Action
Administer:
- Repeat IM epinephrine every 5-10 minutes (Class I)
- IV crystalloid fluids (Class II)
- Corticosteroids (Class III)
Drug | Adult Dosing | Pediatric Dosing |
Hydrocortisone | 250-500 mg IV | 5-10 mg/kg IV (max 500 mg) |
Methylprednisolone | 80-125 mg IV | 1-2 mg /kg IV (max 125 mg) |
Prednisone | 40-60 mg PO qd or bid for 3-5 days | 1-2 mg/kg PO qd or bid for 3-5 days |
- H1 + H2 blockers (Class III)
Class | Name | Adult Dosing | Pediatric Dosing |
H1 blockers, first generation | Diphenhydramine | 25-50 mg IV, IM, PO every 6-8 hr | 1 mg/kg (max 50 mg/dose) IV, IM, PO |
Hydroxyzine HCl | 25 mg PO daily to tid | ≤40 kg: 2 mg/kg/day (max 25 mg/dose) PO divided every 6-8 hr
>40 kg: 25 mg PO daily/bid | |
H1 blockers, second generation | Cetirizine | 10 mg IV, PO daily | Age 6 mo to <12 mo: 2.5 mg PO, IV daily
Age 12 mo to <6 yr: 2.5-5 mg PO, IV daily
Age 6-12 yr: 5-10 mg PO, IV daily
Age ≥12 yr: 10 mg PO, IV daily |
Loratadine | 10 mg PO daily | Age 2-6 yr: 5 mg PO daily
Age ≥6 yr: 10 mg PO daily | |
H2 blockers | Cimetidine | 300 mg PO every 6 hr | 10 mg/kg (max 300 mg/dose) PO every 6 hours |
Famotidine | 20 mg PO, IV bid | 0.5 mg/kg (max 20 mg/dose) PO, IV, bid |
- Epinephrine infusion if no response/ unstable (Class I)
Method
| Adult Dose | Pediatric Dose
(weight <30 kg) | Special Considerations
|
Intramuscular | 0.01 mg/kg (max dose of 0.5 mg)
0.3-0.5 mg per dose
Autoinjector: 0.3 mg | 0.01 mg/kg per dose (max dose 0.5 mg)
Pediatric autoinjector: 0.15 mg | Anterolateral thigh
Repeat every 5-10 minutes if not improving*
*Can be administered more frequently if clinically indicated. |
Intravenous | Infusion: 0.01-0.2 mcg/kg/min; titrate to effect
Non–weight-based infusion is 1-35 mcg/min;
titrate to effect
Bolus: 50-100 mcg over 5-10 minutes
(0.05-0.1 mg over 5-10 minutes ) | Infusion: start at 0.1-1 mcg/kg/min, titrate as needed
Maximum dose: 10 mcg/min | Bolus dosing has a higher risk for cardiovascular complications
Stop or decrease rate if chest pain or arrhythmias occur |
- Glucagon if patient is on beta blockers
- The use of beta-blocking medications such as metoprolol or propranolol has been associated with severe and treatment-refractory anaphylaxis.
- Adult dosing: 1-5 mg IV every 5 minutes, followed by infusion of 5-15 mcg/min, titrated to clinical response
- Pediatric dosing: 20-50 mcg/kg IV (max 1 mg) every 5 minutes
- Glucagon administration may cause nausea, vomiting, hypokalemia, dizziness, and hyperglycemia.
- Add other vasopressors (eg, norepinephrine, vasopressin) if patient is unstable (Class I)
Decision
Is patient improving or stabilized?
Yes - Admit for monitoring: floor vs ICU
No - Admit to ICU
