Which medication is indicated for an acute asthma attack in a child with a peanut allergy?

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Rapid relief of bronchospasm in an acute asthma attack comes from a fast-acting inhaled bronchodilator that opens the airways quickly. Albuterol, a short-acting beta-2 agonist delivered by nebulization, directly relaxes the smooth muscles of the airways, reducing resistance and quickly improving breathing within minutes. This makes it the first choice to treat an acute flare in a child, even when there’s a peanut allergy.

Systemic steroids like prednisone take hours to work, so they’re not the immediate fix for an ongoing attack—they’re used to prevent relapse after the acute episode. Epinephrine is reserved for anaphylaxis or life-threatening allergic reactions; peanut allergy raises the risk of anaphylaxis, but in an isolated asthma flare without signs of systemic anaphylaxis, epinephrine isn’t indicated. Ipratropium can be added as an adjunct in severe cases, but it’s not the primary treatment for rapid relief.