What medications are used to treat a narcotic (opioid) allergy?

From the Guidelines

Medications used to treat a narcotic (opioid) allergy include antihistamines like diphenhydramine (Benadryl) 25-50mg orally or intravenously for mild reactions, and epinephrine (0.3-0.5mg intramuscularly via auto-injector) for severe allergic reactions or anaphylaxis. According to the most recent and highest quality study available, which is not directly provided in the given evidence, the treatment for narcotic allergy typically involves medications for resuscitation, including adrenaline (epinephrine 1:1000), antihistamines, and steroids 1. The following medications can be used:

• Antihistamines like diphenhydramine (Benadryl) 25-50mg orally or intravenously for mild reactions
• Epinephrine (0.3-0.5mg intramuscularly via auto-injector) for severe allergic reactions or anaphylaxis
• Corticosteroids such as prednisone (40-60mg orally) or methylprednisolone (125mg intravenously) to reduce inflammation and prevent delayed reactions
• H2 blockers like famotidine (20mg twice daily) for ongoing symptoms It's essential to note that true opioid allergies are rare, with most reactions being pseudoallergic responses caused by histamine release rather than immune-mediated allergies. If you have a history of opioid allergy, it's crucial to wear a medical alert bracelet, inform all healthcare providers, and discuss alternative pain management options such as non-opioid analgesics (acetaminophen, NSAIDs), certain anticonvulsants, or antidepressants for pain control. In cases of true allergy to one opioid, cross-reactivity with other opioids is possible, so allergy testing and consultation with an allergist may be necessary to identify safe alternatives, as seen in the management of other drug allergies 1.

From the FDA Drug Label

INDICATIONS AND USAGE: Diphenhydramine hydrochloride in the injectable form is effective in adults and pediatric patients, other than premature infants and neonates, for the following conditions when diphenhydramine hydrochloride in the oral form is impractical Antihistaminic 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, and for other uncomplicated allergic conditions of the immediate type when oral therapy is impossible or contraindicated.

Medications for narcotic allergy include antihistamines such as diphenhydramine. Diphenhydramine can be used for the amelioration of allergic reactions, including those caused by narcotics (opioids). Key points to consider:

• Diphenhydramine is used as an adjunct to other standard measures, such as epinephrine, in the treatment of anaphylaxis.
• It is effective for uncomplicated allergic conditions of the immediate type. 2

From the Research

Medications for Narcotic Allergy

• There are no specific medications mentioned in the provided studies that are used to treat a narcotic (opioid) allergy directly 3, 4, 5, 6, 7.
• However, medications such as epinephrine, histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be used to manage anaphylaxis, a life-threatening systemic reaction that can occur in response to an allergen, including narcotics 4.
• For patients with acute pain who have a narcotic allergy, alternative pain management options such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered 3.
• In cases of anaphylaxis, removal of the trigger, early administration of intramuscular epinephrine, and supportive care for the patient's airway, breathing, and circulation are crucial 4.
• Patients with a history of narcotic allergy should be monitored for potential biphasic reactions and managed accordingly 4.

Alternative Pain Management Options

• Acetaminophen and NSAIDs are first-line treatment options for most patients with acute mild to moderate pain 3.
• Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 3.
• Adjunctive medications such as muscle relaxants may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate 3.

Anaphylaxis Management

• Acute management of anaphylaxis involves removal of the trigger, early administration of intramuscular epinephrine, and supportive care for the patient's airway, breathing, and circulation 4.
• Adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered after epinephrine administration 4.