“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 Anagnostou

An 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.
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On this episode, they discuss:

• Why modified criteria for infant and toddler anaphylaxis matter
• Behavioral signs like irritability, clinginess, lethargy, or withdrawal as red flags
• The role of context and timing in recognizing reactions
• Surrogate symptoms — tongue thrusting and lip licking for oral itching, drooling, horse cry
• Why urticaria shows up in 90% of infant anaphylaxis cases
• Epinephrine dosing: the 0.1 mg option for infants 7.5-15 kg and safety of 0.15 mg in smaller babies
• Why not every infant who receives epinephrine needs the ED
• Second-dose timing: five minutes, not ten
• Novel delivery routes on the horizon — intranasal and sublingual epinephrine

Dr. 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.

Posted on February 17, 2026.