Adrenaline IM (Paediatric — Anaphylaxis)

How it works

Adrenaline stimulates alpha- and beta-adrenoceptors, reversing anaphylaxis by causing vasoconstriction, bronchodilatation, reduced mucosal oedema and increased cardiac output.

Prescribing in practice

• In a child with suspected anaphylaxis, give intramuscular adrenaline into the anterolateral thigh without delay using the weight- or age-appropriate dose from a children's formulary, and repeat after a few minutes if there is no improvement.
• The intramuscular route is preferred; intravenous adrenaline is reserved for specialist resuscitation settings because of arrhythmia risk.
• Position the child appropriately, give high-flow oxygen and call for help, as adrenaline is part of a wider resuscitation algorithm.

Monitoring

Monitor airway, breathing, circulation, oxygen saturation and conscious level continuously, and observe after recovery for a biphasic reaction.

Counselling the patient

• Adrenaline is the most important emergency treatment for a severe allergic reaction.
• After treatment the child must be observed in hospital because symptoms can return.
• Carers should be trained in auto-injector technique and when to call for emergency help.

Evidence & guidelines

UK Resuscitation Council and NICE guidance position intramuscular adrenaline as the immediate first-line treatment for anaphylaxis at all ages.