Serious allergic reactions, called anaphylaxis, can be life-threatening. The immune system overreacts to a threat such as a bee sting or a peanut. In response, the body goes into overdrive, releasing compounds such as histamine and tryptase that affect many systems.These lead to inflammatory compounds such as leukotrienes, prostaglandins and factors that contribute to platelets clumping and forming clots. Symptoms range from flushed, itchy skin to rapid heart rate, low blood pressure, hoarseness, wheezing and trouble breathing. Effective treatment may require extra epinephrine.
How to Treat Anaphylactic Reactions:
This type of reaction may require immediate emergency treatment with epinephrine. Usually this is administered as an injection into the muscle of the thigh (StatPearls, Jan. 26, 2023). As you can imagine, when a person can’t breathe or goes into shock, time is of the essence.Children with food allergies are often given epinephrine in the form of an EpiPen to carry with them at all times. That way, a sudden attack can be treated immediately.
Research has shown that effective treatment frequently requires extra epinephrine–two shots, not just one (Pediatrics, April 2010). A review of cases treated in two Boston hospitals show that 12 percent of the youngsters with severe food-induced anaphylactic reactions required more than a single dose.
The foods most likely to trigger a severe anaphylactic response included peanuts, tree nuts, milk, shellfish, fish, and eggs. The children’s reactions often started with a rash and itching and proceeded quickly to swelling, nausea and vomiting and trouble swallowing and breathing. The investigators recommend that children with severe food allergies keep two EpiPens or equivalents, such as Adrenaclick, Auvi-Q, Symjepi or Twinject, with them wherever they go.
Alpha-Gal Also Triggers Reactions:
That study was connducted before alpha-gal allergy became prevalent. Now, many more people may have a delayed anaphylactic reaction to consuming beef, pork, lamb or other mammalian meat. They too may need to keep extra epinephrine on hand.
FDA Approves Epinephrine Nasal Spray:
Inhaled epinephrine is available without a prescription to treat asthma. However, the FDA has not approved Primatene Mist for treating anaphylactic reactions. We have no evidence that it would work to alleviate a life-threatening reaction.
People with severe allergies should be pleased to learn that there is now an alternative to the EpiPen. The FDA has just approved epinephrine in a nasal spray to treat anaphylactic reactions. The medication is called neffy and is designed for use in people who weigh at least 66 pounds. That includes many older children as well as adults. People who are skittish about needles may welcome this new form of epinephrine. The devices don’t require refrigeration and are designed to be portable. They are sold as a two-pack, so that each patient will have extra epinephrine available if it is needed.
Downsides of Neffy:
The neffy spray has not been tested in people experiencing anaphylactic shock, so it remains to be seen how well it will work in emergency situations. Side effects can include sneezing, stuffy or itchy nose, throat irritation, stomach ache, dizziness and nausea.
