What is the treatment for a Steri (sterile strip) strip allergic reaction?

Treatment of Steri-Strip Allergic Reaction

Remove the Steri-Strips immediately and manage the reaction based on severity: for mild localized contact dermatitis, apply topical corticosteroids and cool compresses; for systemic anaphylaxis, administer intramuscular epinephrine 0.3-0.5 mg (adults) or 0.01 mg/kg (children, max 0.3 mg) as first-line treatment. 1, 2

Immediate Assessment and Strip Removal

• Remove the offending Steri-Strips promptly to prevent further allergen exposure, as avoidance is the primary mode of therapy for adhesive-induced reactions 3, 2
• Assess the severity of the reaction to determine appropriate management pathway 1
• Differentiate between localized allergic contact dermatitis (ACD) and systemic anaphylaxis, as treatment differs significantly 2, 4, 5

Management of Mild to Moderate Local Reactions (Contact Dermatitis)

For localized erythema, pruritus, or rash without systemic symptoms:

• Apply cool compresses to the affected area to reduce inflammation and provide immediate comfort 6
• Topical corticosteroids (such as hydrocortisone cream) should be applied to the affected area 3-4 times daily for localized inflammation 7
• Oral antihistamines (diphenhydramine 25-50 mg in adults or 1-2 mg/kg in children) can be administered if pruritus is present 1, 6, 8
• Monitor the site for resolution, which typically occurs within several days 6

Management of Severe Systemic Reactions (Anaphylaxis)

If the patient develops systemic symptoms including urticaria, difficulty breathing, mucosal swelling, hypotension, or widespread symptoms:

• Administer intramuscular epinephrine immediately as first-line treatment: 0.3-0.5 mg in adults or 0.01 mg/kg in children (maximum 0.3 mg) in the anterolateral thigh 1, 5
• Do not delay epinephrine to give antihistamines, as fatal reactions have been associated with delayed epinephrine administration 1
• Provide supportive care for airway, breathing, and circulation 5
• Administer intravenous fluid bolus with Ringer's lactate (10-20 mL/kg) if hypotension or significant vomiting is present 1

Adjunctive Medications (Only After Epinephrine)

• H1 antihistamines: diphenhydramine 25-50 mg IV or oral (adults) or 1-2 mg/kg (children) 1, 8
• H2 antihistamines: ranitidine 1-2 mg/kg per dose (maximum 75-150 mg) or famotidine in combination with H1 antihistamines 1
• Corticosteroids: prednisone 1 mg/kg (maximum 60-80 mg) orally to prevent recurrent or protracted anaphylaxis 1
• Beta2 agonists for bronchospasm if present 5
• Glucagon (20-30 μg/kg for children or 1-5 mg for adults) if the patient is on beta-blockers with refractory hypotension 1

Observation Period

• Monitor patients for 4-12 hours depending on risk factors for severe anaphylaxis, as biphasic reactions (recurrence without reexposure) can occur 1, 5
• Patients with severe reactions (Grades III-IV) may require ICU admission, particularly if prolonged resuscitation or ongoing vasopressor requirements are present 3

Prevention and Follow-Up

• Document the adhesive allergy prominently in the medical record to prevent future exposure 2, 4
• For patients with systemic reactions, prescribe an epinephrine auto-injector (2 doses) with proper training on its use 1
• Provide education on allergen avoidance and an anaphylaxis emergency action plan 1
• Refer to an allergist for proper identification of the specific allergen component (often acrylate-based adhesives in Steri-Strips) and long-term management 2, 4
• Consider patch testing to identify the specific sensitizing agent if recurrent adhesive exposure is anticipated 2, 4

Alternative Wound Closure Options

• For future wound care, use non-adhesive alternatives such as sutures, staples, or latex-free, acrylate-free adhesives 3, 4
• Dermabond® (cyanoacrylate-based) appears to have the lowest risk of ACD and can be considered as a first-line alternative, though it is more expensive 4
• Ensure a latex-safe environment if latex allergy is also suspected, as cross-reactivity can occur 3

Common Pitfalls to Avoid

• Do not use antihistamines as primary treatment for systemic reactions instead of epinephrine 1
• Do not misdiagnose ACD as cellulitis and inappropriately prescribe antibiotics when the reaction is clearly localized to the adhesive contact area 4
• Do not fail to monitor for biphasic reactions after initial symptom resolution 1, 5
• Do not assume all adhesive reactions are the same—different adhesive components (acrylates, colophony, etc.) cause different sensitivities 2, 4