What is the treatment for an allergic reaction in an urgent care setting?

From the Guidelines

Urgent care centers should prioritize the administration of epinephrine via auto-injector or injection for severe allergic reactions, including anaphylaxis, as it is the first-line treatment and cornerstone of anaphylaxis management, as recommended by the most recent study 1. When treating allergic reactions in urgent care, it is essential to assess the severity of the reaction and provide appropriate treatment. For mild reactions, antihistamines like diphenhydramine (Benadryl) 25-50mg orally every 4-6 hours or cetirizine (Zyrtec) 10mg daily may be prescribed. However, for more severe reactions with respiratory symptoms or significant swelling, epinephrine (0.3-0.5mg for adults, 0.15mg for children) via auto-injector or injection should be administered promptly, along with corticosteroids such as prednisone 40-60mg daily for 3-5 days to reduce inflammation, as suggested by 1. Some key points to consider when treating allergic reactions in urgent care include:

• Administering epinephrine promptly for severe reactions, including anaphylaxis, as it is the most effective treatment, as stated in 1 and 1
• Providing antihistamines and corticosteroids as adjunctive treatment, as recommended by 1
• Observing patients for 1-4 hours depending on severity and prescribing an epinephrine auto-injector for future reactions, as suggested by 1 and 1
• Developing a follow-up plan with an allergist to identify triggers and prevent recurrences, as recommended by 1 It is crucial to note that patients with severe reactions, including anaphylaxis, should be transferred to an emergency department for more intensive monitoring and treatment, as they require emergency care. Urgent care is appropriate for mild to moderate reactions, but severe reactions require a higher level of care.

From the FDA Drug Label

Adrenalin® is a non-selective alpha and beta adrenergic agonist indicated for: Emergency treatment of allergic reactions (Type 1), including anaphylaxis The signs and symptoms associated with anaphylaxis include flushing, apprehension, syncope, tachycardia, thready or unobtainable pulse associated with hypotension, convulsions, vomiting, diarrhea and abdominal cramps, involuntary voiding, airway swelling, laryngospasm, bronchospasm, pruritus, urticaria or angioedema, swelling of the eyelids, lips, and tongue. Diphenhydramine hydrochloride in the injectable form is effective... For amelioration of allergic reactions to blood or plasma, in anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled

The treatment for allergic reactions in urgent care includes:

• Epinephrine (IM) as the first line of treatment for anaphylaxis, with a dose of 0.3 to 0.5 mg for adults and children over 30 kg, and 0.01 mg/kg for children under 30 kg 2
• Diphenhydramine (IV) as an adjunct to epinephrine for the amelioration of allergic reactions, after the acute symptoms have been controlled 3

From the Research

Allergic Reaction Treatment in Urgent Care

• The primary treatment for anaphylaxis, a life-threatening allergic reaction, is the administration of intramuscular epinephrine 4, 5, 6, 7.
• Early administration of epinephrine is critical to prevent a potentially fatal outcome 4, 6, 7.
• After epinephrine administration, adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered 4.
• Antihistamines, such as diphenhydramine, loratadine, and cetirizine, can be used to treat acute allergic reactions, but they are not a substitute for epinephrine in the treatment of anaphylaxis 8, 7.
• Nonsedating antihistamines, such as loratadine and fexofenadine, may be preferred over sedating antihistamines like diphenhydramine due to their lower risk of adverse effects 8.
• Corticosteroids may be used in the treatment of anaphylaxis, but their effectiveness is still being studied, and their use should be revisited 6.

Management of Anaphylaxis

• Patients with anaphylaxis should be monitored for a biphasic reaction, which can occur within 4 to 12 hours after the initial reaction 4, 5.
• The management of anaphylaxis should focus on developing an emergency action plan, referral to an allergist, and patient education on avoidance of triggers and appropriate use of an epinephrine auto-injector 4.
• Guidelines for the management of anaphylaxis recommend the use of epinephrine as the first-line treatment, followed by supportive care and adjunct medications as needed 4, 5, 7.

Treatment Outcomes

• Studies have shown that early administration of epinephrine can reduce the risk of uncontrolled reactions, hospital admission, and the need for intravenous fluids 6.
• The use of antihistamines, such as diphenhydramine, may be associated with a lower risk of uncontrolled reactions and hospital admission, but their effectiveness is still being studied 6, 8.
• Corticosteroids may be associated with an increased risk of hospital admission and the need for intravenous fluids, and their use should be revisited 6.