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Table 4 Graded challenge—suggested protocol and medications to have on-handView full size image

From: Practical guide for evaluation and management of beta-lactam allergy: position statement from the Canadian Society of Allergy and Clinical Immunology

Medications to have on-hand

Medication

Dose

 

Pediatric

Adult

Epinephrine 1 mg/mL (1: 1000) administered IM

0.01 mg/kg

 > 25 kg: use Adult dosing

0.5 mg

Antihistamine

Diphenhydramine if unable to tolerate oral medications

1 to 2 mg/kg/dose (IM or PO); maximum: 50 mg/dose

25–50 mg

Cetirizine

6 m to < 2 years: 2.5 mg

2 to 5 years: 2.5–5 mg

 ≥ 6 years: use adult dosing

10–20 mg

Glucocorticoids

Prednisone

1–2 mg/kg

20–60 mg

Short-acting bronchodilator (metered dose inhaler with spacer)

4–8 inhalations every 20 min for 3 doses

4–8 inhalations every 20 min for up to 4 h