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Questions and Answers About the Use of Activated Charcoal to Treat Peanut Allergy Reactions - A recently released Journal of Allergy & Clinical Immunology study touts the use of activated charcoal as a treatment option in slowing or preventing life-threatening reactions to peanut proteins. Following are questions and answers about the use of charcoal for treating peanut allergy reactions.
- What is activated charcoal?
- Activated charcoal is a substance sometimes given in emergency rooms, by mouth or through a stomach tube, to victims of poisonings. This treatment is used because activated charcoal absorbs ("complexes") substances in the gut thereby reducing their ability to enter the body.
- How is activated charcoal administered?
- Activated charcoal in powder form is mixed with water to create a "slurry". It is also available in flavored/sorbital-containing liquids, which absorb less than regular activated charcoal, and as capsules.
- Medical professionals have the advantage of being able to administer activated charcoal via a stomach tube. This allows them to give a patient the proper dose very quickly, and taste does not come into play. It is unlikely that a child's parents could administer sufficient amounts of activated charcoal while at home or during a drive to a hospital.
- Commonly Used Brand Names of Activated Charcoal According to the National Institute of Health's Website:
- Actidose-Aqua
- Actidose with Sorbitol
- CharcoAid
- CharcoAid G
- CharcoAid 2000
- Insta-Char in an Aqueous Base
- Insta-Char in an Aqueous Base with Cherry Flavor
- Insta-Char Pediatric in an Aqueous Base with Cherry Flavor
- Insta-Char Pediatric with Cherry Flavor in a Sorbitol Base
- Insta-Char with Cherry Flavor in a Sorbitol Base
- Liqui-Char
- Liqui-Char with Sorbitol
- Is activated charcoal available over the counter?
- Yes, activated charcoal can be purchased over the counter in health food stores, drug stores, and stores that sell dietary supplements.
- How can activated charcoal be used to help treat an allergic reaction?
- Theoretically, if peanut protein is in the gut, and activated charcoal is given, the activated charcoal would absorb the peanut protein that is in the gut (that has not yet entered the body) thereby reducing or possibly eliminating absorption of the peanut protein from the gut into the body.
- It is unlikely that activated charcoal would be useful in treating an allergic reaction, or anaphylactic reaction, that occurs after minute amounts of peanut protein have been absorbed by the tissue inside the mouth.
- What did the study show?
- The study investigators mixed peanut protein (alone or mixed in food) and activated charcoal in a test tube and then took the mixture and evaluated how well the charcoal was able to make the peanut protein "unavailable" to detection by various measurement techniques. It was found that at a high enough dose of activated charcoal, the peanut protein was effectively absorbed and made essentially unavailable for detection by various methods.
- What did the researchers conclude?
- Although the study did not involve giving activated charcoal to persons with peanut allergy, the researchers suggest that activated charcoal may be a useful additional treatment to slow or prevent further absorption of peanut protein from the gut after accidental ingestion by persons with peanut allergy.
- What are the general recommendations for persons with peanut allergy (and other food allergies)?
- The primary current treatment recommendations include strict avoidance of the food and prompt medical treatment if the food is accidentally ingested. The primary medication prescribed for a severe reaction is injected epinephrine (or adrenaline) available for self injection using a simple device that is carried by persons with serious food allergy. This medication reduces swelling, improves breathing and supports circulation allowing a food-allergic person to get to an emergency room for more care. Additional medication includes antihistamines taken usually by mouth. For any serious reactions, individuals must immediately also seek medical care at an emergency room because additional doses and types of medications may be needed.
- Can activated charcoal be used in place of epinephrine?
- No. Epinephrine works to reverse the symptoms of a severe allergic reaction caused by proteins that have entered the bloodstream, whereas activated charcoal binds the allergenic protein in the stomach that have not already entered the body and caused the reaction. Therefore, activated charcoal should never be used in place of epinephrine for a reaction NOR should administration of epinephrine, when needed, be delayed because of potential administration of activated charcoal.
- Will activated charcoal interfere with other medications?
- Yes. Activated charcoal can interfere with oral medications, such as antihistamine taken by mouth, because it binds the medications in the stomach. Therefore, activated charcoal may block the effect of the antihistamine. However, antihistamines can also be given by injection in an emergency room, if necessary.
- Will activated charcoal render epinephrine ineffective?
- No. Epinephrine is given by a needle (injection), whereas activated charcoal is given by mouth and will not affect the lifesaving properties of epinephrine.
- Are there any side affects of taking activated charcoal?
- There are no specific adverse effects of taking activated charcoal, although the liquid formulations may taste bad to some persons-and be intolerable for many children. However, aspiration of activated charcoal (for example, vomiting it and then choking and inhaling the vomit) could potentially cause lung damage, and chemical imbalances, stomach and intestinal obstruction, and cornea abrasion sometimes occur. Additionally, activated charcoal will turn stools black.
- Note: It would be risky and difficult to give activated charcoal to patients who vomit during allergic reactions, or who have central nervous system signs and symptoms.
- Does activated charcoal act the same as ipecac? Can ipecac be used to treat an allergic reaction?
- Activated charcoal binds the protein. Ipecac induces vomiting. Ipecac is generally not recommended for an allergic reaction because repetitive vomiting could result in complications on top of other allergic symptoms (e.g., choking on vomit during troubled breathing).
- Can activated charcoal be taken in advance of meals to reduce the need to be careful about ingestion of peanut (or other food allergens)?
- This strategy would DEFINITELY NOT be recommended because the peanut protein could still potentially enter the bloodstream before having a chance to be in contact with the charcoal.
- Should we alter the treatment of peanut allergy (or other food allergy) based upon the result of the study?
- The answer to this question may evolve as more studies become available. As indicated above, the authors of this study suggest that activated charcoal may be a useful additional therapy for peanut allergy (the particular food studied) and do not comment upon its use for other foods (although one may expect a similar phenomenon). It must be appreciated that the use of activated charcoal for persons with food allergic reactions would be based upon conclusions drawn, at this time, only from a study performed in a test tube. The authors compare the use of activated charcoal for peanut allergy to treatment for poisonings (when charcoal is typically given in an emergency room or by paramedics before getting to the hospital, sometimes given by a tube into the stomach). They indicate that it would be more useful to administer it soon after ingestion rather than after a delay. Therefore, some physicians may advocate the use of activated charcoal at this time.
- Should activated charcoal be a part of an allergy treatment plan?
- Right now there are no studies concerning the role of activated charcoal in an actual food-allergic reaction. If a reaction is already occurring, the activated charcoal would not stop the effect of the allergen already absorbed, but theoretically could prevent/reduce further protein from entering the bloodstream. However, the charcoal could also eliminate the effect of oral antihistamines that are commonly given in allergic reactions outside of the hospital. Also, the impact of the charcoal would vary depending upon the amount of food eaten at the meal and the amount of peanut protein in that food. Finally, particularly for young children, because of taste and amount needed to be consumed, administration of the activated charcoal may be difficult or impossible. Therefore, specific general recommendations are currently lacking. Follow your current treatment plans and consider speaking to your/your child's doctor regarding whether or not activated charcoal might be an effective addition to your treatment plan. Your doctor can best discuss the types of charcoal formulations available, under what circumstances it might be given, and how much to administer. Do not change your/your child's treatment plan without guidance from your doctor.
- To see a related press release, click here.
Last modified on 7/31/03. [Copyright © 2003] [Disclaimer] The Food Allergy & Anaphylaxis Network 10400 Eaton Place, Suite 107 Fairfax, VA 22030 (800) 929-4040