Emergency Preparedness – Allergic Reactions and Anaphylaxis

Introducing food allergens early is a great way to prevent food allergies from developing in your baby, but sometimes, even when the common food allergens are started at the right time (between 4 and 6 months of age and when developmentally ready), some infants may still develop a food allergy and have a reaction to something they eat. This is an allergic reaction. Allergic reactions can either be IgE-mediated or non-IgE-mediated. There are two types because there are different things that can happen in your baby’s body because of the food they ate, depending on which allergy type they have.

For babies, most IgE-mediated allergic reactions are mild. Serious allergic reactions, called anaphylaxis, are rare. Fortunately, there is a great treatment available that little ones respond very well to: epinephrine. Since your child can’t tell you how they feel yet, this guide will teach you exactly what to look for so you can act fast. Here you will learn how to:

• Recognize the signs of an IgE-mediated allergic reaction, including mild symptoms and more severe ones
• Give epinephrine if you think your baby or toddler is experiencing anaphylaxis
• Create an Anaphylaxis Action Plan with your healthcare team
• Use different epinephrine devices

What does an allergic reaction look like in babies and toddlers?

While the sounds babies and toddlers make are adorable, they don’t always tell us a lot. Babies and toddlers can’t use all the right words to say what they are feeling or if something hurts. Older children may say things like, “My throat feels funny” or “My stomach hurts.” Babies instead show changes in how they act and how they look.

Allergic reactions do not all look the same. Some are mild and stay in one part of the body. Others are more serious and involve more than one body system or affect breathing or circulation. Sometimes it can be easy to mistake an allergic reaction for normal behavior. Knowing what to look out for helps guide us on what to do next.

Signos y síntomas leves

Mild reactions are usually limited to one body area and do not spread or get worse quickly. In these cases…

• stop feeding your baby the food
• watch for changes, and
• talk with your healthcare team about next steps.

Signos y síntomas graves

A serious allergic reaction, called anaphylaxis, is when your baby has severe symptoms. Anaphylaxis also happens when your baby has mild symptoms but in more than one body area. For example, hives by itself is a mild symptom, and limited vomiting by itself is a mild symptom, but both hives and vomiting together would be anaphylaxis. Sometimes allergic reactions can start with mild symptoms, but get worse as time passes, leading to anaphylaxis.

What to do if your child is having a serious allergic reaction

If your baby is having severe symptoms and…

• They are NOT yet diagnosed with a food allergy and/or do not have epinephrine, call 911.
• They are diagnosed with a food allergy and have epinephrine, give epinephrine and follow your baby’s Anaphylaxis Emergency Action Plan. An easy way to remember what to do is to follow the REAct steps outlined below.

R: Reconocer la anafilaxia

Watch for serious symptoms like trouble breathing, vomiting, sudden sleepiness, swelling, or symptoms affecting two or more body systems. Use the above chart to see what symptoms might look like specifically in infants and toddlers.

E: Epinefrina primero

Administre epinefrina (el medicamento de primera línea para detener la reacción) de inmediato.

If your baby or toddler is experiencing some symptoms and you’re not sure it’s anaphylaxis, the best approach is to still give epinephrine. Early treatment can keep a reaction from getting worse and make your baby or toddler feel better quickly. 

Coloca a tu bebé en posición después de administrarle epinefrina.. After giving epinephrine, position your baby based on their symptoms:

Si tiene dificultad para respirar o tos:

• Hold your baby upright against your chest.
• Support their head and make sure their legs aren’t dangling.

If the baby’s head and body are limp and floppy, or if they’re hard to wake up:

• Lay your baby flat on the back with legs slightly raised.
• Do not pick your baby up suddenly or let your baby move around too much.

If there’s vomiting:

• Lay your baby on their side to prevent choking.

Cuándo administrar una segunda dosis de epinefrina

Administre una segunda dosis de epinefrina si:

• Symptoms do not get better in about 5 minutes after the first dose, or
• Symptoms come back or get worse

If you give a second dose of epinephrine, call 911.

Reminder: Keep two doses of epinephrine available at all times. Don’t forget to refill the prescription ASAP.

Activar – Activar plan de emergencia

These days, guidelines allow a bit more flexibility on what happens after epinephrine is given for anaphylaxis. If your child’s anaphylaxis is treated early and symptoms quickly get better after a first dose of epinephrine, you may not need to call 911. Your healthcare team will discuss with you whether this is an option for your child.

In these cases…

• there needs to be more than one dose of epinephrine available
• your baby cannot have severe or life-threatening symptoms
• another person is present
• you’re comfortable managing the situation
• symptoms largely get better after treatment, and
• the healthcare team previously approved this for your child

Call 911 if…

• you don’t have a second dose of epinephrine
• symptoms return or worsen after the first dose of epinephrine
• symptoms do not go away quickly or completely after the first dose of epinephrine
• a second dose of epinephrine is needed

In the past, families were often taught to call 911 after giving epinephrine, no matter what. This was because emergency medical personnel could give additional epinephrine, IV fluids, oxygen, and other medications if the first dose of epinephrine wasn’t enough. The recommendation was NOT because epinephrine was unsafe or because epinephrine itself needed monitoring.

After a serious allergic reaction, whether you needed to call 911 or not, be sure to schedule a follow-up appointment with your child’s healthcare team. Discuss what happened and make a change to your child’s Anaphylaxis Action Plan, if needed.

Get an Anaphylaxis Action Plan from your healthcare team

If your baby is diagnosed with a food allergy, your healthcare team will create an Plan de acción para la anafilaxia. This guide makes it easy for you, your family, and other caregivers to be on the same page and know exactly what to do during an allergic reaction.

The plan usually includes:

• Your child’s name, date of birth, weight, and a photo
• Una lista de alergias conocidas a alimentos o medicamentos.
• Síntomas a los que prestar atención.
• Cuándo y cómo administrar epinefrina.
• Cuándo llamar al 911.
• Information about the prescribed epinephrine device and dose
• Números de contacto de los cuidadores principales y cualquier contacto de emergencia adicional
• Your child’s healthcare team information

Your healthcare team will work together with you to review the anaphylaxis action plan. They will review:

• How to recognize allergic reactions
• When epinephrine should be used
• How to use the epinephrine auto-injector
• Where and how to store the medication

If you have questions, you can bring them up at any time during these discussions.

Guarda una copia del Plan de Acción contra la Anafilaxia:

1. En casa.
2. En su bolsa de pañales o kit de viaje.
3. With daycare or other childcare providers
4. Anywhere your child spends a lot of time, like a relative’s house
5. On your phone

Puede ser útil tomar una fotografía del plan completo y guardarla en una carpeta en su teléfono. Puede incluir fotografías de los medicamentos que toma su hijo. Esto hace que sea fácil compartir la información con otros si es necesario.

Including a photo of your child on the plan can help caregivers confirm they are following the correct plan for the correct child.

Download a copy of the AAP’s Anaphylaxis Action Emergency Plan

What to know about the different epinephrine devices

Not all epinephrine devices are the same. They can vary in look and how they are given. Some come with a trainer device (has no medicine and no needle in it) that you can practice with. Double check which device your child has and review the specific instructions below:

An intranasal device (given via the nose instead of an injection into the thigh) is available for toddlers above 15 kg (33 lbs).

The science behind an allergic reaction and epinephrine

A food allergy is when the immune system responds to a food in a way that is not normal. We use our immune system to fight germs such as viruses and bacteria. Sometimes, the immune system becomes confused and reacts to specific foods that are harmless to most people.

One type of food allergy, called an IgE-mediated food allergy, can cause reactions that affect one or more areas of the body. The signs and symptoms can be different from one person to another, or even from one reaction to the next in the same person.

IgE is a protein called immunoglobulin E. IgE is involved in most allergic reactions that can become severe, serious, and sometimes get worse quickly. IgE can move around in the body, but it is also found on allergy cells such as mast cells and basophils. These are important parts of the immune system that play a role in serious, potentially life-threatening allergic reactions.

If someone eats their allergen, such as peanut or cashew, the peanut or cashew protein can bind to IgE and trigger the signs and symptoms of an allergic reaction. Allergy cells, such as mast cells and basophils, can then release the substances stored inside them. These substances are chemicals such as platelet-activating factor, leukotrienes, cytokines, chemokines, and histamine. These cause symptoms in different organ systems. Often, these organ systems are grouped into the skin and mucosal surfaces (such as the inside of the mouth), respiratory system (lungs and upper airway), cardiovascular system (heart and blood vessels), gastrointestinal system (stomach and intestines), and neurologic system (brain).

Epinephrine is the treatment for serious allergic reactions, including anaphylaxis. Epinephrine works quickly and directly where it is needed. It acts on target organs such as the heart, lungs, and blood vessels to prevent a reaction from getting worse and to make symptoms better. Importantly, epinephrine also works on the cell membranes of allergy cells, such as mast cells and basophils. It can stabilize these cells and help prevent them from releasing additional inflammatory mediators.

Additional resources for families

Estos recursos confiables pueden ayudarle a encontrar información fiable sobre la anafilaxia en bebés, conectarse con otras familias y sentirse más preparado:

• Red de alergias y asma:
  • Infant Anaphylaxis: Causes, Symptoms, and Treatment Guide
• American College of Allergy, Asthma & Immunology (ACAAI)
• American Academy of Allergy, Asthma & Immunology (AAAAI)
• HealthyChildren.org
  • How to Create an Allergy and Anaphylaxis Emergency Plan
  • How to Use an Epinephrine Auto-Injector or Nasal Spray for Anaphylaxis

Buscar apoyo

Managing food allergies and allergic reactions can feel overwhelming at times. It is common for caregivers to feel concerned, stressed, or uncertain, especially after an allergic reaction or emergency situation. Support can be helpful as part of ongoing care. This may include:

• Talking with your child’s healthcare team
• Learning more about food allergy management
• Connecting with support resources or other families

Caregivers play an important role in recognizing and responding to allergic reactions. Over time, many families become more confident with experience and education.

Preguntas y respuestas sobre la anafilaxia en bebés

The more you know, the more confident you will feel when it comes to your child’s food allergy. Here are answers to some common questions we’re asked about infant anaphylaxis.