严重过敏反应是一种速发、危及生命的全身性超敏反应。国内一线医生对该病认识不足，核心治疗药物肾上腺素的延迟或不规范使用是导致重症结局的主要原因。该文基于2例临床病例，结合国内外最新指南，系统阐述儿童严重过敏反应的早期识别与诊断，以肾上腺素为核心的急救策略，以及难治性严重过敏反应的处理流程。对于经典严重过敏反应，及早大腿外侧肌内注射肾上腺素是挽救生命的关键；对于难治性严重过敏反应，需在2剂肌内注射无效后及时启动肾上腺素静脉持续泵入，同时积极液体复苏，必要时联合二线血管活性药物。抗组胺药和糖皮质激素仅为辅助治疗，不能替代肾上腺素。规范的出院后长期管理和新型无创给药途径的推广，将进一步改善儿童严重过敏反应的预后。

Anaphylaxis is a rapid-onset, life-threatening systemic hypersensitivity reaction. Insufficient awareness of this condition in China and delayed or inappropriate use of epinephrine—the core treatment—are major causes of severe outcomes. Based on two clinical cases and the latest domestic and international guidelines, this article systematically describes early recognition and diagnosis of anaphylaxis in children, epinephrine-centered emergency management strategies, and the treatment protocol for refractory anaphylaxis. For classic anaphylaxis, early intramuscular injection of epinephrine into the anterolateral thigh is lifesaving. For refractory anaphylaxis, intravenous continuous infusion of epinephrine should be initiated promptly after two ineffective intramuscular injections, combined with aggressive fluid resuscitation and, if necessary, second-line vasoactive drugs. Antihistamines and corticosteroids are only adjunctive therapies and cannot replace epinephrine. Standardized post-discharge long-term management and the promotion of novel noninvasive delivery routes will further improve prognosis of pediatric anaphylaxis.