Q: Our baby has an egg allergy. What does anaphylaxis usually look like in a baby, and is it safe to use an auto-injector with an infant under 6 months old?
Dr. Sicherer: Symptoms of anaphylaxis in a baby are like those in an older child. There can be sudden onset of hives, swelling, cough, wheeze, high-pitched breathing (stridor), trouble breathing, vomiting and skin or lip color changes, among other symptoms.
It can be tricky, however, to identify more subtle initial symptoms. An older child can describe itching or stomach pain, but an infant cannot.
Early symptoms of a food allergy reaction in an infant could include crying, irritability, clinginess, sleepiness, drooling, spitting up and redness. The difficulty is that these are all “symptoms” that a healthy baby could have as well. A baby could also have an illness that is not allergy, but shares some of the same symptoms, such as an infection, heart or lung problem or seizures.
However, the “big picture” can typically point one in the direction of suspecting an allergic reaction. For example, observing hives and coughing soon after a meal would suggest an allergic reaction/anaphylaxis.
Most epinephrine auto-injectors have an epinephrine dose is 0.15 mg, which is ideal for a child weighing 33 pounds and over. In 2018, the brand Auvi-Q introduced an 0.1 mg epinephrine auto-injector, designed for younger children weighing between 16.5 pounds and 33 pounds.
If that type of auto-injector isn’t readily available, an alternative for a lower dose is to use a syringe to draw a small amount of epinephrine from a vial. However, doing so in an emergency takes dexterity and is prone to error.
As well, knowing that epinephrine is a very safe medication, experts have suggested using the auto-injector dose of 0.15 mg for infants weighing as little as 16.5 pounds is also acceptable. Talk to your doctor about the options.
Dr. Scott Sicherer is a practicing allergist, clinical researcher and professor of pediatrics. He is Director of the Jaffe Food Allergy Institute and Chief of Pediatric Allergy and Immunology at the Icahn School of Medicine at Mount Sinai in New York. He’s also the author of Food Allergies: A Complete Guide for Eating When Your Life Depends On It.Submit a Question View all posts by this medical expert.