What medications are used to treat food allergies?

Medications for Food Allergy Management

Epinephrine is the first-line medication for treating food-induced anaphylaxis, with antihistamines and corticosteroids serving as adjunctive treatments for milder allergic reactions. 1, 2

Emergency Medications for Food Allergies

First-Line Treatment

• Epinephrine: The only appropriate first-line medication for treating anaphylaxis 2
  • Administered via auto-injector into the mid-outer thigh (vastus lateralis muscle)
  • Adult dose: 0.3-0.5 mg of 1:1000 concentration epinephrine IM 2
  • FDA-approved for emergency treatment of allergic reactions including anaphylaxis 3
  • Can be repeated every 5-15 minutes if symptoms persist 2

Adjunctive Medications

• H1 Antihistamines (for milder symptoms or as adjunctive therapy) 1

  • Diphenhydramine: 25-50 mg IV/PO
  • Useful for flushing, urticaria, or mild angioedema
  • Not appropriate as sole treatment for anaphylaxis

• H2 Antihistamines (for better symptom control) 2

  • Ranitidine: 50 mg IV
  • Famotidine: 20 mg IV

• Corticosteroids (to prevent biphasic reactions) 1, 2

  • Prednisone: 40-60 mg PO
  • Methylprednisolone: 60-80 mg IV
  • May help prevent protracted or biphasic anaphylaxis

• Bronchodilators (for respiratory symptoms) 1

  • Used as adjunctive treatment for patients with bronchospasm
  • Not a substitute for epinephrine

Medication Protocol for Food Allergy Reactions

For Severe Reactions (Anaphylaxis)

1. Immediately administer epinephrine via auto-injector 1, 2
2. Call emergency services/911
3. Place patient in recumbent position with legs elevated 2
4. Administer IV fluids (normal saline) for hypotension 2
5. Consider adjunctive medications:
   • H1 antihistamines
   • H2 antihistamines
   • Corticosteroids

For Mild-to-Moderate Reactions

1. H1 antihistamines for isolated mild symptoms (flushing, urticaria, mild angioedema) 1
2. Monitor for progression to more severe symptoms
3. If progression occurs, administer epinephrine immediately 1

Emerging Treatments for Food Allergies

Immunotherapy Options

• Oral Immunotherapy (OIT): FDA-approved for peanut allergy 4, 5

  • Involves gradual exposure to increasing amounts of food allergen
  • Aims to induce desensitization or tolerance 1
  • Can cause adverse reactions ranging from mild oropharyngeal symptoms to anaphylaxis 1

• Sublingual Immunotherapy (SLIT) 1, 6

  • Allergen administered as drops or tablets under the tongue
  • Currently investigational for food allergies

• Epicutaneous Immunotherapy 6

  • Application of allergen to the skin
  • Currently in clinical trials

Biologics

• Omalizumab: Recently FDA-approved for food allergy 5
  • Anti-IgE monoclonal antibody
  • Provides protection against reactions to accidental ingestion
  • Can be used as monotherapy or adjunct to immunotherapy

Patient Education and Management

Emergency Action Plan

• All patients with food allergies should have: 1
  • Written anaphylaxis emergency action plan
  • Epinephrine auto-injector prescription (2 doses)
  • Training on proper auto-injector use
  • Medical identification (bracelet or card)

Follow-up Care

• Referral to an allergist/immunologist for evaluation 1, 2
• Education on allergen avoidance 1
• Regular checking of auto-injector expiration dates 1

Common Pitfalls in Food Allergy Management

1. Delayed epinephrine administration: Epinephrine should be given immediately for anaphylaxis, not delayed while waiting for antihistamines to work 2

2. Relying solely on antihistamines: Antihistamines are not appropriate as the only treatment for anaphylaxis 1, 2

3. Inadequate monitoring: Patients should be observed for 4-6 hours after anaphylaxis due to risk of biphasic reactions 1, 2

4. Insufficient prescribing: Patients should be prescribed two doses of epinephrine auto-injector, as a second dose may be needed 2

5. Poor patient education: Many parents lack adequate knowledge about when and how to use epinephrine auto-injectors 7

6. Limited availability in schools: Despite their importance, epinephrine auto-injectors are often insufficiently available in school settings 8

Food allergies affect approximately 7.6% of children and 10.8% of adults in the US, with peanut being the leading cause of fatal and near-fatal anaphylaxis, followed by tree nuts and shellfish 4. Proper medication management, with emphasis on prompt epinephrine administration for anaphylaxis, is essential to reduce morbidity and mortality from food allergic reactions.