Symptoms of a food allergy reaction can affect different parts of the body. Severe symptoms include:
- Lung: shortness of breath, wheezing, repetitive cough
- Heart: pale, blue, faint, weak pulse, dizzy
- Throat: tight, hoarse, trouble breathing/swallowing
- Mouth: significant swelling of the tongue or lips
- Skin: many hives over body, widespread redness
- Gut: repetitive vomiting or severe diarrhea
- Psychological: feeling something bad is about to happen, anxiety, confusion
Someone having a severe allergic reaction could have a combination of symptoms from different body areas. These symptoms can quickly progress to anaphylaxis, a life-threatening condition that requires epinephrine.
Epinephrine is the only medication that can reverse the symptoms of anaphylaxis. It is available in an easy-to-use auto-injector (Auvi-Q ®, EpiPen®, Generic Epinephrine Auto-Injector [Authorized Generic of EpiPen®] or Adrenaclick®).
Your allergist may prefer that epinephrine be used with only mild symptoms, or before symptoms even emerge. Consult with your doctor and refer to your personalized Food Allergy & Anaphylaxis Emergency Care Plan.
- Use epinephrine at the first sign of a severe allergic reaction, or as prescribed.
- Call 911. Tell the dispatchers that you have used epinephrine to treat a suspected anaphylactic reaction to food. Request an ambulance with epinephrine on board.
- Go to the emergency room for further treatment, even if symptoms appear to resolve with the epinephrine. The person may need more medication or treatment to manage the reaction.
Epinephrine is a safe and relatively harmless drug. When in doubt, use it! The risks of anaphylaxis outweigh any risks from giving the medication.
Take extra caution only with patients for whom an increased heart rate could be a problem. This includes elderly patients and those with known heart disease. But still use epinephrine to treat anaphylaxis in these people.
Once epinephrine is administered, other medications also may be used to control the reaction:
Steroids (e.g., cortisone) may be given, typically in the emergency room, to help reduce inflammation after an anaphylactic attack. They can be given orally (by mouth) or intravenously. Although steroids do not work fast enough for emergency treatment, they may help prevent a severe reaction from coming back.
Antihistamines, known as H1 or H2 blockers, are prescribed to relieve mild allergy symptoms. They reduce or block histamines—chemicals your body releases when it comes into contact with an allergen. For anaphylaxis, many emergency departments give both H1 and H2 blockers. Medications in the H1 class include diphendydramine (Benadryl®), cetirizine (Zyrtec®) and others. Ranitidine (Zantec®) and famotidine (Pepcid®) are examples of H2 blockers. An antihistamine cannot control a severe reaction and is no substitute for epinephrine.
Asthma Medications. Short-acting bronchodilators (known as “rescue” inhalers) may be used to help relieve asthma symptoms and other breathing problems once epinephrine has been given. One example of this medication is albuterol (Alupent®, Proventil®, Ventolin®). Asthma medications should not be used to treat the breathing problems during anaphylaxis—use the epinephrine.