A 10-year-old male playing baseball develops sudden shortness of breath with inspiratory wheeze. His father notes a peanut allergy. You should administer?

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When a child with a known peanut allergy suddenly develops shortness of breath and inspiratory wheeze, the most important step is to treat potential anaphylaxis immediately. Epinephrine is the first-line therapy because it tackles the life-threatening parts of the reaction: it opens the airways by bronchodilation, reduces swelling in the airway by constricting blood vessels, and improves blood pressure by supporting vascular tone. These combined effects can rapidly reverse airway obstruction and prevent progression to shock.

Administering epinephrine intramuscularly should be done without delay. The dose is weight-based (about 0.01 mg/kg of a 1:1000 solution, with an upper limit per dose) and can be repeated every few minutes if symptoms persist. After epinephrine is given, provide supportive care such as oxygen and close monitoring; bronchodilators like albuterol may be used if wheezing persists, but they do not replace epinephrine. Antihistamines like diphenhydramine are adjuncts with slower onset and are not the primary treatment for anaphylaxis.

In this scenario, the priority is epinephrine to reverse the underlying pathophysiology of anaphylaxis, followed by continued monitoring and transport for definitive care.