What is the first line treatment for an allergic reaction involving the face?

From the Guidelines

The first line treatment for an allergic reaction involving the face is epinephrine administered intramuscularly, specifically 0.01 mg/kg of a 1:1000 solution to a maximum of 0.5 mg in adults and 0.3 mg in children, as it is the most effective treatment for anaphylaxis and can help prevent morbidity and mortality. This is supported by the most recent and highest quality study, which emphasizes the importance of prompt epinephrine administration in the treatment of anaphylaxis 1.

Key Considerations

• Epinephrine is the cornerstone of anaphylaxis management and should be administered promptly in the event of an allergic reaction involving the face, as delayed injection can be associated with poor outcomes, including fatality 1.
• Antihistamines and glucocorticoids may be used as adjunctive therapy, but they should not be administered before or in place of epinephrine, as they have a slower onset of action and may not be effective in treating acute symptoms 1.
• Cold compresses and identification of the triggering allergen can also help reduce symptoms and prevent future reactions.

Administration and Dosage

• Epinephrine should be administered intramuscularly into the anterolateral thigh, with a dose of 0.01 mg/kg of a 1:1000 solution to a maximum of 0.5 mg in adults and 0.3 mg in children 1.
• Additional doses of epinephrine may be administered every 5 to 15 minutes if anaphylaxis signs or symptoms persist 1.

Importance of Prompt Treatment

• Prompt treatment with epinephrine is crucial in preventing morbidity and mortality associated with anaphylaxis, as delayed treatment can lead to poor outcomes, including fatality 1.
• The use of epinephrine as first-line treatment can help reduce the risk of biphasic anaphylaxis and improve patient outcomes 1.

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 Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary

The first line treatment for an allergic reaction involving the face is epinephrine (IM), with the following dosages:

• Adults and children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2
• Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2

From the Research

First Line Treatment for Allergic Reaction Involving the Face

• The first line treatment for an allergic reaction involving the face is epinephrine, as it is the mainstay of recommended treatment for anaphylaxis 3.
• Epinephrine is often administered in the prehospital setting and has been shown to reduce the likelihood of uncontrolled reactions, receipt of intravenous fluids in the emergency department, and hospital admission 3.
• Antihistamines, such as H1 antihistamines, can also be used to treat allergic reactions, including those involving the face, and have been shown to be beneficial in reducing symptoms 4.
• Corticosteroids may also be used in the management of anaphylaxis, but their use should be revisited as they have been shown to increase the likelihood of requiring intravenous fluids and hospital admission 3.

Treatment Options

• Epinephrine:
  • Reduces the likelihood of uncontrolled reactions
  • Reduces the likelihood of receipt of intravenous fluids in the emergency department
  • Reduces the likelihood of hospital admission
• Antihistamines:
  • Reduces symptoms of allergic reactions
  • Can be used in combination with other treatments
• Corticosteroids:
  • May increase the likelihood of requiring intravenous fluids
  • May increase the likelihood of hospital admission

Important Considerations

• Delayed epinephrine administration is a risk factor for fatal anaphylaxis 3.
• Antihistamines and corticosteroids should be used in conjunction with epinephrine, as they are not a replacement for epinephrine in the treatment of anaphylaxis 3.
• The use of corticosteroids in anaphylaxis should be revisited due to the potential for increased adverse outcomes 3.