Anaphylactic Reactions - Know it. Treat it.

May 14, 2021

By Barret Procyshyn, Pharmacist at Dauphin Clinic Pharmacy

May is Food Allergy Awareness Month in Canada and with spring weather here we are going to be spending more time outdoors along with the wasps and bees. As mentioned in last week's Pharmacy Feature the only self-treatment for anaphylaxis is epinephrine and then you must seek medical help. It is the only drug that can reverse symptoms of anaphylaxis and is considered life-saving medication. Oral allergy medications such as Reactine and Benydryl should not be used to treat anaphylaxis.

Remember the acronym FAST for recognizing signs of anaphylaxis:

FACE: hives, itching, redness, swelling of face, lips, or tongue

AIRWAY: trouble breathing, swallowing, or speaking, nasal congestion; sneezing

STOMACH: stomach pain, vomiting, diarrhea

TOTAL BODY: hives, itching, swelling, weakness, dizziness, sense of doom, loss of consciousness

Epinephrine is the drug form of the hormone adrenaline that the body produces on its own. It helps to reverse symptoms of an allergic reaction by opening the airways, improving blood pressure, and accelerating heart rate. Epinephrine can seem intimidating; however, it is quite safe to use in healthy individuals. It rarely causes harm, even if it was accidentally given when not needed. If any side effects occur at all, they could include rapid heart rate (not dangerously rapid), paleness, dizziness, weakness, tremors, and headache. It is important to highlight these side effects are generally mild and go away within a few minutes.

Even if epinephrine is used, you still need to go to the hospital for observation and potentially further treatment. If someone with asthma or allergies is having trouble breathing and you are unsure if it is an asthma attack, treat with epinephrine first. The epinephrine may improve breathing even if asthma is the cause. Antihistamines can be used to treat hives or rashes but will not stop anaphylaxis. Antihistamines can be used after you have used your epinephrine.

All epinephrine auto-injectors should be kept in their original protective case out of direct sunlight and at room temperature (15 -25 degrees Celsius). They should be replaced after the expiry date. Your Clinic Pharmacist will help with that by giving you a courtesy call to replace it right before it expires.

Epinephrine can be administered in the thigh, though light pants if required. Hold the autoinjector firmly and press it against the skin. A clicking noise will be heard as the needle is activated, automatically injecting the epinephrine as you continue to hold it against the skin for 5 to 10 seconds. Gently massage the thigh after the injection is complete. Get medical attention or to the nearest emergency room as soon as possible. If there is wheezing or trouble breathing the person should sit up in a supported position. Otherwise, the person should lay as flat as possible with the feet elevated. If symptoms resume, an additional dose can be provided within 5 to 15 minutes.

Epinephrine in Canada is currently available in 3 brands. The Epi-Pen is likely the most used brand. Epi-Pens come in two doses, one for youth 30kg and under and the other for everyone who weighs 31kg and up.

Allerject has become available again as well in both pediatric and adult dosing. Allerject is popular because the auto-injector assists with voice recorded instructions on how to provide the dose. Often someone having an allergic reaction cannot self-administer their dose and if a bystander is unfamiliar with how to use it, the instructions could be extremely helpful.

Emerade is the new epinephrine on the market. It is marketing two doses of 0.3mg and 0.5mg. The higher dose should be recommended by your physician for certain patients. A pediatric dose of Emerade is not available yet.

Dauphin Clinic Pharmacy has recently accessed a payment assistance program for Emerade auto-injectors. The program, along with your own 3^rd party coverage, will currently cover up to 100% of the cost of an auto-injector. If you or someone you know needs to have epinephrine available, they can contact the pharmacy for more information. This is a greatly beneficial program as none of the epinephrine devices are low in cost. Epinephrine is available with or without a prescription. To have coverage for the epinephrine you may still require getting a prescription from a doctor or pharmacist.

 

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