What is the treatment for an allergic reaction?

From the Guidelines

The most effective treatment for an allergic reaction, particularly anaphylaxis, is immediate administration of epinephrine via an auto-injector, such as an EpiPen, at 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, as recommended by the most recent guidelines 1. This approach is supported by the latest practice parameter update on anaphylaxis, which emphasizes the critical role of epinephrine in managing acute, life-threatening systemic allergic reactions 1.

Key Considerations for Treatment

• For mild to moderate allergic reactions, antihistamines like diphenhydramine (Benadryl) 25-50mg orally every 4-6 hours or cetirizine (Zyrtec) 10mg daily can be used to alleviate symptoms such as hives, itching, or sneezing.
• Oral corticosteroids, such as prednisone 40-60mg daily for 3-5 days, may be added for moderate reactions to reduce inflammation, although their use in acute anaphylaxis is more controversial due to their slow onset of action 1.
• Epinephrine is the cornerstone of anaphylaxis management and should be administered promptly without delay, as emphasized by multiple studies, including those focusing on stinging insect hypersensitivity 1 and the general management of anaphylaxis 1.

Administration and Follow-Up

• Epinephrine should be administered intramuscularly into the anterolateral thigh for rapid absorption.
• After epinephrine administration, the person should lie flat with legs elevated unless breathing is difficult, and emergency services should be contacted immediately.
• Identifying and avoiding the allergen is crucial for preventing future reactions.

Evidence Basis

The recommendation for epinephrine as the first-line treatment for anaphylaxis is based on the most recent and highest quality evidence available, including the 2020 practice parameter update on anaphylaxis 1, which provides a comprehensive review of the diagnosis, assessment, and management of anaphylaxis, emphasizing the role of epinephrine. Other studies, such as those published in 2017 1 and 2011 1, also support the use of epinephrine as the drug of choice for anaphylaxis, highlighting its effectiveness and the importance of prompt administration.

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 treatment for an allergic reaction is epinephrine (IM). 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) intramuscularly or subcutaneously into the 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 the anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2.

From the Research

Treatment of Allergic Reactions

The treatment of allergic reactions, particularly anaphylaxis, is a critical aspect of managing life-threatening situations. According to various studies 3, 4, 5, 6, 7, the primary treatment for anaphylaxis involves:

• Immediate injection of intramuscular epinephrine as the first-line emergency treatment
• Administration of epinephrine via an auto-injector or prefilled syringe
• Potential use of secondary treatments such as corticosteroids or antihistamines, but not as a replacement for epinephrine

Key Considerations for Treatment

Some key considerations for the treatment of allergic reactions include:

• Prompt administration of epinephrine is crucial in managing anaphylaxis
• Patients should be educated on the proper use of epinephrine auto-injectors and carry them at all times
• A "1-2-3" approach to anaphylaxis treatment can help guide management steps: administer a first dose of epinephrine, activate emergency medical services if necessary, and consider additional doses or treatments as needed
• The use of antihistamines and corticosteroids in anaphylaxis management is still being studied, with some evidence suggesting a potential benefit for antihistamines but limited data on corticosteroids 6

Importance of Education and Access to Epinephrine

Education and access to epinephrine are critical components of anaphylaxis management. Studies highlight the importance of:

• Patient education on recognizing symptoms of an allergic reaction, using epinephrine auto-injectors, and activating emergency medical services
• Ensuring access to epinephrine, particularly in schools and other public settings, to prepare for potential anaphylaxis cases
• The need for clear guidelines and regulations on the use of epinephrine auto-injectors, including standardized assessment criteria and training programs 7