The only treatment for anaphylaxis is epinephrine. In order to use epinephrine safely, one needs to know the timing and the situation when epinephrine is to be used. Anaphylaxis is a systemic event that occurs after the ingestion of the offending allergen. The anaphylactic reaction usually occurs within 15-20 minutes of the ingestion or exposure. 80% of anaphylaxis occurs with skin eruptions. This leaves only 20% that may develop shortness of breath or hypotension.
I usually tell our parents that with the ingestion of an allergen, one needs to watch the child for symptoms. If the symptoms are only urticarial and the child is smiling, playful and acting normally, oral antihistamine may be of some benefit. If the clinical symptoms are anything more than the above described, then epinephrine is the drug of choice. Therefore, hives, coughing and/or hoarseness of voice would require epinephrine. Giving the child epinephrine, even though they may not have anaphylaxis, will not hurt them. When evaluating the child for anaphylaxis, if you think epinephrine, then give epinephrine.
