More Information Allergy skin tests. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Hives. American Academy of Dermatology. Accessed April 25, Hives urticaria. American College of Allergy, Asthma and Immunology. Khan DA. Chronic urticaria: Standard management and patient education. Goldsmith LA, et al. Urticaria and angioedema. In: Fitzpatrick's Dermatology in General Medicine.
New York, N. Chronic urticaria: Treatment of refractory symptoms. Bernstein JA, et al. Epinephrine: Epinephrine is the single most important drug in the anaphylaxis emergency kit. Epinephrine will also reverse skin and gastrointestinal symptoms. H1 Antihistamines e. This class of medication is particularly effective for skin symptoms and swelling that is not affecting the airways. This class of medication is not a good first choice for fainting, loss of consciousness, lethargy, difficulty breathing, low blood pressure, or poor circulation, but it can act as an important supporting medication to epinephrine.
H2 Antihistamine e. These products only should be injected into the anterolateral aspect of the thigh. Patients, family members, and caregivers should be thoroughly trained on the proper use of epinephrine autoinjectors.
Pharmacists also should supply patients with written instructions to reinforce proper use. Patients should be reminded to seek medical care regardless of response to self-treatment, so that they can access additional therapies, such as oxygen, intravenous IV fluids, corticosteroids, respiratory support, inotropic agents, albuterol, and histamine 2 receptor antagonists H2RAs. Adjunctive therapies include antihistamines, corticosteroids, and albuterol.
Dopamine may be required to maintain blood pressure, and glucagon can be used in patients taking beta-blockers who have refractory anaphylaxis. Oxygen administration is especially important in patients who have a history of cardiac or respiratory disease, inhaled b2-agonist use, and who have required multiple doses of epinephrine. The use of normal IV saline also is recommended.
Antihistamines H1 and H2 antagonists are often used as adjunctive therapy for anaphylaxis. It is important to note that because these agents have a much slower onset of action than epinephrine, they should never be administered alone as a treatment for anaphylaxis.
Diphenhydramine is approved by the FDA for treatment of anaphylaxis, and IV administration provides faster onset of action. H2RAs, such as ranitidine and cimetidine, block the effects of released histamine at H2 receptors, therefore treating vasodilatation and possibly some cardiac effects, as well as glandular hypersecretion.
Some research suggests that H2 blockers with H1 blockers have additive benefit over H1 blockers alone in treating anaphylaxis. Ideally, the optimal management of anaphylaxis is avoidance of known triggers, but if a reaction occurs, being prepared is crucial to successful management and preventing complications. Patients with a history of anaphylactic reactions should be encouraged to wear Medic Alert bracelets indicating known allergies.
They should be counseled on the proper use of the autoinjectors and always carry them for prompt self-treatment. They should always keep track of the expiration date of their autoinjector. Patients with a history of allergies should avoid known allergens and be reminded to always read the labels of medications and food products. April 1, Yvette C. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
Consider vasopressor infusion for hypotension refractory to volume replacement and epinephrine injections. Continuous hemodynamic monitoring is important. For patients with a history of idiopathic anaphylaxis or asthma, and patients who experience severe or prolonged anaphylaxis, consider the use of systemic glucocorticosteroids. Although glucocorticosteroids typically are not helpful acutely because they may have no effect for 4 to 6 hours even when administered intravenously , their use may prevent recurrent or protracted anaphylaxis.
Oral administration of glucocorticosteroids eg, prednisone, 0. Prevention Ideally, the optimal management of anaphylaxis is avoidance of known triggers, but if a reaction occurs, being prepared is crucial to successful management and preventing complications.
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