From the Guidelines
If you suspect mold-induced anaphylaxis, immediately use an epinephrine auto-injector (EpiPen, Auvi-Q) at the first sign of symptoms and call emergency services (911). The standard adult dose is 0.3mg and 0.15mg for children, injected into the outer thigh 1. After using epinephrine, take an antihistamine like diphenhydramine (Benadryl) 25-50mg for adults or 1mg/kg for children. Seek emergency medical care even if symptoms improve, as anaphylaxis can recur. For long-term management, identify and avoid the specific mold trigger, consider allergy testing with an allergist, and carry epinephrine auto-injectors at all times if you have a known mold allergy.
Some key points to consider:
- Epinephrine is the medication of choice for the initial treatment of anaphylaxis, and it should be administered promptly at the onset of apparent anaphylaxis 1.
- Antihistamines and glucocorticoids should not be considered as substitutes for epinephrine, but they can be used as adjunctive therapy for cutaneous signs and symptoms associated with anaphylaxis 1.
- The management of anaphylactic and anaphylactoid reactions is identical, and a sequential approach to management is recommended 1.
- Fatalities during anaphylaxis usually result from delayed administration of epinephrine and from severe respiratory complications, cardiovascular complications, or both 1.
It is essential to note that anaphylaxis can occur rapidly, and prompt recognition of signs and symptoms is crucial. If there is any doubt, it is generally better to administer epinephrine 1. Medical facilities should have an established protocol to deal with anaphylaxis and the appropriate equipment to treat the episode 1.
From the FDA Drug Label
Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. The treatment for anaphylaxis, including that caused by mold exposure, is epinephrine (IM), as it is used for emergency treatment of allergic reactions (Type I), including anaphylaxis.
- The signs and symptoms of 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 2
From the Research
Treatment for Anaphylaxis Caused by Mold Exposure
- The treatment for anaphylaxis, including that caused by mold exposure, involves immediate removal of the trigger and administration of epinephrine 3, 4, 5, 6, 7
- Epinephrine should be administered intramuscularly at a dose of 0.01 mg/kg (1:1000), with a maximum single dose of 0.5 mg, and can be repeated after 5-10 minutes if needed 3, 5, 6
- After epinephrine administration, patients should be placed supine with their lower limbs elevated and monitored for potential biphasic reactions 3, 7
- Adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered after epinephrine administration 6, 7
- Patients should be educated on the use of epinephrine autoinjectors and development of an emergency action plan, and referred to an allergist for further management 3, 4, 7
Key Considerations
- Anaphylaxis is a life-threatening condition that requires immediate treatment 3, 4, 5, 6, 7
- Delayed epinephrine use is a potential risk factor for fatalities in anaphylaxis 3
- Patients with coexisting asthma, mast cell disorders, older age, underlying cardiovascular disease, peanut and tree nut allergy, and drug-induced reactions are at higher risk for severe or fatal anaphylactic reactions 7
- Serum tryptase levels may be obtained to confirm the diagnosis of anaphylaxis when the clinical diagnosis is not clear 7