What is the treatment regimen for an allergic reaction to medication?

From the Guidelines

The treatment for an allergic reaction to medication, particularly for severe reactions like anaphylaxis, should immediately include the administration of epinephrine (0.3-0.5mg intramuscularly in the mid-outer thigh for adults) as the first line of treatment, followed by emergency medical attention. This approach is supported by the most recent guidelines, such as those from the 2024 American Heart Association and American Red Cross guidelines for first aid 1. For mild to moderate reactions, stopping the offending medication and using oral antihistamines like diphenhydramine (25-50mg every 4-6 hours) or cetirizine (10mg daily), and topical corticosteroids such as hydrocortisone 1% cream, may provide relief. However, the primary concern in managing allergic reactions, especially anaphylaxis, is to ensure immediate intervention with epinephrine to prevent morbidity and mortality, as emphasized by studies on anaphylaxis management 1.

Key considerations in the management of allergic reactions include:

• Immediate cessation of the suspected allergenic medication.
• Administration of epinephrine for anaphylaxis, with potential repeat doses as needed.
• Use of antihistamines and corticosteroids for less severe reactions or as adjunctive therapy in anaphylaxis.
• Ensuring patient education on recognizing symptoms of allergic reactions and the proper use of epinephrine auto-injectors.
• Consideration of desensitization protocols for patients who must receive medications known to cause allergic reactions, under the guidance of an experienced healthcare provider.

The effectiveness of these treatments is based on their ability to block histamine receptors, reduce inflammation, or counteract the life-threatening effects of anaphylaxis by opening airways and maintaining blood pressure. Given the potential for severe outcomes, including death, from untreated or inadequately treated anaphylaxis, prioritizing immediate and effective intervention is crucial. The most recent and highest quality evidence, such as the 2024 guidelines 1, should guide clinical decision-making to optimize patient outcomes in terms of morbidity, mortality, and quality of life.

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 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 treatment regimen for an allergic reaction to medication, specifically anaphylaxis, involves administering epinephrine intramuscularly or subcutaneously. The dosage is as follows:

• Adults and children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) 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), every 5 to 10 minutes as necessary 2

From the Research

Treatment Regimen for Allergic Reaction to Medication

The treatment regimen for an allergic reaction to medication typically involves a combination of medications and emergency procedures. The primary treatment for anaphylaxis, a severe and life-threatening allergic reaction, is the administration of epinephrine via an intramuscular injection 3, 4, 5.

First-Line Treatment

• Epinephrine is the first-line treatment for anaphylaxis, and it should be administered promptly, even if the diagnosis is uncertain 4.
• The "1-2-3" approach to anaphylaxis treatment is recommended, which involves administering a first dose of intramuscular epinephrine, activating emergency medical services if symptoms do not resolve, and considering a second or third dose of epinephrine if necessary 5.

Second-Line Treatment

• Antihistamines and corticosteroids may be given in second line to help alleviate symptoms and reduce the risk of biphasic reactions 3, 6.
• Corticosteroids have been shown to reduce the length of hospital stay, but their effectiveness in reducing revisits to the emergency department is unclear 6.

Long-Term Management

• Patients who have experienced an allergic reaction to medication should be equipped with rescue medications, such as an epinephrine auto-injector, and should receive proper instruction on its use 3.
• An allergological work-up should be performed to identify the cause of the allergic reaction and to develop a plan for avoiding future reactions 3.
• Patients should be educated on how to recognize the signs and symptoms of an allergic reaction and how to respond promptly and effectively 4, 7.