As summer comes to a close, our focus as health care providers tends to switch to runny noses and head colds. The bees and pollen are done for the summer, but does that mean that all allergens have been neutralized? School is back in session, meaning the discovery of new allergies. Peanuts. Shellfish. The common enemies. Kids are trying new foods and being exposed to different environments. With new surroundings and diversified pallets comes the risk or anaphylaxis. Anaphylaxis is a time sensitive emergency that is particularly troublesome in pediatrics. According to the Mayo Clinic, anaphylaxis is defined as “a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you’re allergic to, such as a peanut or the venom from a bee sting.” (Mayo Clinic, 2013) So why are kids more at risk for an anaphylactic reaction?
Anyone that has ever responded to an emergency involving a pediatric patient will attest to the fact that nerves play a role in the decision-making process and can affect your treatment modalities. Pediatrics in distress require decisive and aggressive treatment, or they will deteriorate rapidly. As most of you know, the airway anatomy, while similar to adults, differs in a few important ways. Children’s tongues are much larger, and their lower airways are much narrower. During anaphylaxis, there is a histamine release that causes inflammation due to foreign, unrecognized particles in the body. This typically manifests in the form of angioedema. Simply put, angioedema is characterized by swelling the upper airway; primarily the face, tongue, or upper neck. Due to the fact that children already have smaller airways and larger tongues, this poses a great problem that can involve immediate respiratory compromise. Anaphylaxis also can present with bronchoconstriction that inhibits gas exchange in the lungs, as well as decreased cardiac output from widespread vasodilation.
No matter your location, emergency help can feel like it’s hours away as you watch a pediatric patient crashing in front of you. What are some simple things that you can do in the meantime? Position your patient optimally; laying people who are already experiencing respiratory compromise flat only makes breathing more difficult. If there is an epinephrine auto injector readily available, preferably prescribed to the patient, time is of the essence. There are several different brands of epinephrine auto injectors available, but the delivery is fairly similar. When in doubt, ALWAYS read the instructions before administering. The preferred site of injection is the lateral thigh; this location has enough adipose tissue to cushion the area. Pull the cap off of the pen and observe to find which end contains the needle while attempting to not inject yourself. You might think that is common sense, but you would be surprised by the amount of times someone has accidentally injected themselves while trying to help a friend. Stab the injector into the lateral thigh and depress the trigger on the end for approximately ten seconds to guarantee that the solution has entered into the intramuscular space. This is perhaps one of the most important interventions that can be done for someone experiencing an anaphylactic reaction. Epinephrine has a few different properties that all pertain to reversing anaphylaxis. It improves vasoconstriction. This has two actions; it improves blood pressure as well as reduces swelling. Also, epi has bronchodilatory properties. By relaxing the musculature in the lungs, oxygen is able to go into circulation and carbon dioxide is able to exit the body.
Bottom line, anaphylaxis has the potential to turn into a life-threatening condition in a matter of seconds. It is important to have a plan in place prior to something bad happening. Immediate activation of the 911 system is crucial in order that the child receives ongoing monitor and possibly continued intervention if their condition has not improved. Anaphylaxis is frightening, for the patient and provider. Especially when dealing with kids, it is important to remain calm above all else.