Pediatric Emergency Care and Medicine: Open Access

Introduction

Allergic reactions are among the most common emergencies encountered in pediatric care, ranging from mild skin manifestations such as urticaria to life-threatening conditions like anaphylaxis. Children are particularly vulnerable due to developing immune systems and frequent exposure to allergens through food, environmental triggers and medications. The rising prevalence of pediatric allergies globally highlights the need for prompt recognition, efficient emergency response and long-term preventive strategies. Emergency care for pediatric allergic reactions requires rapid intervention to stabilize airway, breathing and circulation, while addressing the underlying trigger. Failure to act swiftly in cases of severe reactions can result in fatal outcomes within minutes. Beyond acute management, preventing recurrent episodes through education, allergen avoidance and long-term medical plans is equally crucial. This article explores the spectrum of pediatric allergic reactions, emergency care approaches and strategies for prevention to reduce morbidity and mortality [1].

Description

Allergic reactions in children are immune-mediated responses triggered by allergens such as food proteins (milk, peanuts, tree nuts, shellfish), insect stings, medications and environmental factors like pollen or dust mites. Pathophysiologically, the reactions involve activation of mast cells and basophils, releasing histamine and other mediators that cause vasodilation, bronchoconstriction and increased vascular permeability. The severity ranges from localized urticaria and angioedema to systemic anaphylaxis, a medical emergency characterized by hypotension, airway obstruction and shock. Clinical manifestations differ in severity and onset. Mild reactions may include pruritus, rash, watery eyes, or rhinitis. Moderate reactions can progress to swelling of lips or eyelids, abdominal pain, nausea, or vomiting. Severe anaphylactic reactions typically present with stridor, wheezing, hypotension, tachycardia and altered consciousness. In children, early signs like irritability, lethargy, or refusal to eat may signal evolving anaphylaxis. Prompt recognition of this spectrum is vital to guide emergency interventions and prevent deterioration [2].

Emergency care of pediatric allergic reactions prioritizes stabilization of airway, breathing and circulation. For anaphylaxis, intramuscular epinephrine is the first-line, life-saving intervention and should be administered promptly at the earliest signs of severe reaction. Delays in epinephrine administration are strongly associated with poor outcomes. Oxygen supplementation, airway support and intravenous fluids may be required to manage hypoxemia and circulatory collapse. Adjunctive therapies such as antihistamines and corticosteroids can help control symptoms but should never delay epinephrine administration. For mild to moderate allergic reactions, antihistamines are often sufficient, alongside close monitoring to detect progression to severe forms. Emergency teams must be vigilant for biphasic anaphylaxis, where symptoms recur after initial resolution, sometimes hours later. This risk necessitates observation in a medical facility after stabilization, typically for 4â??6 hours or longer depending on severity. In cases where airway compromise is severe, advanced airway management including intubation may be necessary. Rapid triage, age-appropriate resuscitation and multidisciplinary coordination are key to successful emergency care [3].

Preventive measures are essential to reduce recurrence and improve quality of life in children with allergies. Identifying and avoiding known allergens remains the cornerstone of prevention. Food allergies, the leading cause of anaphylaxis in children, require strict dietary modifications, clear labeling and education of caregivers, teachers and peers. Personalized emergency action plans, including epinephrine auto-injector training for families and school personnel, provide vital preparedness for future episodes. Immunotherapy offers a promising long-term intervention for select allergies, particularly environmental and insect venom allergies, by gradually desensitizing the immune response. Ongoing research into oral immunotherapy for food allergies shows potential but requires careful monitoring. Public health initiatives, such as increasing awareness about hidden allergens, improving food labeling standards and enhancing access to epinephrine, are critical preventive strategies. Additionally, routine follow-ups with pediatric allergists help monitor disease progression, reassess triggers and update emergency plans [4].

Pediatric allergic reactions range from mild manifestations such as rashes and itching to life-threatening anaphylaxis, making timely recognition and emergency care critical. In severe cases, intramuscular epinephrine is the first-line, life-saving intervention, supported by airway management, oxygen and fluids, while antihistamines and corticosteroids serve as adjuncts. Because children often have recurrent exposures to allergens like food, insect stings, medications, or environmental triggers, prevention is equally important through strict allergen avoidance, caregiver and school staff education and the use of personalized emergency action plans with epinephrine auto-injectors. Long-term strategies, including allergen immunotherapy and regular follow-up with specialists, further reduce risks, while public health measures such as clear food labeling and awareness programs enhance community preparedness. Together, accurate emergency response and preventive strategies significantly improve safety and quality of life for children with allergies [5].

Conclusion

In conclusion, pediatric allergic reactions remain a significant emergency concern, with outcomes largely determined by the speed and appropriateness of intervention. Immediate administration of epinephrine, coupled with supportive airway and circulatory management, can be lifesaving in severe cases. Pediatric allergic reactions, ranging from mild to life-threatening, demand rapid recognition and efficient emergency care to prevent severe outcomes. Epinephrine remains the cornerstone of anaphylaxis management, while supportive measures address airway, breathing and circulation. Beyond emergency stabilization, long-term prevention strategies focusing on allergen avoidance, education and immunotherapy are vital for reducing morbidity and improving quality of life. A multidisciplinary approach involving families, healthcare providers, schools and public health systems ensures optimal preparedness and protection for children at risk.

Acknowledgment

None.

Conflict of Interest

None.

References

1. Shaker MS, Wallace DV, Golden DB, Oppenheimer J, Bernstein JA, et al. (2020). Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 145: 1082-1123.

                                                      Google Scholar Cross Ref Indexed at

2. Martelli A, Ippolito R, Votto M, De Filippo M, Brambilla I, et al. (2020). What is new in anaphylaxis?. Acta Biomed 91: e2020005.

                                                      Google Scholar Cross Ref Indexed at

3. Kastner M, Harada L, Waserman S (2010). Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. Allergy 65: 435-444.

                                                      Google Scholar Cross Ref Indexed at

4. Arroabarren E, Alvarez-García J, Anda M, De Prada M, Ponce C, et al. (2018). Impact of Specific Training in Anaphylaxis for Triage Nursing Staff in the Pediatric Emergency Department of a Tertiary Hospital. J Investig Allergol Clin Immunol 28(6), 401-406.

                                                      Google Scholar Cross Ref Indexed at

5. Calvani M, Cardinale F, Martelli A, Muraro A, Pucci N, et al. (2011). Risk factors for severe pediatric food anaphylaxis in Italy. Pediatr Allergy Immunol 22: 813-819.

                                                      Google Scholar Cross Ref Indexed at