Pediatric Community

  • 1.  Allergy/Rash Nurse Initiated Protocol

    Posted 10-09-2025 01:18 PM

    Hello All,

    There has been a request from my bedside staff to investigate the use of a nurse-initiated protocol for an allergic reaction.

    This would be used for kids who present with a rash, or itching WITHOUT any signs of respiratory distress, the initial request was for diphenhydramine but I believe that cetirizine is the current preferred drug.

    Does anyone have something like this they would be willing to share?

    Thanks!
    Liz



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    Elizabeth Leming BSN;BA;CCRN
    Clinical Practice Specialist
    Children's Minnesota
    St Paul MN
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  • 2.  RE: Allergy/Rash Nurse Initiated Protocol

    Posted 10-10-2025 10:58 AM

    Hi,

    We have discussed creating a nurse initiated protocol for anaphylaxis at our organization but we have not moved forward with it. However, we are currently revising the provider order set for allergic reaction and are considering adding cetirizine,but not yet removing diphenhydramine. Sorry this may not be super helpful, but wanted to share the discussions we are having regarding this subject as well. 



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    Ivelisse Sanchez, DNP, APRN, ACCNS-P, CPN, CPEN
    CNS-APRN Coordinator, Pediatric Emergency Departments
    Advocate Children's Hospital
    Oak Lawn & Park Ridge, IL
    email: ev_sanz@yahoo.com
    email: ivelisse@ecsmediallc.com
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    Original Message


  • 3.  RE: Allergy/Rash Nurse Initiated Protocol

    Posted 7 days ago

    Hello Ivelisse,

    Good to connect with you again! We spoke previously, Dr. Mohr connected us.

    I am not sure if we will roll out a full anaphylaxis protocol, but my provider group showed interest in a rash/itching protocol for triage using cetirizine. I am not (yet) an APRN, so I'm trying to be very clear with my provider team that I will not start writing a protocol without a clinical partner identified, as I do not want any semblance of me working above my scope of practice as an RN.

    If you happen to find anything about this kind of protocol, I'd love to hear more! 



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    Elizabeth Leming BSN;BA;CCRN
    Clinical Practice Specialist
    Children's Minnesota
    St Paul MN
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    Original Message


  • 4.  RE: Allergy/Rash Nurse Initiated Protocol

    Posted 7 days ago

    Hi, 

    We just updated our nursing treatment protocols regarding this and removed Benadryl and changed it to Zyrtec (Citrizine). This applies for urticaria/insect bites. For signs of anaphylaxis, the provider has to be contacted for the Epi order. 

    We do Cetirizine (Zyrtec): 
    • 6 mo to 2 yo – 2.5 mg
    • 2 yo to 10 yo – 5 mg
    • > 10 yo – 10 mg



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    Jennifer Kemp MSN;RN
    RN
    Burlington CT
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    Original Message