Sections

Food Allergies

Medication

Medication Summary

For patients with mild reactions, such as localized urticaria, oral itch, or mild abdominal pain, treatment may be limited to an oral antihistamine.

If the patient has systemic symptoms, the treatment of choice is self-injectable epinephrine administered by intramuscular injection in the lateral thigh.^[77]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.^[77]Although corticosteroids are often given for anaphylaxis, they are not believed to alter the early symptoms; theoretically, they may reduce late symptoms.

The first immunotherapy for peanut allergy was approved by the FDA in 2020.^[5]

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.

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

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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.

Cetirizine (Zyrtec)

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Second-generation histamine H1-receptor antagonist. Competes with histamine on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract. Available in a variety of oral formulations (tablet, liquid, chewable, oral disintegrating) to allow ease of administration.

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.

Epinephrine (EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q)

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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. Products are available as autoinjectors to ease caregiver or self-administration. Auvi-Q also provides audible instructions and visual cues.

Class Summary

Immunotherapy implements gradual desensitization and maintenance to protect peanut allergic individuals in case of accidental exposure to an allergen.

Peanut oral allergen powder (Palforzia, Peanut Arachis hypogaea allergen powder-dnfp)

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Indicated for mitigation of allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanut in patients with a confirmed diagnosis of peanut allergy. Treatment is administered in 3 sequential phases: Initial dose escalation, up-dosing, and maintenance. Administer initial dose escalation to patients aged 4-17 years; up-dosing and maintenance may be continued in patients aged 4 years or older. Use in conjunction with a peanut-avoidant diet. Efficacy was not shown in the clinical trial participants aged 18 years or older.

Questions

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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, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD Clinical Professor of Medicine, George Washington University School of Medicine; 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, Association of American Physicians

Disclosure: Nothing to disclose.

Acknowledgements

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

Food Allergies Medication

Medication Summary

Antihistamines

Class Summary

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

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

Cetirizine (Zyrtec)

Cetirizine (Zyrtec)

Alpha/Beta Adrenergic Agonists

Class Summary

Epinephrine (EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q)

Epinephrine (EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q)

Immunotherapy

Class Summary

Peanut oral allergen powder (Palforzia, Peanut Arachis hypogaea allergen powder-dnfp)

Peanut oral allergen powder (Palforzia, Peanut Arachis hypogaea allergen powder-dnfp)

Food Allergies Medication

Medication Summary

Antihistamines

Class Summary

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

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

Cetirizine (Zyrtec)

Cetirizine (Zyrtec)

Alpha/Beta Adrenergic Agonists

Class Summary

Epinephrine (EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q)

Epinephrine (EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q)

Immunotherapy

Class Summary

Peanut oral allergen powder (Palforzia, Peanut Arachis hypogaea allergen powder-dnfp)

Peanut oral allergen powder (Palforzia, Peanut Arachis hypogaea allergen powder-dnfp)

References

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