Great Line

Tweeted by @AllergicLiving

"Allergist Talks About Anaphylaxis (Severe Allergic Reactions)"
https://m.youtube.com/watch?v=184oft9bW0s&feature=youtu.be

QuoteAntihistamines will never ever ever stop a severe anaphylaxis reaction from progressing. The right thing to do is, as early as possible with one of these episodes, is to use your epinephrine auto-injector

{snort}



EXACTLY.

Saw this quote on Facebook.  Supposedly attributable to Dr. Wallace from "recent" anaphylaxis conference.

Speaking about the role of antihistamines in anaphylaxis:

"Antihistamines are what you give to reduce itching and hives while you watch the patient die of anaphylaxis."

This is the procedure we have followed in the past.

Siena (age 5 at the time) ate a product with lentils.  She did not feel well (we did not know of her lentil allergy at that time).  Called 911.  She felt weak and had a stomach ache and was lying down and had a cough.  We gave her epi-pen.  No hives. Firefighters arrived in about 4 minutes.. 2 mins later, ambulance arrived - took her to North York General Hospital.

Upon arrival the doctors gave her epi-pen #2 (about 15 mins after epi-pen 1).  They hooked her up to an IV and gave her steroids and benedryl.... kept the IV attached for 5 hrs.  After being discharged, she received steroid prescription for following 3 days.

There were no hives until after we arrived at the hospital, when only a few small ones appeared.  But even in the absence of hives, we knew right away she needed the epi-pen, and when we got to the hospital the E/R doctor knew she needed a second epi-pen. (actually, epi-pen jr)

After dealing with allergies all these years, we are probably the best ones to know if she needs an epi-pen. An EMT would not see any hives and may not even think it is necessary but we know our daughter and her allergic history of reactions to various allergens.

Tweeted by @Allergy

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"Anaphylaxis treatment: current barriers to adrenaline auto-injector use"

http://onlinelibrary.wiley.com/doi/10.1111/all.12387/full?utm_content=bufferb6b2b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Quote
Limited awareness of the treatment of anaphylaxis by health professionals

Data from several cohort studies illustrate the extent of under-treatment of anaphylaxis and the low rate of adrenaline use [12, 15, 39-41], with most cases of anaphylaxis that require hospitalization not receiving an AAI on discharge. Adrenaline is much less commonly used than antihistamines and corticosteroids in treating anaphylaxis despite both antihistamines [42] and corticosteroids [43, 44] having an onset of action that is delayed and too late to prevent respiratory and/or cardiovascular arrest, which can occur within minutes [23].

I'm tinkering with getting my EMT basic this summer. This'll come in handy during "that" portion. I should ask Silver how her son handled it, continues to handle it in the field.

"Safety of epinephrine for anaphylaxis in the emergency setting"
http://www.wjem.org/upload/admin/201311/d095a4afd3dc3f7fc3baa8d33a54d10b.pdf

QuoteWhy not antihistamines or corticosteroids first?

QuoteThere is no evidence that they provide life-saving treatment (i.e. they do not prevent or relieve upper airway obstruction, hypotension, or shock).[24] Antihistamines [IM or intravenous (IV)] are adjunctive therapies and may be tried after epinephrine is administered to help control cutaneous and cardiovascular manifestations, such as itching, flushing, urticaria, angioedema, and nasal and eye symptoms, as well as prevent secondary reactions.

Everything You Wanted to Know About Epinephrine and More 
Wednesday, February 26, 2014 at 7pm Eastern (4pm Pacific)

Register: https://www4.gotomeeting.com/register/170327023



Angela Nace, PharmD, author of our very popular Epinephrine Comparison blog post, and Michael Pistiner, MD, MMSc, Chair of KFA's Medical Advisory Team and frequent guest speaker on our webinar series, will answer your questions about epinephrine.  Submit your questions in advance on the registration.  We thank Mylan Specialty for sponsoring this event.

You know, if someone actually was having to epi themselves or their child once a week, as you suggest, they likely really need to review their management practices.


Upon further reflection, I said that I wouldn't epi for just a rash.  That's not necessarily true.  If I had a rash and found out that I had somehow consumed something with apple in it, I would go ahead and epi, no waiting, no questions asked.  But that is my plan (approved by a board certified allergist), and if I've come into contact with something with apples, I've played this game enough times to know where it is going.

Yes, it's a really top-notch review article.  VERY detailed and thorough examination of what current is (and is not) known about the allergic cascade and relevant pharmacology.   

Quote from: CMdeux on January 21, 2014, 05:14:36 PM
John-- PLEASE consider carefully reading the following:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096462/

Totally off topic.  Oh, we saw the author of that study when she was doing her fellowship with Dr. Wood.  We loved Dr. Keet. Honestly, all of Dr. Wood's fellows are top notch. Dr. Keet now does research at Hopkins. Dr. Sharma, who writes for the American Allergic Living, was also one of Dr. Wood's fellows and now heads up pediatric allergy at Children's in DC.

Quotebut the first sign of their kid with a red bump and they are reaching for the epi-pen

What a terribly dismissive statement. I have never administered the EpiPen for a "red bump" or even for an area of localized hives. Goodness a stray red bump could be anything in an atopic child who is prone to eczema as well as contact reactions. 

Again, anecdotal, but in talk with previous pediatrician who was one of the types to talk to a patient as a colleague as long as you could keep up with him we covered the difference of knowledge and use of epinephrine (specifically the fear of it within some first responders) in pediatric patients presenting with anaphylaxis.

Hashing it out we surmised it's because many first responders see so many patients with pre-existing cardiac conditions which leads them to erroneously assume if an elderly person with a weakened heart is prone to a strong beta agonist then surely a pediatric patient must be at equal or more risk not realizing it's contrary to that belief.

This is one of those areas that really FARE probably needs to gain speed on to make sure the discipline of immunology, its best practices, NIH guidelines, critical care and first responders of ALL level and training should align.

By the way it's worth mentioning that THIS thread is about epinephrine. For coverage of the wide array of antihistamines (or even prednisone for those of us who are using it post-reaction or for other reasons) then take 5 seconds to use the search function to find and read the conversations about them. Many of us are using daily antihistamines such as Zyrtec, Claritan and Allegra to use their trade names and Benadryl as part of our EAPs.

My tolerance for hyperbole, false dichotomy, straw men, ad hominem and garden variety BS without showing the least bit of professionalism and demonstrable knowledge when queried with cold hard fact from both well read individuals and/or the pharmacology professionals who can themselves mint other pharmacology professionals through PhD levl, is worn thin.

 

EMT B here is:  pass knowledge exam ---> graded practicum ---> certification.


Just to clarify this point, as well-- there are no absolute contraindications to IM epinephrine for the treatment of anaphylaxis.  Not even cardiac ones. 

Concerns about epinephrine as a drug often as not revolve around IV administration, which IS much more hazardous.  IM administration is quite safe.