Anaphylaxis--REGARDLESS of severity--intramuscular epinephrine

[Macabre]

Anaphylaxis--REGARDLESS of severity--intramuscular epinephrine/adrenaline in anterolateral thigh--emergency medicine guide  http://t.co/MVrH5jlZlW



"However, even in the emergency setting, the patient may not present with life-threatening symptoms. Because mild initial symptoms can quickly progress to a severe, even fatal, reaction, the first-line treatment for any anaphylaxis episode-regardless of severity-is intramuscular injection of epinephrine into the anterolateral thigh; delaying its administration increases the potential for morbidity and mortality. When a reaction appears as "possible anaphylaxis," it is generally better to err on the side of caution and administer epinephrine."

[GingerPye]

Thanks for posting, Mac!

[brownie]

I can't really understand what the plan should be from this.  We need a plan for "dummies".  For example, my son ate a contaminated chocolate bar.  His stomach didn't feel good.  He said his throat felt a bit funny for a few minutes.  It cleared with Benadryl as we sat outside the ER.  Should I have given him the epi?  I still don't know.  I guess it was technically 2 symptoms but there was no visible sign of anything, no vomiting, no breathing difficulty.  Sadly, I know I hold back because 1) a needle is traumatic and 2) it would have meant hours in a strange ER and a huge medical bill for nothing.  If it was as easy to pop as a benadryl I would have done it in a heartbeat.

I would bet that 99% of people wouldn't use the epi in that situation, but I had it in my hand outside an ER.  I had a parent tell me the other day that their son didn't have a serious peanut allergy like my son...he's not anaphylactic.  But their son has had his throat swell up just from being at a baseball game near peanut shells?!?!?!  This is the attitude most people have.  It would be really nice if there was a clear guideline on when epinephrine is called for that was well-distributed to non-medical personnel.

[spacecanada]

I hear you, brownie.  I've been there with myself a few times.  If I had to Epi for queasiness and skin itches, even the slightest combination of either, I'd be Epi-ing myself for 'minor' reactions I get from touching things, being in a house where they ate nuts recently, or simply rubbing my eyes.  Granted, I remove myself from those situations as soon as symptoms present and closely monitor, giving Benadryl in 30 minutes if symptoms don't progress beyond stage 1.  Now, should I be using Epi every time and spending hours in the ER frequently or doing like you did, which is what I normally do when I haven't directly ingested anything?  I wish they were clear symptoms = Epi but anaphylaxis symptoms are on a sliding scale and it's impossible to draw a line of where to Epi. 

My GP reprimands me every time I tell her I took Benadryl because she thinks those minor reactions are Epi-worthy with two (very mild) symptoms, so maybe we need to change our way of thinking?  Tough call.

[CMdeux]

Honestly, though...

how would you have any kind of life other than being locked inside a bubble or homebound if that were how one were to approach things?

I have regrets about not using Epi when I should have.

I do.

But not over the grade 1 symptom combos.  Nor over stuff that seems to have been likely CONTACT reactivity.  That just doesn't have the "danger" feel that inhalation or ingestion stuff does. 

[spacecanada]

Well put, CM.  I agree 100%.  (Even with the regrets... it happens.)