[How I treat anaphylaxis in children]

Anaphylaxis is a rapid-onset, life-threatening systemic hypersensitivity reaction. Insufficient awareness of this condition in China and delayed or inappropriate use of epinephrine-the core treatment-are major causes of severe outcomes. Based on two clinical cases and the latest domestic and international guidelines, this article systematically describes early recognition and diagnosis of anaphylaxis in children, epinephrine-centered emergency management strategies, and the treatment protocol for refractory anaphylaxis. For classic anaphylaxis, early intramuscular injection of epinephrine into the anterolateral thigh is lifesaving. For refractory anaphylaxis, intravenous continuous infusion of epinephrine should be initiated promptly after two ineffective intramuscular injections, combined with aggressive fluid resuscitation and, if necessary, second-line vasoactive drugs. Antihistamines and corticosteroids are only adjunctive therapies and cannot replace epinephrine. Standardized post-discharge long-term management and the promotion of novel noninvasive delivery routes will further improve prognosis of pediatric anaphylaxis.