Table 5 Emergency medications for a severe reaction during an office-based infant OFC

First-line treatment

Epinephrine (1:1000 concentration)

0.01 mg/kg IM in the mid-outer thigh in health care settings or 0.15 mg of autoinjector IM in the mid-outer thigh in community settings Epinephrine doses may need to be repeated every 5–15 min

Adjunctive treatment

Albuterol nebulization

0.15 mg/kg every 20 min × 3 doses (minimum of 2.5 mg per dose) over 5–15 min

Albuterol MDI inhalation

2 puffs, 90 μg per puff, with face mask

Oxygen

8–10 L/min through a face mask

Diphenhydramine

1.25 mg/kg administered orally

Cetirizine

2.5 mg administered orally

Normal saline (0.9% isotonic solution) or lactated ringers

20 ml/kg per dose administered over 5 min intravenously

Steroids

Prednisolone 1 mg/kg administered orally or Solu-Medrol 1 mg/kg administered intravenously