Infant Anaphylaxis Often Missed
2026-08-06
An uncomfortable truth emerges from two new allergy publications: infants and toddlers are not getting epinephrine when they most need it. Instead of textbook hives and complaints of throat tightness, researchers describe floppy babies, sudden vomiting, pallor, and inconsolable crying, signs that often masquerade as infection, reflux, or simple irritability.
The authors argue that this diagnostic fog is not just unfortunate; it is dangerous. Across case series and registry data, they document delayed recognition of anaphylaxis, low use of intramuscular epinephrine, and heavy reliance on antihistamines and corticosteroids, despite guidelines that identify epinephrine as first‑line therapy to halt systemic mast cell degranulation and prevent cardiovascular collapse.
Clinical nuance, they suggest, now matters more than any algorithm. The papers call for explicit caregiver teaching on early signs of anaphylaxis in nonverbal children, wider prescription of epinephrine autoinjectors, and rehearsal of action plans in daycare and emergency settings, embedding the concept that a single prompt dose of epinephrine is safer than one more minute of hesitation.
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