Pediatric emergency medicine trisk 1684 1684
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (132.86 KB, 1 trang )
Treating serum sickness and serum sickness–like reactions should be guided by
reaction severity while also recognizing that reactions are usually self-limited.
Thus, the mainstay of therapy is to remove offending antigens, provide
symptomatic relief, and monitor for complications.
Pharmacologic management may include treatment with antihistamines,
NSAIDs, and corticosteroids. Antihistamines are commonly used to treat pruritus,
rashes, and angioedema. Options include the first generation antihistamine such
as diphenhydramine (1 mg/kg/dose every 6 hours; maximum 50 mg) or secondgeneration antihistamines (e.g., cetirizine; 2.5 mg to 10 mg daily) which are
longer acting and less likely to cause CNS depression ( Table 85.3 ). Arthralgias,
arthritis, and fever should be treated with NSAIDs such as ibuprofen (5 to 10
mg/kg/dose every 6 to 8 hours; maximum 2.4 g per 24 hours) or naproxen (5 to 6
mg/kg/dose every 12 hours, maximum 1 g per 24 hours). Patients with severe
arthritis despite NSAIDs may benefit from a short course of corticosteroids
including prednisone/prednisolone (1 to 2 mg/kg/day; maximum 60 to 80 mg per
day) or dexamethasone (0.6 mg/kg dose given daily; maximum 16 mg).
Unfortunately, there is no data to guide duration of steroid administration as some
patients may have rapid symptom resolution while others will have persistent
symptoms necessitating a steroid taper. Although rarely used to treat serum
sickness reactions, plasmapheresis may play a role in life-threatening reactions
with high circulating levels of immune complexes. Most children with serum
sickness are managed as outpatients with close primary care follow-up and strict
instructions to avoid the offending agent. Children with severe involvement
(arthritis with inability to walk, renal dysfunction) may benefit from
hospitalization particularly if there is diagnostic uncertainty.
ALLERGIC RHINITIS AND CONJUNCTIVITIS
CLINICAL PEARLS AND PITFALLS
Allergic rhinitis accounts for significant morbidity and health care costs.
Although there is a paucity of comparative effectiveness data in
children, intranasal corticosteroids are considered first-line therapies to
manage symptoms. Nonsedating antihistamines and montelukast are
common alternative therapies.
Current Evidence
Background
