Anaphylaxis medications & treatments
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Anaphylaxis is a very common condition in the United States. A study in the Journal of Allergy and Clinical Immunology found that anaphylaxis occurred in around 1 in 50 Americans. Many experts believe that the rate is probably closer to 1 in 20. Worldwide, it is estimated that anaphylaxis will occur in 1% to 3% of the population during their lifetime.
What is anaphylaxis?
Anaphylaxis is a severe allergic reaction that is a result of exposure to an allergen. When you are allergic to something, your immune system releases inflammatory mediators and cytokines from mast cells (histamine) and basophils after re-exposure to a specific antigen.
Anaphylaxis can be potentially life-threatening if you don’t get medical help immediately. Around half of the deaths due to anaphylaxis occur within the first hour so early recognition and treatment can substantially reduce the risk of mortality. It should be noted that the faster the onset and progression of symptoms of anaphylaxis, the more severe the possible outcomes.
Food allergies, insect stings, and medications are the most common causes of anaphylaxis. Some foods that can increase your risk of anaphylaxis include:
- Shellfish such as lobster and shrimp
- Tree nuts such as walnuts, almonds, and cashews
Other common triggers that may lead to anaphylactic shock include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antibiotics such as penicillins and cephalosporins
- Radiocontrast dye used for CT scans
- Neuromuscular blocking agents used for anesthesia
- Wasp, fire ant, yellow jacket, hornet, or bee stings
- Latex from balloons, rubber bands, or hospital gloves
How is anaphylaxis diagnosed?
The diagnosis of anaphylaxis is typically made when your symptoms occur within 1 hour of exposure to a specific allergen. Your doctor or allergist may also perform a blood test to measure certain enzymes such as tryptase or histamine, which can be elevated for up to 3 hours after anaphylaxis. You may also be given an allergy test to try and determine your triggers.
The first symptoms of anaphylaxis may present like typical allergy symptoms such as a runny nose or skin rash. More serious symptoms will typically appear within 30 minutes, including:
- Chest tightness
- Shortness of breath or trouble breathing
- Face, lips, and throat swelling
- Hoarse voice
- Fast heart rate
- Low blood pressure (hypotension)
- Abdominal pain
If you notice symptoms of anaphylaxis, inject a dose of epinephrine if available along with a follow-up trip to a hospital emergency room.
What are some anaphylaxis treatment options?
Anaphylaxis is a life-threatening medical emergency that progresses quickly and requires immediate medical attention. Some common treatment options include:
- EpiPen (epinephrine). This is the most effective medication used to treat anaphylaxis. It should be administered in your thigh at the first signs of anaphylaxis. An EpiPen Auto-Injector can usually reverse your symptoms within a few minutes. If your symptoms persist, you may give another shot 5 to 15 minutes later. If you have had a previous anaphylactic reaction, you should always carry 2 epinephrine auto-injectors. Once you have administered a dose of epinephrine, you should call 911 or go to the nearest emergency department for evaluation.
- Oxygen. Once at the hospital, you may receive oxygen to help you breathe.
- Antihistamines. Although IV antihistamines are commonly used, there is very little evidence to prove their effectiveness.
- Corticosteroids. While steroids will most likely not have any effect during your current anaphylactic reaction, they may help reduce the risk of a second wave of symptoms called biphasic anaphylaxis.
- Proventil (albuterol). You may receive a beta-2 agonist via a nebulizer if your doctor suspects you have lower airway obstruction.
What is the best medication for anaphylaxis?
The best medication for the treatment of anaphylaxis will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with anaphylaxis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter anaphylaxis medications approved by the Food and Drug Administration (FDA).
Best medications for anaphylaxis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|EpiPen (epinephrine)||Alpha/beta-agonist||Injection||Administer 0.3mg under the skin or into the muscle of the thigh. May repeat dose after 5-15 minutes if needed.||Anxiety, restlessness, tremors, dizziness, sweating, increased heart rate, injection site reactions, nausea, vomiting, pale skin, headache|
|Symjepi (epinephrine)||Alpha/beta-agonist||Injection||Administer 0.3mg under the skin or into the muscle of the thigh. May repeat dose after 5-15 minutes if needed.||Anxiety, restlessness, tremors, dizziness, sweating, increased heart rate, injection site reactions, nausea, vomiting, pale skin, headache|
|EpiPen JR (epinephrine)||Alpha/beta-agonist||Injection||Administer 0.15mg under the skin or into the muscle of the thigh. May repeat dose after 5-15 minutes if needed.||Anxiety, restlessness, tremors, dizziness, sweating, increased heart rate, injection site reactions, nausea, vomiting, pale skin, headache|
|Auvi-Q (epinephrine)||Alpha/beta-agonist||Injection||Administer 0.1mg under the skin or into the muscle of the thigh once.||Anxiety, restlessness, tremors, dizziness, sweating, increased heart rate, injection site reactions, nausea, vomiting, pale skin, headache|
|Solumedrol (methylprednisolone)||Corticosteroid||Injection||1mg to 2mg/kg intravenously, then 0.5mg/kg IV every 6 hours for 1 to 2 days.||Swelling, increased blood pressure, high blood sugar, abdominal pain, weakness, insomnia, mood changes, acne, increased appetite|
|Proventil (albuterol)||Beta-2 agonist||Inhaled||2.5mg to 5mg in 3ml of NaCl via nebulizer as needed.||Tremor, nervousness, insomnia, nausea, fever, vomiting, headache, dizziness|
|Benadryl (diphenhydramine)||Antihistamine||Injection||Adults: 25mg to 50mg via IV every 4 to 6 hours as needed.|
Children: 1mg to 2mg/kg via IV every 4 to 6 hours as needed.
|Drowsiness, confusion, dizziness, dry mouth, blurred vision, constipation|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of anaphylaxis medications?
As with all medicines, those used for anaphylaxis will have some side effects, depending on the class you are taking:
- Epinephrine commonly causes restlessness, tremors, dizziness, sweating, increased heart rate, injection site reactions, nausea, vomiting, pale skin, and headache
- Steroids such as Medrol (methylprednisolone) can cause swelling, increased blood pressure and blood sugar, abdominal pain, weakness, insomnia, mood changes, acne, and increased appetite.
- Beta-2 agonists such as Proventil (albuterol) cause tremors, nervousness, trouble sleeping, nausea, fever, vomiting, headache, and dizziness.
- Antihistamines such as Benadryl (diphenhydramine) can cause fatigue, confusion, dizziness, dry mouth, blurred vision, and constipation. In some patients, especially pediatric patients, antihistamines can cause restlessness, nervousness, and increased heart rate.
What are some home remedies for anaphylaxis?
Unfortunately, in most cases, there’s no way to treat the underlying condition that can lead to anaphylaxis. There are steps you can take to reduce the risk of a future episode and be prepared if it occurs.
The best way to prevent anaphylaxis is to stay away from the triggers that cause this severe allergic reaction. Some other measures you can take include:
- Complete an Anaphylaxis Emergency Action Plan and keep it at work, school, or any other place where you may need someone to recognize your symptoms and provide treatment.
- Keep 2 in-date epinephrine auto-injectors on you at all times.
- Wear a medical alert bracelet or necklace with your specific allergies listed.
- Consider immunotherapy if you have certain triggers such as insect stings and food allergies.
- Read food labels carefully before buying or eating any products if you have food allergies. Be very cautious if eating out because ingesting a small amount of food you are allergic to can cause a serious reaction.
Frequently asked questions about anaphylaxis
What are the most common symptoms of anaphylaxis?
The first symptoms you experience may be mild like a runny nose or skin rash. You then may start to have more serious symptoms within 30 minutes, including confusion, pain or tightness in your chest, difficulty breathing, wheezing, swelling of your face, lips, or throat, low blood pressure, weakness, and an increased heart rate.
What are the most common triggers of anaphylaxis?
The most common causes of anaphylaxis are:
- Food allergies such as eggs, shellfish, peanuts, milk, almonds, walnuts, soy, and wheat.
- Insect stings from fire ants, wasps, bees, hornets, and yellow jackets.
- Drug allergies from medications such as NSAIDs, antibiotics, and neuromuscular blocking agents used in anesthesia.
- Latex from balloons, rubber bands, or hospital gloves.
At what age can you develop anaphylaxis?
Although they are mostly diagnosed during childhood, you can develop anaphylaxis at any age. You are at a higher risk if you have an allergy-related skin condition (eczema) or have had a severe allergic reaction in the past.
What is biphasic anaphylaxis?
Biphasic anaphylaxis is when you have a second wave of symptoms after the first symptoms go away. This second wave can be hours or even days after the first wave. About 20% of people who have anaphylaxis get biphasic anaphylaxis.
Related resources for anaphylaxis
- Anaphylaxis overview. American Academy of Allergy Asthma and Immunology
- Anaphylaxis symptoms and causes. MayoClinic
- Common inciting sources in the etiology of anaphylaxis. National Library of Medicine – StatPearls
- Anaphylaxis practice essentials. Medscape
- Anaphylaxis symptoms and treatment. Cleveland Clinic