Infant anaphylaxis: What it looks like when they can't tell you

"I have come across allergists in different countries who often don't even prescribe epinephrine for very young children that have only had a history of mild reactions." — Dr. Katherine AnagnostouAn inconsolable cry. A baby who's just not acting right. Tongue thrusting. Lip licking. Scratching at their own tongue. These aren't the symptoms that make it into standard diagnostic criteria — but they might be the clearest signal a non-verbal child can give. On this episode, Dr. Mariam Hanna is joined by pediatric allergist and immunologist Dr. Katherine Anagnostou to explore how anaphylaxis presents in infants and toddlers, why the standard criteria don't always apply, and how allergists can help caregivers recognize — and treat — serious reactions in children who can't yet put words to what they're feeling.On this episode:Why modified criteria for infant and toddler anaphylaxis matterBehavioral signs like irritability, clinginess, lethargy, or withdrawal as red flagsThe role of context and timing in recognizing reactionsSurrogate symptoms — tongue thrusting and lip licking for oral itching, drooling, horse cryWhy urticaria shows up in 90% of infant anaphylaxis casesEpinephrine dosing: the 0.1 mg option for infants 7.5-15 kg and safety of 0.15 mg in smaller babiesWhy not every infant who receives epinephrine needs the EDSecond-dose timing: five minutes, not tenNovel delivery routes on the horizon — intranasal and sublingual epinephrineDr. Anagnostou returns to one principle throughout: parents generally know their children pretty well. The job of the allergist isn't to create fear or overcomplicate recognition — it's to help families spot what's different, understand the context, and feel equipped to act when it matters.Have an idea for the show or a comment, send us a text!Visit the Canadian Society of Allergy and Clinical ImmunologyFind an allergist using our helpful toolFind Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_caThe Allergist is produced for CSACI by PodCraft Productions