Food Allergies Medication

  • Author: Scott H Sicherer, MD; Chief Editor: Michael A Kaliner, MD   more...
 
Updated: Mar 7, 2012
 

Medication Summary

For patients with a history of mild reactions, such as the development of urticaria and pruritus, following the ingestion of a food allergen, treatment may be limited to an oral antihistamine. However, the potential for a more severe reaction on subsequent exposures must be taken into consideration because of the possibility of the ingestion of a larger dose than previously ingested or the chance of an unexpected or unrecognized increase in the patient’s degree of sensitivity.

If the patient has significant systemic symptoms, the treatment of choice is self-injectable epinephrine administered by intramuscular injection in the lateral thigh.[79] Patients must be educated regarding when to use their self injector and the proper technique. They should also be instructed to obtain immediate medical assistance (eg, call 911) in the event of anaphylaxis.

Epinephrine should likely be administered to any patient with a history of a severe allergic reaction as soon as ingestion of the food allergen is discovered and the first symptoms appear (and possibly even before symptoms appear).

Patients should not depend on bronchodilators or antihistamines to treat anaphylaxis. However, antihistamines can be used as additional therapy during an allergic reaction, and a bronchodilator may be used as adjunctive therapy for asthma.[80] Although corticosteroids are often given for anaphylaxis, they are not believed to alter the early symptoms; theoretically, they may reduce late symptoms.

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Antihistamines

Class Summary

These agents act by competitive inhibition of histamine at the H1 receptor. This mediates the wheal and flare reactions, bronchial constriction, mucous secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.

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Chlorpheniramine (Chlor-Trimeton, Teldrin, Aller-Chlor, Chlor-Hist)

 

Chlorpheniramine is used to treat intense, localized allergic reactions. This agent competes with histamine or H1-receptor sites on effector cells in blood vessels and the respiratory tract.

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Diphenhydramine (Anti-Hist, Aler-Dryl, Benadryl)

 

This is a first-generation antihistamine with anticholinergic effects that binds to H1 receptors in the CNS and the body. It competitively blocks histamine from binding to H1 receptors. It is used for symptomatic relief of symptoms caused by release of histamine in allergic reactions.

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Alpha/Beta Adrenergic Agonists

Class Summary

These are used in the emergency management of systemic allergic reactions or anaphylaxis (eg, urticaria, angioedema, bronchospasm, cardiovascular collapse). The effects are immediate and dramatic. The appropriate use of this class of medication can be lifesaving, especially in the emergency management of anaphylaxis.

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Epinephrine (Adrenalin, EpiPen, Twinject)

 

Epinephrine is the drug of choice for the treatment of anaphylaxis. It helps to decrease symptoms of anaphylaxis by increasing systemic vascular resistance, elevating diastolic pressure, producing bronchodilation, and increasing inotropic and chronotropic cardiac activity. In addition, epinephrine helps to reduce urticaria, angioedema, laryngeal edema, and other systemic manifestations of anaphylaxis.

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Contributor Information and Disclosures
Author

Scott H Sicherer, MD  Professor of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine of New York University

Scott H Sicherer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD  Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians

Disclosure: Alcon Consulting fee Consulting; Teva Consulting fee Consulting; Meda Honoraria Speaking and teaching; Ista Consulting fee Consulting; sunovian Consulting fee Consulting; dey Honoraria Review panel membership

Additional Contributors

Dan Atkins, MD Assistant Professor, Department of Pediatrics, University of Colorado Health Sciences Center; Head, Division of Ambulatory Pediatrics, Department of Pediatrics, Director, Pediatric Day Program, National Jewish Medical and Research Center

Dan Atkins, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American Thoracic Society

Disclosure: Nothing to disclose.

Stephen C Dreskin, MD, PhD Professor of Medicine, Departments of Internal Medicine, Director of Allergy, Asthma, and Immunology Practice, University of Colorado Health Sciences Center

Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American Association of Immunologists, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, and Joint Council of Allergy, Asthma and Immunology

Disclosure: Genentech Consulting fee Consulting; American Health Insurance Plans Consulting fee Consulting; Johns Hopkins School of Public Health Consulting fee Consulting; Array BioPharma Consulting fee Consulting

John M James, MD Consulting Staff, Department of Pediatrics, Department of Allergy and Immunology, Colorado Allergy and Asthma Centers, PC

John M James, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, American Medical Association, Colorado Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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