By: Michael Pistiner, MD, MMSc, FAAP
Severe allergic reactions are unpredictable—they can happen anywhere, anytime. Symptoms can even go away with treatment and come back later. Parents of children with severe allergies to certain foods, insect stings, latex, and medication know this all too well.
What's the Plan?
In an effort to appropriately treat anaphylaxis—a potentially life-threating, severe allergic reaction—the American Academy of Pediatrics (AAP) developed the clinical report, Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan. The report explains to pediatricians and other health care providers how to create and use the new AAP Allergy and Anaphylaxis Emergency Plan. This new emergency care plan (ECP) is based on the most up to date and appropriate treatment of anaphylaxis. It's also clearly written and easy to understand. See for yourself!
Download the AAP Allergy and Anaphylaxis Emergency Plan (PDF) here.
The plan also emphasizes the important role of epinephrine and de-emphasizes the role of antihistamines (e.g., Benadryl). It lists symptoms and clearly tells the caregiver or child when to use the epinephrine auto-injector. Allergy and anaphylaxis emergency plans are especially important to provide to schools and child care facilities.
Anaphylaxis emergency care plan overview:
Includes simple criteria to identify potential allergic emergencies for use by patients, families, school staff, and all caregivers
Is accessible and understandable to anyone caring for your child
Given to school, child care, after school programs, or any place where others care for your child
Trains others using your child's specific ECP
When creating an ECP, it is also important to customize it to the specific needs of your child, allergies, family, and your state and local regulations. (Some may have their own forms already in place; you can encourage them to use this new one.)
If in Doubt, Give Epinephrine!
The AAP report also includes more evidence for why epinephrine is so important and safe and that delaying the use of epinephrine and relying on antihistamines is a bad idea!
Epinephrine is the first line treatment for anaphylaxis, because it works quickly by delivering a dose of medicine directly into a child's muscle. The auto-injectors are especially designed for easy use in non-medical settings. Delays in giving epinephrine for anaphylaxis can increase the risk of death, long hospitalization, and a second anaphylactic reaction called a biphasic reaction.
Things to know about epinephrine:
First-line treatment of choice
Acts where it is needed
Will make you feel better
Delays in administration increase risk of death
Err on the side of caution and give if any doubt
Anyone caring for a child with an allergy that can be life threatening must know how to recognize anaphylaxis and know when and how to give the lifesaving treatment for severe allergic reactions. The AAP Allergy and Anaphylaxis Emergency Plan and clinical report were designed to help with this—wherever your child is and whomever is caring for him or her.
Be Better Prepared for an Allergic Emergency:
Together, these new AAP resources will help pediatric teams give families the information and written plans needed to ensure that they are ready to deal with an allergic emergency in any setting—school, child care, sports practice, play dates, etc. In situations when you are not with your child, these written plans will also arm nurses, teachers, coaches, parents, relatives, babysitters, etc. with the tools they need in the event of an emergency.
Additional Information & Resources:
About Dr. Pistiner:
Michael Pistiner, MD, MMSc, FAAP is a Boston based pediatric allergist for Atrius Health. He is a member of the American Academy of Pediatrics Section on Allergy and Immunology Executive Committee and has a special interest in food allergy and anaphylaxis education and advocacy. Dr. Pistiner is also the father of a child with food allergy and cofounder and content creator of AllergyHome.org, a free food allergy and anaphylaxis educational resource.