A 3-month-old infant develops generalized urticaria and stridor within 15 minutes of receiving pentavalent vaccine at a session site. What is the correct initial management?

• A Chlorpheniramine maleate orally and observation for 30 minutes
• B Hydrocortisone 100 mg intravenously as the first drug
• C Adrenaline 0.5 mL of 1:10,000 solution subcutaneously
• D Adrenaline 0.01 mL/kg of 1:1000 solution intramuscularly in the anterolateral thigh ✓

Explanation

Anaphylaxis after immunization is managed immediately with adrenaline 0.01 mL/kg of 1:1000 (1 mg/mL) solution given intramuscularly into the anterolateral thigh, repeated every 5 to 15 minutes if needed, maximum 0.5 mL. Intramuscular thigh injection gives fastest absorption. Antihistamines and steroids are adjuncts only and never first line. The 1:10,000 concentration is reserved for intravenous use in cardiac arrest settings, not for IM anaphylaxis treatment.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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