Treatment
-Intramuscular epinephrine (1st-treatment to give).
-Rx autoinjection epinephrine,
-R/o biphasic anaphylactic reaction: Refer to the ER all patients who have an anaphylactic reaction even if they have taken Epi-pen and symptoms have resolved. They are at risk of a biphasic anaphylactic reaction.
-Refer all patients who have had a diagnosis of anaphylaxis to an allergist for a full-allergy evaluation.
Patients with a peanut allergy who have an anaphylactic reaction should go to the ER after giving themselves epinephrine from auto-injector. Even if their symptoms resolve after giving themselves the epinephrine, they should still go to the ER because they are at risk of a biphasic reaction. The ER has more Epi and resuscitation services if they needed them.
“Patients with a peanut allergy can have reactions to infinitesimal amounts of peanut protein, including residue on the lips of other people.”
- Diphenhydramine can help reduce subsequent symptoms,
- prednisone is generally given, although its value is unproven.
- The AAP guideline recommends that all peanut- allergic patients who require a dose of adrenalin be observed in an emergency department.
- Peanut-allergic patients tend to have accidental exposure about once every 5 years in spite of efforts at avoidance.” ABFM
Further Reading / References
Anaphylaxis in the acute care setting. CMAJ 2014;186(9):694.
Epinephrine for first-aid management of anaphylaxis. Pediatrics 2017;139(3):e20164006.
https://www.ncbi.nlm.nih.gov/m/pubmed/20094000/?i=2&from=/24591280/related