Allergic Reactions

Step by Step

1. EpiPen IMMEDIATELY - Don't wait to see if it gets worse. Inject into outer thigh, through clothing if needed.
2. Call 911 - Must get to hospital even if improved. Reaction can return (biphasic).
3. Position correctly:
   • Difficulty breathing: Sit up
   • Feeling faint: Lie down, legs elevated
   • Unconscious: Recovery position (on side)
4. Second EpiPen if no improvement after 5-15 minutes
5. Antihistamine after epinephrine (helps with hives, swelling)
6. Be ready for CPR if breathing stops

EpiPen Usage

1. Remove from case
2. Remove blue safety cap (top)
3. Grip orange end (don't put thumb over either end)
4. Swing and push ORANGE end firmly against OUTER THIGH
5. Hold in place 3 seconds (newer) or 10 seconds (older models)
6. Remove, massage injection site 10 seconds
7. Note the time given

NEVER put thumb, fingers, or hand over either end. If accidental injection into thumb/finger, go to ER immediately - can cause tissue death.

Auto-injectors expire. Check date. Replace when expired. Keep at room temperature, don't refrigerate or freeze.

Food (Top 9 - 90% of reactions)

• Milk
• Eggs
• Peanuts
• Tree nuts (almonds, cashews, walnuts, etc.)
• Fish
• Shellfish (shrimp, crab, lobster)
• Soy
• Wheat
• Sesame

Peanuts and tree nuts cause most severe reactions. Shellfish and nuts most common adult allergies. Milk and eggs most common in children (often outgrown).

Other Common Triggers

• Insect stings: Bees, wasps, hornets, yellow jackets, fire ants
• Medications: Penicillin and related antibiotics, aspirin, NSAIDs, sulfa drugs
• Latex: Gloves, balloons, condoms, medical devices
• Contrast dye: Used in some medical imaging
• Exercise: Rare, usually in combination with food
• Unknown: 20-30% of anaphylaxis has no identified cause

After initial treatment, symptoms can RETURN 1-72 hours later (usually within 8 hours) with no new exposure. This is why hospital observation is required even after EpiPen and improvement.

Risk factors: Severe initial reaction, delayed epinephrine, need for multiple EpiPens

Normal Reaction vs Allergic

Normal: Pain, redness, swelling at sting site. Ice, antihistamine, remove stinger.

Large local: Swelling extends beyond sting site (whole arm from hand sting). Uncomfortable but usually not dangerous. Antihistamine, ice, monitor.

Allergic: Any symptoms away from sting site (hives elsewhere, throat tightness, breathing difficulty). EpiPen, 911.

Bee Sting Treatment (Non-Allergic)

1. Remove stinger: Scrape with credit card or fingernail. Don't squeeze (releases more venom).
2. Wash with soap and water
3. Ice: 20 min on, 20 min off
4. Antihistamine: For itching
5. Ibuprofen: For pain and swelling
6. Monitor: Watch for allergic symptoms over next few hours

Antihistamines

Diphenhydramine (Benadryl): Fast-acting, causes drowsiness. 25-50mg adults, 1mg/kg children. Every 4-6 hours. Best for acute reactions.

Loratadine (Claritin): Non-drowsy, once daily. 10mg adults. Better for prevention/daily use.

Cetirizine (Zyrtec): May cause mild drowsiness, once daily. 10mg adults. Good balance of speed and duration.

Fexofenadine (Allegra): Non-drowsy, once or twice daily. 180mg or 60mg twice daily.

Source: Any pharmacy, grocery store, online. Generic works fine. Store brands are cheaper.

Antihistamines help hives, itching, swelling but do NOT treat airway swelling or low blood pressure. Epinephrine is the only treatment for anaphylaxis. Antihistamines are supportive, not primary.

Epinephrine Auto-Injectors

Brands: EpiPen, Adrenaclick, Auvi-Q (voice instructions). Generic versions available.

Dosing:

• 0.3mg (adult/child over 66 lbs)
• 0.15mg (child 33-66 lbs)

Prescription required. Carry two auto-injectors (one may fail or not be enough).

Source: Pharmacy with prescription. $100-700 depending on brand and insurance. Manufacturer coupons often available. Generic epinephrine injectors are cheapest (~$100-200).

DIY: No substitute for epinephrine in anaphylaxis. If no EpiPen available: antihistamine (helps but won't stop anaphylaxis), call 911, position appropriately, be ready for CPR. Hospital has epinephrine - getting there fast is critical.

For Known Allergies

• Avoid triggers: Read labels, ask about ingredients, check medications
• Carry EpiPen: Always, everywhere. Two auto-injectors.
• Medical alert jewelry: Identifies allergy if unconscious
• Tell others: Friends, family, coworkers, restaurants about allergy
• Check expiration: EpiPens expire, replace annually or when expired
• Allergy testing: Identify all allergens
• Immunotherapy: Allergy shots can reduce severity over time (for insect and some food allergies)

Allergy Kit

• Epinephrine auto-injector (2)
• Antihistamine (Benadryl)
• Medical alert bracelet
• Action plan card (what to do, emergency contacts)

Schools, workplaces should know about severe allergies and where EpiPen is kept. Train family/friends how to use it.