Pediatric Anaphylaxis: Rethinking the Rules with Dr. Tim Dribin

When should we give epinephrine, and how long do children need to be observed afterward?

Dr. Bob Belfer speaks with pediatric emergency physician and researcher Dr. Tim Dribin (Cincinnati Children’s Hospital Medical Center) about pediatric anaphylaxis. Drawing on multicenter research and bedside experience, they explore how to improve recognition, reduce hesitation around epinephrine, and tailor observation and discharge decisions to the individual patient.

They discuss early peanut introduction, the lessons of the LEAP trial, and AnaTool, a clinical support tool designed to help healthcare professionals recognize and manage anaphylaxis. They also examine Dr. Dribin’s 2025 study in The Lancet Child & Adolescent Health on the timing of repeat epinephrine, what it suggests about shorter observation periods for selected patients, and which children warrant greater caution. The conversation addresses reaction severity, access to epinephrine, local care pathways, and shared decision-making with families.

Finally, a lightning round covers intranasal epinephrine, diagnostic pitfalls involving gastrointestinal symptoms, and the roles of steroids and antihistamines. They tackle another challenging question: does every child who receives epinephrine in the community need an ED visit? Dr. Dribin discusses emerging evidence, the practical challenges of these decisions, and the research needed to guide future care.

Studies and resources discussed

Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122(5):984-991.

Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803-813. The LEAP trial.

Dribin TE, Muraro A, Camargo CA Jr, et al. Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report—a GA²LEN project. J Allergy Clin Immunol. 2025;156(2):406-417.e6.

AnaTool: FARE’s interactive anaphylaxis clinical support tool for healthcare professionals, with assessment of anaphylaxis likelihood and epinephrine dosing guidance.

Dribin TE, Sampson HA, Zhang Y, et al. Timing of repeat epinephrine to inform paediatric anaphylaxis observation periods: a retrospective cohort study. Lancet Child Adolesc Health. 2025;9(7):484-496.

Dribin TE, Schnadower D, Sampson HA, et al. Prediction model for children with anaphylaxis who may not require emergency department care: a multicenter retrospective cohort study. J Allergy Clin Immunol Pract. 2026;14(9):2038-2050.e5.

About the guest

Dr. Tim Dribin is a pediatric emergency physician at Cincinnati Children’s Hospital Medical Center. His research focuses on improving the recognition and management of anaphylaxis, personalizing observation and discharge decisions, and developing tools to support clinicians, patients, and caregivers in the ED and community.

About the podcast

The PEM Podcast features thoughtful conversations, practical teaching, and the people and ideas shaping pediatric emergency medicine. It is hosted by Dr. Bob Belfer and is part of HipPEMcrates, an independent pediatric emergency medicine education platform.

Visit HipPEMcrates.com for pediatric emergency medicine articles, literature reviews, clinical pearls, and educational resources.