Peanut Allergy

[see Anaphylaxis]




Physical exam


Differential Diagnosis


  1. Identification and elimination of foods
  2. Injectable epinephrine and a written emergency plan in case of accidental ingestion should be given to children with asthma and IgE mediated food allergies
  3. Patients should be aware of the biphasic nature of the reaction and they should contact their physician after the emergency treatment is completed
  4. Current recommendations include:
  5. The patients should have a Medic-Alert Bracelet or Necklace

Instructions for Follow-Up


Prevention & Screening


Admit Orders: Anaphylaxis

1. Admit to:
2. Diagnosis: Anaphylaxis
3. Condition:
4. Vital Signs: Call MD if:
5. Activity:
6. Nursing: Inputs and outputs, pulse oximeter.
7. Diet: Regular
8. IV Fluids: 2 IV lines. Normal saline or LR 10-20 mL/kg rapidly over 1h, then D5 1/2 NS at 1-1.5 times maintenance.
9. Special Medications:
  -O2 at 4 L/min by NC or mask.
  -Epinephrine, 0.01 mg/kg [0.01 mL/kg of 1 mg/mL = 1:1000] (maximum 0.5 mL) subcutaneously, repeat every 15-20 minutes prn. Usual dose for infants is 0.05-0.1mL, for children 0.1-0.3 mL, and for adolescents 0.3-0.5 mL. If anaphylaxis is caused by an insect sting or intramuscular injection, inject an additional 0.1 mL of epinephrine at the site to slow antigen absorption.
  -Epinephrine racemic (if stridor is present), 2.25% nebulized, 0.25-0.5 mL in 2.5 mL NS over 15 min q30 min-4h.
  -Albuterol (Ventolin [0.5%, 5 mg/mL soln]) nebulized 0.01-0.03 mL/kg (max 1 mL) in 2 mL NS q1-2h and prn; may be used in addition to epinephrine if necessary.
  -For severe symptoms, give hydrocortisone 5 mg/kg IV q8h until stable, then change to oral prednisone. If symptoms are mild, give prednisone: initially 2 mg/kg/day (max 40 mg) PO q12h, then taper the dose over 4-5 days.
  -Diphenhydramine (Benadryl) 1 mg/kg/dose IV/IM/IO/PO q6h, max 50 mg/dose OR
  -Hydroxyzine (Vistaril) 0.5-1 mg/kg/dose IM/IV/PO q4-6h, max 50 mg/dose.
10. Extras and X-rays: Portable CXR.
11. Labs: CBC, SMA 7, ABG.