Ari R. Cohen, MD, FAAP: Diagnosing Anaphylaxis in Pediatric Populations


Cohen details some of the diagnostic criteria for anaphylaxis in pediatric populations, differences in symptoms among children and adolescents, and the virtues of epinephrine.

For parents and caregivers of young children and adolescents with allergies, the threat of anaphylaxis brought on by allergen exposure is a sobering thought.

Despite this, there are a multitude of recommendations for the treatment of anaphylaxis, not least of which is an emergency epinephrine injection.

In an interview with HCPLive, Ari R. Cohen, MD, FAAP, Chief of Pediatric Emergency Medicine, Massachusetts General Hospital, spoke of the virtues of epinephrine in the treatment of anaphylaxis, as well as the diagnostic criteria that clinicians use to define anaphylaxis in young patients.

The data Cohen referenced in the interview was available in his session, “Anaphylaxis Update: Be Prepared!”, which was presented at the American Academy of Pediatrics (AAP) 2021 Virtual Conference.

“We have numerous studies have shown that emergency medicine primary care doctors use other treatments such as antihistamines, steroids, h2 antagonists, all in an effort to treat anaphylaxis,” Cohen said. “But the only thing that really treats the anaphylaxis and really stops this massive cascade (of events) is epinephrine, and the sooner you use the epinephrine the better chance of a good recovery you're going to have.”

Though auto injectors of the emergency medicine are often expensive, Cohen noted that the actual drug was “remarkably cheap” and that a standard syringe was suitable for administering epinephrine.

He also spoke of some of the diagnostic criteria for pediatric patients, particularly younger patients who might not completely meet the criteria for anaphylaxis.

Children often manifest symptoms differently than adult patients, Cohen noted, and as such might not be diagnosed with anaphylaxis. However, they might benefit from anaphylaxis treatment, and as such he believed these patient populations should be treated. He proposed several changes in the diagnostic criteria of anaphylaxis in young children.

“I think we have to think about it a little bit differently in the younger children than we do and even the older children, which are much more similar to adults,” Cohen said. “We may have to loosen our criteria a little bit or be more willing to treat a few kids that are would not be meet the actual definition of anaphylaxis with epinephrine because there's a very little downside… I don't like kids screaming because I'm sticking them with a needle, but the actual adverse side effects of a dose of an intramuscular epinephrine is really quite well, relative to the risk of not treating a kid that's in that's having anaphylaxis because they're not quite meeting criteria.”

To hear more from Dr. Cohen on his AAP session on anaphylaxis, watch the video above.

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