Treatment of Drug Allergy With Adrenaline?
Treatment of Drug Allergy With Adrenaline?
I have read in a paper that adrenaline should be the drug of first choice in the case of bee-sting allergy, even if the patient has only urticaria. Do you advise the same for drug allergy? For example, what if the patient has only angioedema and urticaria and comes to the emergency department? When do you use adrenaline and when only antihistamines?
Kevser Onbasi, MD
Antihistamines and epinephrine can both be useful in treating cases of acute allergic reactions to medications. If this is the first reaction to a medication, it is important to closely monitor the patient for several hours because allergic reactions can begin with mild symptoms, such as hives or itching, and later progress to include more-severe manifestations affecting the respiratory or cardiovascular systems. For initial reactions limited to the skin, it makes sense to administer an antihistamine, such as diphenhydramine, and then closely monitor for the appearance of other symptoms. It is important to emphasize that although antihistamines can relieve skin symptoms, such as itching and urticaria, they are not effective in treating anaphylactic episodes involving the respiratory or cardiovascular systems. Therefore, the patient should be carefully assessed for symptoms of anaphylaxis and then reevaluated periodically for several hours. If there are signs or symptoms of anaphylaxis, epinephrine should be administered intramuscularly, and transport to an acute care facility for other supportive care should be arranged.
If the patient has had previous adverse reactions to the same medication, it is important to ask about the severity of the reactions after these exposures. If the patient has a history of cardiovascular or respiratory symptoms after exposures in the past, this could modify the treatment approach. Under these circumstances, immediate use of epinephrine and transport to an acute care facility should be considered, even if the reaction appears to be relatively mild.
I have read in a paper that adrenaline should be the drug of first choice in the case of bee-sting allergy, even if the patient has only urticaria. Do you advise the same for drug allergy? For example, what if the patient has only angioedema and urticaria and comes to the emergency department? When do you use adrenaline and when only antihistamines?
Kevser Onbasi, MD
Antihistamines and epinephrine can both be useful in treating cases of acute allergic reactions to medications. If this is the first reaction to a medication, it is important to closely monitor the patient for several hours because allergic reactions can begin with mild symptoms, such as hives or itching, and later progress to include more-severe manifestations affecting the respiratory or cardiovascular systems. For initial reactions limited to the skin, it makes sense to administer an antihistamine, such as diphenhydramine, and then closely monitor for the appearance of other symptoms. It is important to emphasize that although antihistamines can relieve skin symptoms, such as itching and urticaria, they are not effective in treating anaphylactic episodes involving the respiratory or cardiovascular systems. Therefore, the patient should be carefully assessed for symptoms of anaphylaxis and then reevaluated periodically for several hours. If there are signs or symptoms of anaphylaxis, epinephrine should be administered intramuscularly, and transport to an acute care facility for other supportive care should be arranged.
If the patient has had previous adverse reactions to the same medication, it is important to ask about the severity of the reactions after these exposures. If the patient has a history of cardiovascular or respiratory symptoms after exposures in the past, this could modify the treatment approach. Under these circumstances, immediate use of epinephrine and transport to an acute care facility should be considered, even if the reaction appears to be relatively mild.
