Medication Summary

If the syndrome has progressed to anaphylaxis, then intramuscular epinephrine or emergency self-injectable epinephrine (eg, Adrenaclick, EpiPen, Twinject) is the drug of choice.

Class Summary

Epinephrine, administered intramuscularly, is the drug of choice for the treatment of severe anaphylaxis in a patient with exercise-induced anaphylaxis. Epinephrine antagonizes the effects of the chemical mediators, including histamine and leukotrienes, on smooth muscle and blood vessels.

Epinephrine (Adrenaclick, EpiPen, EpiPen Jr, Twinject)

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Epinephrine should be administered intramuscularly in the mid-anterolateral thigh. This agent possesses alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. The beta-agonist effects of epinephrine include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.

Class Summary

These agents are used to treat minor allergic reactions and anaphylaxis. They prevent histamine response in sensory nerve endings and blood vessels. These agents are more effective in preventing histamine response than in reversing it. They act by competitive inhibition of histamine at the H1 receptor. This mediates the wheal-and-flare reactions, bronchial constriction, mucus secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.

Diphenhydramine (Benadryl, Benylin)

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Diphenhydramine is indicated for symptomatic relief of symptoms caused by release of histamine in allergic reactions.

Class Summary

Beta-agonists relax bronchial smooth muscle by action on beta₂ -receptors, with little effect on cardiac muscle contractility. These agents are used in the prevention of exercise-induced bronchospasm.

Albuterol

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Albuterol is indicated for the prevention of exercise-induced bronchospasm and for adults and children aged 4 years and older for the treatment or prevention of bronchospasm with reversible obstructive airway disease.

Class Summary

Corticosteroids help to control severe allergic conditions intractable to conventional treatment in patients with serum sickness and drug reactions. Corticosteroids may prevent protracted or biphasic symptoms during acute anaphylaxis. However, they do not provide rapid relief of upper or lower airway obstruction, shock, or other symptoms of anaphylaxis.

Prednisone

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Prednisone is an immunosuppressant for the treatment of allergic reactions. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear neutrophil activity.

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Author

Peter N Huynh, MD Chief of Allergy and Immunology, Kaiser Permanente, Panorama City Medical Center

Peter N Huynh, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Edward K Hu, MD Fellow, Division of Allergy and Immunology, LAC+USC Medical Center

Edward K Hu, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology

Disclosure: Nothing to disclose.

Salima A Thobani, MD Kaiser Permanente

Salima A Thobani, MD is a member of the following medical societies: American College of Physicians, American Medical Student Association/Foundation, American Medical Women's Association

Disclosure: Nothing to disclose.

Lyne Scott, MD Chief, Division of Allergy and Immunology, Director, Fellowship Training Program, Director, The Breathmobile Program, LAC+USC Healthcare Network; Assistant Professor, Department of Pediatrics, Keck School of Medicine of the University of Southern California

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

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD Faculty, Division of Allergy/Immunology and Infectious Diseases, Department of Pediatrics, Saint Peter's University Hospital

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Pediatric Research, Society for Mucosal Immunology

Disclosure: Nothing to disclose.

Acknowledgements

C Lucy Park, MD Head, Division of Allergy, Immunology, and Pulmonology, Associate Professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine

C Lucy Park, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Medical Association, Chicago Medical Society, Clinical Immunology Society, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Paul H Sammut, MBBCh, FAAP, FCCP Medical Director of the Pediatric Intensive Care Unit, Associate Professor, Department of Pediatrics, Section of Pulmonology, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

William B Stratbucker, MD, Assistant Professor of Pediatrics, Division of General Academic Pediatrics, Rush Medical College; Consulting Staff, Rush University Medical Center, Rush Children's Hospital

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Exercise-Induced Anaphylaxis Medication

Medication Summary

Sympathomimetic agents

Class Summary

Epinephrine (Adrenaclick, EpiPen, EpiPen Jr, Twinject)

Epinephrine (Adrenaclick, EpiPen, EpiPen Jr, Twinject)

Antihistamines