Page 33 - 2026 SMOG

ALLERGIC REACTION
Signs and Symptoms Differential Diagnosis
• Itching or hives • Urticaria (rash only)
• Cough/wheeze/respiratory distress • Anaphylaxis (2 or more symptoms)
• Chest/throat tightness • Shock (other than anaphylactic)
• Difficulty swallowing • Angioedema
• Hypotension or shock • Aspiration/airway obstruction
• Edema • Asthma or COPD
• Nausea/vomiting • Pulmonary edema/CHF
Rule out MOI as a differential diagnosis. UNIVERSAL PATIENT CARE PROTOCOL, MEDICAL
O (if hypoxemic), IV/IO PROTOCOL, cardiac monitor (ASAP)
2
Adult Pediatric
• Hives/rash only, no respiratory complaint • Hives/rash only, no respiratory complaint
˚ Diphenhydramine 25mg PO; ˚ Diphenhydramine
10–50mg IV/IM
Up to 6 y/o 6.25mg PO
■
˚ Methylprednisolone 125mg IV/IO ■ 6–12 y/o 12.5–25mg PO
• Shock/unresponsive or respiratory ■ >12 y/o 25–50mg IV/IM/PO
distress/failure ˚ Methylprednisolone 2mg/kg IV
˚ EpiPen or Epinephrine 1mg/mL; • Shock/unresponsive or respiratory
0.3–0.5mg IM
distress/failure
˚ 500mL IVF if not previously started ˚ EpiPen Jr for <30kg or Epinephrine
˚ Albuterol 90mcg 2–3 puffs MDI or ˚ 1mg/mL; 0.01mg/kg SQ/IM (max 0.3mg)
20mL/kg IVF Bolus
2.5–5mg via nebulizer
˚ Diphenhydramine 25–50mg IV/IO ˚ Albuterol metered-dose inhaler
4–8 inhalations q20min (max 3 doses)
Methylprednisolone 125mg IV/IO
˚
■
• Worse or unstable ˚ Albuterol by nebulizer
˚ Epinephrine IV infusion at 15mcg/min ■ 0.15mg/kg q20min (max single dose
5mg; max 3 doses)
(see EPINEPHRINE INFUSION
CHART) ˚ Diphenhydramine 25–50mg IV/IO/IM/PO
˚ Methylprednisolone 1–2mg/kg IV;
maximum daily dose 125mg
Notes, Cautions, Warnings
• Use caution prior to giving epinephrine IV to patients >50 y/o, pregnant, with a history of
cardiac disease, or with HR >150. Epinephrine can precipitate dysrhythmias/ischemia-all
patients should be on monitors and have a 12-lead ECG
• Epinephrine can precipitate dysrhythmias/ischemia-all patients should be on monitors and have
a 12-lead ECG
• The shorter the interval from contact to symptoms, the more severe the reaction
• Arrhythmia: See appropriate pediatric cardiac guidelines
• Non-Arrhythmia: See HYPOTENSION PROTOCOL or RESPIRATORY DISTRESS
PROTOCOL

2026 Standard Medical Operating Guidelines (SMOG) • 25