food allergy first aid medicine

During an acute attack of food allergy, especially when there is a precursor to a severe systemic allergic reaction, the only emergency drug of choice is an epinephrine auto-injector (commonly known as an "epinephrine pen"). The antihistamines (loratadine, cetirizine, etc.) and glucocorticoids (dexamethasone, prednisone, etc.) we often take can only be used as auxiliary drugs and cannot replace the life-saving role of epinephrine.

Last month, I treated a 6-year-old child with peanut allergy at the allergy clinic. Her mother always felt that epinephrine pens were "too strong" and she was afraid of damaging the baby, so she only dared to take loratadine with her when she went out. That day at the amusement park, the baby took a bite of another child's peanut-flavored biscuit. Within five minutes, his lips swelled into sausages and he began to gasp and gasp. Her mother panicked and gave her half a tablet of loratadine. After waiting for ten minutes, she saw that the baby's face was turning purple before calling 120. When he was sent to the emergency department, his larynx was already swollen to the second degree, and he was intubated to save his life. Afterwards, she repeatedly confirmed with me with the epinephrine pen prescribed by the doctor, saying that she would never take any chances again.

In fact, this mother’s misunderstanding cannot be entirely blamed. Currently, there are indeed two different clinical ideas about the treatment of severe allergic reactions: one is the hierarchical medication logic that has been used for decades. It is believed that epinephrine is only needed when symptoms of the respiratory tract and circulatory system occur, and antihistamines are sufficient for simple skin symptoms. Many veteran doctors at the grassroots level still follow this principle.； The other is the "early use without hesitation" principle that has been promoted by the World Allergy Organization and the Chinese Allergy Society in the past 10 years. As long as people with a clear history of severe allergies only develop a rash or swollen lips after exposure to allergens, it is recommended to inject epinephrine as soon as possible - Bi Allergies progress at an incredible speed. Statistics show that 1/3 of severe allergic reactions will rapidly progress to shock within 10 minutes of the onset of skin symptoms. If you wait until you are breathless and unable to stand before taking out the medicine, your hands may be shaking to the point of being unable to open the package.

There is no absolute right or wrong between the two views. The core difference is the different acceptance of risks. I personally prefer the latter. After all, compared with the risk of death from anaphylactic shock, the side effects of epinephrine are really negligible. Many people are afraid of epinephrine because they are afraid of panic, trembling hands, and headaches after the injection. I have met several patients who came over in a panic after the injection, saying that they felt their heart was going to jump out and whether they were poisoned. In fact, this kind of transient reaction lasts for half an hour at most and disappears. There are currently no reports of serious adverse reactions caused by the correct use of emergency doses of epinephrine worldwide. On the contrary, there are dozens of food allergy patients in our country who die every year because they did not use epinephrine in time.

Someone must ask, then the loratadine, cetirizine, and dexamethasone I prepared are useless? No, these are auxiliary medicines that can be taken after taking epinephrine to relieve rashes and itching, and to prevent recurrence of allergies in the future, but they absolutely cannot replace epinephrine as first aid medicine. To put it bluntly, when an allergy attack reaches a life-saving level, using loratadine to deal with it is like using a mineral water bottle to put out a fire. It is not completely useless, but by the time you finish watering it, the house will be burned down. As for hormones such as dexamethasone, it takes at least 2 to 4 hours to take effect. By the time it takes effect, the day lily is cold and can only be used for follow-up consolidation treatment, which cannot catch up with the time window for emergency treatment.

Let’s talk about how to use the epinephrine pen. It’s actually very simple. You don’t need to dispense medicine or find a vein. You just take it out, pull out the safety cap, and prick it on the outside of your thigh through your pants. Hold it down for 10 seconds, pull it out, and rub the injection site. It will take effect in basically 1 to 2 minutes. If the symptoms are not relieved after 5 to 15 minutes, you can take a second shot. Regardless of whether you feel better after the injection, you must go to the hospital for at least 4 hours of observation, because about 20% of people will have a "bipolar reaction", which means that the symptoms will suddenly relapse a few hours after the symptoms subside. It is very dangerous not to be in the hospital at this time.

When I prescribe medicine to all patients with severe food allergies, I will repeat three sentences: First, always keep the epinephrine pen where you can easily reach it. Don’t stuff it at the bottom of your suitcase or put it in the mezzanine of your backpack. If something happens, you won’t be able to find it.； Second, it’s best to prepare two, one for yourself and one for your family and friends who are traveling with you. If you have an attack and can’t take it yourself, others can help you. ； Third, write your allergy history and the location of first aid medicine on the lock screen of your phone. If you even faint, passers-by can help you immediately.

When it comes to food allergies, you really don’t have to worry about anything but the unexpected. Don’t take it lightly because you think your allergies were not serious before. The severity of allergies may be different every time you attack. It’s better to have life-saving things ready than not having them when you need them.