Anaphylaxis and the use of Injectable Epinephrine

 

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Anaphylaxis and the use of Injectable Epinephrine

February 17, 2016

 

I have/my child has a history of severe allergic reactions. What are some of the medications I should use?

When a patient has a history of severe allergic reactions, there are several issues that need to be addressed in terms of treatment. How severe is the reaction? Is it an allergic reaction or an intolerance? Which medications are appropriate at which times of the reaction?

 

The three main types of medications that are used for severe allergic reactions (anaphylaxis), are antihistamines, oral steroids and injectable epinephrine.

 

I am frightened to use injectable epinephrine. Do I HAVE TO have it in my plan?

Many patients and parents of patients find themselves intimidated by injectable Epinephrine. They are frightened of the side effects and of the “pain” of administration. This is the reason that Epinephrine is used when the patient is at risk for a lifethreatening allergic reaction.

 

So, if there is a RISK of anaphylaxis, then injectable Epinephrine should be in the treatment plan.

 

In fact, failure to use injected Epinephrine early on is a significant problem. A good exploration of this phenomenon is described in the article titled “Early Treatment of FoodInduced Anaphylaxis with Epinephrine Is Associated with a Lower Risk of Hospitalization”

 

http://www.jaciinpractice.org/issue/S22132198(14)X00073

 

If I do use Epinephrine, WHEN should it be administered?

Once it has been determined that the patient is having a severe reaction, Epinephrine should be given without delay.

 

Oral antihistamines and other medications should be administered AFTER the Epinephrine is given. Of course once you decide to give Epinephrine, you should activate the Emergency Medical System by calling 911 right away.

 

And once I do, then what do I do?

You have called 911, you have given Epinephrine. Now you monitor the patient by watching them and keeping track of whatever vital signs you havepulse rate, blood pressure if you can. Patients are usually need to be monitored by a healthcare provider after a reaction has occurred. The amount of time that this monitoring is appropriate will sometimes vary depending on the patient’s history and the nature of the reaction.

 

How do I get the teaching/training on how to use the Injectable Epinephrine?

It is important to be well trained in the use of the injectable Epinephrine. Though it is easy to use, many patients are intimidated by its use and will often delay using it out of fear. We provide training for patients with on hands “show and tell” using a trainer as well as diagrams and handouts.

 

What other things can I do to manage my allergic reaction?

Understanding your risk of anaphylaxis by appropriate evaluation is your best start. There are several cornerstone testing options. However, all good evaluations start with a detailed history and physical exam. After the history and physical is performed, that should be used to tailor which tests are appropriate.

 

What kinds of testing should be done?

All patients should be aware that no test is perfect and in order to avoid false positive or false negative findings, only testing with a high “pretest” probability should be performed. There are many ways of approaching testing for allergiesthese include regular allergy skin tests, blood tests, freshly made extract testing, patch testing and oral challenge procedures.

 

The American Academy of Allergy, Asthma and Immunology has a good overview of the types of testing that may be appropriate:

 

http://www.aaaai.org/conditionsandtreatments/library/ataglance/allergytesting.aspx

 

Where can I get more information?

https://www.foodallergy.org/

http://www.allergyasthmanetwork.org/education/allergies/anaphylaxis/epinephrine/

https://www.aaaai.org/conditionsandtreatments/allergies/anaphylaxis.aspx

 

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