Pediatric emergency medicine trisk 1668 1668
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CHAPTER 85 ■ ALLERGIC EMERGENCIES
TIMOTHY E. DRIBIN, RICHARD M. RUDDY
GOALS OF EMERGENCY THERAPY
Treatment of anaphylaxis with rapid administration of intramuscular (IM)
epinephrine is imperative to prevent and reverse cardiopulmonary failure.
Treatment of hereditary angioedema includes rapid, controlled airway
management in cases with significant laryngeal edema and prompt
administration of C1-esterase inhibitor concentrate (or alternative therapy) to
reduce complications from acute attacks.
Management of serum sickness includes removing offending antigens,
controlling symptoms (arthralgias and pruritis) with nonsteroidal antiinflammatory drugs (NSAIDs) and antihistamines, and screening for organ
dysfunction (particularly renal involvement).
Intranasal corticosteroids are considered the first-line treatment for allergic
rhinitis. Oral nonsedating antihistamines and montelukast are common
alternative therapies.
RELATED CHAPTERS
Signs and Symptoms
Edema: Chapter 25
Eye: Red Eye: Chapter 27
Rash: Papulosquamous Eruptions and Viral Exanthems: Chapter 70
Sore Throat: Chapter 74
Stridor: Chapter 75
Wheezing: Chapter 84
Medical Emergencies
Dermatologic Urgencies and Emergencies: Chapter 88
Pulmonary Emergencies: Chapter 99
The Children’s Hospital of Philadelphia Clinical Pathway
