What should be done if a patient experiences an allergic reaction to Pepsi?

Management of Allergic Reaction to Pepsi

Patients experiencing an allergic reaction to Pepsi should receive immediate intramuscular epinephrine as first-line treatment, followed by observation for 4-6 hours and referral to an allergist for comprehensive evaluation and management. 1, 2

Initial Management

Immediate Treatment

1. Administer epinephrine intramuscularly:

   • Adults and children ≥30 kg: 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) into anterolateral thigh 2, 3
   • Children <30 kg: 0.01 mg/kg (0.01 mL/kg), maximum 0.3 mg per injection 3
   • May repeat every 5-15 minutes as needed 2, 3

2. Airway and breathing support:

   • Administer 100% oxygen if respiratory symptoms are present
   • Position patient appropriately (recumbent with legs elevated if hypotensive) 2
   • For bronchospasm: albuterol via MDI or nebulizer 2

3. Circulatory support:

   • IV fluid resuscitation: 10-20 mL/kg rapid infusion for hypotension 2
   • For refractory hypotension: additional epinephrine, vasopressors, or glucagon (especially for patients on beta-blockers) 2

Adjunctive Treatments

After epinephrine administration, consider:

• H1 antihistamine: diphenhydramine 1-2 mg/kg (max 50 mg) every 6 hours for 2-3 days 1, 2
• H2 antihistamine: ranitidine 1-2 mg/kg (max 75-150 mg) twice daily for 2-3 days 1, 2
• Corticosteroid: prednisone 1 mg/kg (max 60-80 mg) daily for 2-3 days 1, 2

Observation Period

• Monitor for 4-6 hours after successful treatment 1, 2
• Extended observation (8-24 hours) for patients with:
  • Severe initial reactions
  • History of biphasic reactions
  • Significant comorbidities 2, 4

Discharge Plan

All patients who have experienced anaphylaxis should be sent home with:

1. Epinephrine auto-injector prescription:

   • Prescribe 2 doses 1
   • Provide training on proper use 1, 2
   • Advise on checking expiration dates and proper storage 1

2. Written anaphylaxis emergency action plan 1, 2

3. Patient education on:

   • Allergen avoidance (specifically Pepsi and potentially related products)
   • Recognition of anaphylaxis symptoms
   • When to use epinephrine and seek emergency care 1, 2

4. Medical identification jewelry or anaphylaxis wallet card 1, 2

5. Follow-up appointments:

   • Primary care provider within 1-2 weeks 1
   • Referral to allergist/immunologist for comprehensive evaluation 1, 2, 4

Special Considerations

High-Risk Patients

Patients with the following conditions require extra vigilance:

• Asthma
• Mast cell disorders
• Cardiovascular disease
• Those taking beta-blockers or ACE inhibitors 2, 4

Potential Allergens in Pepsi

• The allergic reaction may be due to ingredients in Pepsi such as:
  • Caramel coloring
  • Preservatives
  • Flavorings
  • Other additives 5

Biphasic Reactions

• Can occur up to 72 hours after initial reaction 2
• More common in severe reactions or those with delayed epinephrine administration 4

Allergist Referral Importance

The allergist will:

• Identify the specific allergen in Pepsi causing the reaction
• Perform appropriate testing (skin tests, serum specific IgE)
• Provide guidance on cross-reactive substances to avoid
• Consider immunotherapy if appropriate 1, 4

Remember that anaphylaxis is a life-threatening emergency, and prompt recognition and treatment with epinephrine is essential for reducing morbidity and mortality 2, 4.