# Pediatric allergic reaction & anaphylaxis

Use weight-based epinephrine first for anaphylaxis, then treat airway, breathing, and perfusion.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-anaphylaxis/
Official source: [SO-P-060 — Allergic Reaction / Anaphylaxis - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- The IM and IV/IO epinephrine solutions have different concentrations and maximum doses.
- Document prearrival epinephrine and diphenhydramine to avoid treating those doses as if they never occurred.

## Source documents

- [SO-P-060 — Allergic Reaction / Anaphylaxis - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf)

## Classify the reaction

- Stable rash/urticaria alone has a different branch from angioedema or systemic anaphylaxis; SpO₂ below 95% moves the patient to the anaphylaxis branch.
- Anaphylaxis findings include hypotension, wheeze, hypoxia, stridor, intraoral swelling, GI symptoms, or impending obstruction.
- For isolated facial/cervical angioedema, the source lists one 0.01 mg/kg IM epinephrine dose (maximum 0.5 mg), held if an auto-injector was already given, plus oxygen and diphenhydramine as specified.

## First-line anaphylaxis care

- Give epinephrine 0.01 mg/kg IM of 1 mg/mL into the lateral thigh; maximum 0.5 mg. Count prior auto-injector treatment as the first dose.
- Provide oxygen as tolerated. For hypotension, give normal saline 20 mL/kg IV/IO, maximum 250 mL per bolus, and contact base; may repeat twice for 3 total boluses.
- For wheeze or room-air hypoxia below 95%, give continuous albuterol 5 mg/6 mL as tolerated.

## Persistent symptoms after about 5 minutes

- With continued hypotension, respiratory distress, or impending obstruction, a second dose may be 0.01 mg/kg IM of 1 mg/mL, maximum 0.5 mg; OR 0.01 mg/kg IV/IO of 0.1 mg/mL, maximum 0.3 mg.
- After initial epinephrine, give diphenhydramine 1 mg/kg IM/IV/IO once, maximum 50 mg, unless already taken before EMS arrival.

## Contact & transport

- Contact base (pediatric-capable preferred) and provide ALS escort to the designated pediatric-capable or other ERC.
- Reassess airway, respiratory effort, perfusion, and response repeatedly. Even a resolving reaction after self-administered epinephrine needs ALS evaluation and transport as described by the source.