |
| Pallor |
Life-threatening signs:
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Airway compromise (stridor, swelling of lips/tongue)
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Severe wheezing or respiratory distress
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Hypotension or shock
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Collapse or unresponsiveness
If any life-threatening signs are present, treat as anaphylaxis immediately.
Treatment (ABCDE Approach)
| Step | Action / Details |
|---|---|
| A – Airway | Assess and secure airway. Consider early airway adjuncts if swelling is severe. Prepare for intubation if airway compromise is progressive. |
| B – Breathing | Provide 100% oxygen via mask or nasal cannula. Monitor oxygen saturation and respiratory effort. Support ventilation as needed. |
| C – Circulation | Establish two large-bore IV lines or intraosseous access if necessary. Rapid fluid bolus with 0.9% saline 20 mL/kg for shock, repeated as needed. Monitor blood pressure, heart rate, perfusion. |
| D – Disability / Drugs | Administer adrenaline (epinephrine) IM 0.01 mg/kg per dose (max 0.5 mg per dose) in the mid-anterolateral thigh. Repeat every 5–10 minutes if no improvement. Adjunct medications: Antihistamines (chlorphenamine 0.25–0.5 mg/kg IV) and corticosteroids (hydrocortisone 2 mg/kg IV). |
| E – Exposure / Evaluation | Monitor temperature, skin changes, rashes. Assess for trigger identification. Remove exposure to allergen if possible. |
Monitoring
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Continuous monitoring of airway, breathing, circulation, and consciousness.
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Frequent reassessment of vital signs and perfusion.
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Observe for biphasic reactions, which may occur hours after initial treatment.
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Prepare for escalation to ICU if persistent hypotension or severe airway compromise occurs.
Key Points Summary
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Anaphylaxis is life-threatening and requires immediate intervention.
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Early administration of IM adrenaline is the cornerstone of treatment.
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ABCDE assessment ensures structured and rapid stabilization.
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Adjunct therapy includes antihistamines, corticosteroids, and fluid resuscitation.
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Remove allergen and monitor for secondary or biphasic reactions.