What is the treatment for a patient with influenza and severe allergic reactions?

Treatment of Influenza in Patients with Severe Allergic Reactions

For patients with influenza and severe allergic reactions, treatment should focus on antiviral therapy with neuraminidase inhibitors while carefully selecting medications that avoid triggering allergic responses. 1, 2

Antiviral Treatment Options

First-line Treatment:

• Oseltamivir (Tamiflu) - 75mg twice daily for 5 days for adults
  • Must be started within 48 hours of symptom onset for optimal efficacy
  • Earlier treatment (within 12-24 hours) provides significantly better outcomes 3
  • Pediatric dosing is weight-based (30-75mg twice daily)
  • Dose adjustment required for renal impairment

Alternative Options (for patients with allergies to oseltamivir):

• Peramivir (Rapivab) - Single IV dose within 2 days of symptom onset 4

  • Adults and adolescents (≥13 years): 600mg IV infusion over minimum 15 minutes
  • Children (6 months-12 years): 12mg/kg IV (up to 600mg maximum)
  • Contraindicated in patients with known serious hypersensitivity to peramivir
  • Dose adjustment needed for renal impairment

• Cell culture-based inactivated influenza vaccine (ccIIV) or Recombinant influenza vaccine (RIV) for future prevention in patients with severe allergies to egg-based vaccines 1

Management of Allergic Reactions

For Patients with History of Severe Allergic Reactions:

• Administer antiviral medications in an inpatient or outpatient medical setting with supervision by healthcare providers able to recognize and manage severe allergic reactions 1
• Consider consultation with an allergist to determine the specific component responsible for previous allergic reactions 1
• Have emergency medications readily available (epinephrine, antihistamines, corticosteroids)
• Monitor for signs of anaphylaxis for at least 30 minutes after administration

Symptomatic Treatment:

• Antipyretics/Analgesics: 2

  • Paracetamol (acetaminophen) 1000mg every 4-6 hours (maximum 4000mg/day)
  • Avoid NSAIDs like ibuprofen if patient has history of allergic reactions to these medications

• Hydration: Encourage increased fluid intake to prevent dehydration, especially important with fever 2

• Respiratory Support:

  • For patients with asthma or respiratory symptoms, ensure appropriate bronchodilator therapy
  • Avoid medications that have previously triggered allergic reactions

Monitoring and Follow-up

• Monitor closely for:

  • Signs of worsening influenza (increasing shortness of breath, persistent high fever)
  • New or recurrent allergic reactions
  • Secondary bacterial infections (pneumonia, sinusitis, otitis media)

• Instruct patients to seek immediate medical attention for:

  • Difficulty breathing
  • Swelling of face, lips, tongue, or throat
  • Severe rash or hives
  • Persistent fever beyond 4-5 days
  • Signs of dehydration

Prevention Strategies

• For future prevention, consider:
  • Annual vaccination with appropriate vaccine formulation based on allergy history
  • For patients with severe allergic reactions to egg-based vaccines, use cell culture-based (ccIIV) or recombinant (RIV) influenza vaccines 1
  • Vaccination should occur in medical settings with supervision for patients with history of severe allergic reactions 1

Special Considerations

• Pregnant patients with influenza should receive prompt antiviral treatment, as benefits outweigh risks 1
• Immunocompromised patients may require longer duration of antiviral therapy and closer monitoring 1
• Combination antiviral therapy (oseltamivir, amantadine, and ribavirin) has not shown significant clinical benefit over oseltamivir monotherapy despite decreased viral shedding 5

Remember that early initiation of appropriate antiviral therapy is crucial for optimal outcomes in influenza patients, particularly those with complicating factors like severe allergic reactions.