What is the first-line pharmacologic treatment for wheezing in an infant?

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In infants with acute wheeze, the priority is to rapidly relieve reversible airway obstruction by bronchodilation. An inhaled short-acting beta-agonist, such as albuterol, provides quick relief by relaxing bronchial smooth muscle, lowering airway resistance, and improving airflow. This rapid action makes it the first-line pharmacologic treatment for wheezing in an infant, whether the cause is bronchiolitis with episodic wheeze or early reactive airway disease.

Epinephrine given intramuscularly is reserved for more life-threatening or specific airway situations (like severe croup or anaphylaxis) and is not the standard first-line treatment for typical infant wheeze. Diphenhydramine, an antihistamine, does not address bronchospasm and is not effective for acute wheezing. Prednisone is a systemic steroid used for certain asthma exacerbations or longer-term management, not as the initial acute therapy for wheeze in an infant.