on the revised recommendations of the Working Group of
the Resuscitation Council (UK).
Dose of intramuscular injection of adrenaline
(epinephrine) for the emergency treatment of
anaphylaxis by healthcare professionalsAge Dose Volume of adrenaline
▶Child 1 month–
5 years150 micrograms 0. 15 mL 1 in 1000
( 1 mg/mL) adrenaline^1
▶Child 6 – 11 years 300 micrograms 0. 3 mL 1 in 1000
( 1 mg/mL) adrenaline
▶Child 12 – 17 years 500 micrograms 0. 5 mL 1 in 1000
( 1 mg/mL) adrenaline^2
These doses may be repeated several times if necessary at 5 -minute
intervals according to blood pressure, pulse and respiratory function.
1. Use suitable syringe for measuring small volume
2. 300 micrograms ( 0. 3 mL) if child is small or prepubertalIntravenous adrenaline (epinephrine)
Intravenous adrenaline/epinephrine should be given only by
those experienced in its use, in a setting where patients can
be carefully monitored.
Where the child is severely ill and there is real doubt about
adequacy of the circulation and absorption from the
intramuscular injection site, adrenaline/epinephrine may be
given byslowintravenous injection, repeated according to
response; if multiple doses are required consider giving
adrenaline by slow intravenous infusion.
It is also important that, where intramuscular injection
might still succeed, time should not be wasted seeking
intravenous access.
Adrenaline/epinephrine is also given by the intravenous
route foracute hypotension.
Angioedema
Angioedemais dangerous iflaryngeal oedemais present. In
this circumstance adrenaline/epinephrine injection, oxygen,
antihistamines and corticosteroids should be given as
described underAnaphylaxis. Tracheal intubation may be
necessary. In some children with laryngeal oedema,
adrenaline 1 in 1000 ( 1 mg/mL) solution may be given by
nebuliser. However, nebulised adrenaline/epinephrine
cannot be relied upon for a systemic effect—intramuscular
adrenaline/epinephrine should be used.
Hereditary angioedema
The treatment of hereditary angioedema should be under
specialist supervision. Unlike allergic angioedema,
adrenaline/epinephrine, corticosteroids, and antihistamines
should not be used for the treatment of acute attacks,
including attacks involving laryngeal oedema, as they are
ineffective and may delay appropriate treatment—intubation
may be necessary. The administration of C 1 -esterase
inhibitor p. 183 (in fresh frozen plasma or in partially
purified form) can terminate acute attacks ofhereditary
angioedema; it can also be used for short-term prophylaxis
before dental, medical, or surgical procedures. Tranexamic
acid p. 82 is used for short-term or long-term prophylaxis of
hereditary angioedema; short-term prophylaxis is started
several days before planned procedures which may trigger an
acute attack of hereditary angioedema (e.g. dental work) and
continued for 2 – 5 days afterwards. Danazol [unlicensed
indication] is best avoided in children because of its
androgenic effects, but it can be used for short-term
prophylaxis of hereditary angioedema.
ANTIHISTAMINES›NON-SEDATING
Acrivastine 19-May-2017
lINDICATIONS AND DOSE
Symptomatic relief of allergy such as hayfever, chronic
idiopathic urticaria
▶BY MOUTH
▶Child 12–17 years: 8 mg 3 times a daylCONTRA-INDICATIONSAvoid in Acute porphyrias p. 603
lINTERACTIONS→Appendix 1 : antihistamines, non-
sedating
lSIDE-EFFECTS
▶Common or very commonDrowsiness.dry mouth
▶Frequency not knownDizziness.rash
SIDE-EFFECTS, FURTHER INFORMATIONNon-sedating
antihistamines such as acrivastine cause less sedation and
psychomotor impairment than the older antihistamines,
but can still occur; sedation is generally minimal. This is
because non-sedating antihistamines penetrate the blood
brain barrier to a much lesser extent.
lALLERGY AND CROSS-SENSITIVITYContra-indicated if
history of hypersensitivity to triprolidine.
lPREGNANCYMost manufacturers of antihistamines advise
avoiding their use during pregnancy; however, there is no
evidence of teratogenicity.
lBREAST FEEDINGMost antihistamines are present in
breast milk in varying amounts; although not known to be
harmful, most manufacturers advise avoiding their use in
mothers who are breast-feeding.
lRENAL IMPAIRMENTAvoid in severe impairment.
lPATIENT AND CARER ADVICE
Driving and skilled tasksAlthough drowsiness is rare,
nevertheless patients should be advised that it can occur
and may affect performance of skilled tasks (e.g. cycling or
driving); alcohol should be avoided.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Capsule
▶Benadryl Allergy Relief(McNeil Products Ltd)
Acrivastine 8 mgBenadryl Allergy Relief 8 mg capsules|
24 capsulep£ 5. 45Bilastine 22-May-2017
lINDICATIONS AND DOSE
Symptomatic relief of allergic rhinoconjunctivitis and
urticaria
▶BY MOUTH
▶Child 12–17 years: 20 mg once dailylCONTRA-INDICATIONSAvoid in Acute porphyrias p. 603
lINTERACTIONS→Appendix 1 : antihistamines, non-
sedating
lSIDE-EFFECTS
▶Common or very commonDrowsiness.headache
▶UncommonAnxiety.appetite increased.asthenia.bundle
branch block.diarrhoea.dry mouth.dyspnoea.fever.
gastritis.gastrointestinal discomfort.insomnia.nasal
complaints.nausea.oral herpes.pre-existing condition
improved.pruritus.QT interval prolongation.sinus
arrhythmia.thirst.tinnitus.vertigo.weight increased
SIDE-EFFECTS, FURTHER INFORMATIONNon-sedating
antihistamines such as bilastine cause less sedation and
psychomotor impairment than the older antihistamines,
but can still occur; sedation is generally minimal. This isBNFC 2018 – 2019 Allergic conditions 173
Respiratory system3