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J Allergy Clin Immunol Pract. 2019 Apr;7(4):1148-1156.e5. doi: 10.1016/j.jaip.2018.10.052. Epub 2019 Feb 5.

Guiding Principles for the Recognition, Diagnosis, and Management of Infants with Anaphylaxis: An Expert Panel Consensus.

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Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo. Electronic address:
Departments of Pediatrics and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
Alabama College of Osteopathic Medicine, Dothan, Ala.
Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass.
Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Department of Pediatrics & Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Division of Allergy and Immunology, University of Tennessee Health Science Center, Memphis, Tenn.


Infant anaphylaxis is an emerging risk, with food allergy the most common cause. Although the presentation of anaphylaxis involves the same systems as in older children and adults, there are real-world challenges to identifying symptoms of an allergic emergency in nonverbal children, as well as implementing optimal treatment. Recognition of anaphylaxis in infants can be challenging because allergic symptoms and certain normal infant behaviors may overlap. Intramuscular epinephrine is the treatment of choice for infants, as it is for older children and adults, and an epinephrine autoinjector approved by the Food and Drug Administration is now available for infants weighing between 7.5 and 15 kg. A panel of experts sought to develop guiding principles for the recognition, diagnosis, and management of anaphylaxis in infants, and provide a framework for the development of new guidelines and future research. Accordingly, anaphylaxis emergency action planning for infants was addressed by the panel. In considering formation of future infant anaphylaxis guidelines, health care providers should be aware of the needs to improve the recognition, diagnosis, and management of infants with anaphylaxis. Future research should identify and validate clinical criteria for the diagnosis of anaphylaxis in infants, as well as risk factors for the most severe reactions.


Anaphylaxis; Epinephrine; Epinephrine autoinjector; Food allergy; Infant anaphylaxis; Needle length


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