Don’t Depend on Antihistamines: Epinephrine Stops Anaphylaxis

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The only medication that halts the progression of anaphylaxis is epinephrine.

Yet, according to data collected from emergency departments in Canada, many people do not realize the importance of administering epinephrine for food allergy symptoms.

The study analysis showed that about half the adults with severe allergic reactions did not get epinephrine in or outside a hospital. Children fared somewhat better, but about one third of them did not receive emergency epinephrine treatment, though most had been prescribed auto-injectors.

Why Epinephrine

The children in the study that did not receive epinephrine were given a corticosteroid or an antihistamine instead. These medications may relieve visible allergy symptoms such as hives, but cannot alleviate systemic symptoms including breathing difficulties.

“Antihistamines and steroids are not established as primary management of anaphylaxis,” said researcher Dr. Moshe Ben-Shoshan. “The only drug that stops the progression of anaphylaxis is epinephrine.”

Ben-Shoshan points out that:

  1. The risk of side effects with epinephrine is minimal; most adults experience none.
  2. People do not avoid a hospital stay by avoiding epinephrine use. By not administering epinephrine, they are more likely to deteriorate and end up in a hospital bed.

Prompt injection of epinephrine might also eliminate the need for additional doses of the medication at the ER.

When To Give Epinephrine

Here are FARE's (Food Allergy Research & Education) epinephrine guidelines for suspected or active food allergy reactions.

Inject epinephrine immediately for ANY of the following severe symptoms:

  • Lungs: shortness of breath, repetitive cough, wheezing
  • Heart: faint/weak pulse, dizzy, pale, blue
  • Throat: tightness, hoarse, trouble swallowing or breathing
  • Mouth: significant swelling of tongue and/or lips
  • Skin: many hives over the body, widespread redness
  • Gut: severe diarrhea or repetitive vomiting
  • Other: a feeling that something bad is about to occur, confusion, anxiety

Inject epinephrine immediately for MORE THAN ONE of the following mild symptoms:

  • Nose: sneezing, itchy or runny nose
  • Mouth: an itchy mouth
  • Skin: mild itch, a few hives
  • Gut: mild nausea or discomfort

After giving epinephrine, call 911 and request an ambulance that carries epinephrine.

If symptoms do not diminish, or they return, another epinephrine dose may be given five minutes or more after the initial injection.

Sources: Allergic Living; FARE Photo credit: Ryan Polei

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