Anaphylaxis--REGARDLESS of severity--intramuscular epinephrine/adrenaline in anterolateral thigh--emergency medicine guide http://t.co/MVrH5jlZlW (http://t.co/MVrH5jlZlW)
"However, even in the emergency setting, the patient may not present with life-threatening symptoms. Because mild initial symptoms can quickly progress to a severe, even fatal, reaction, the first-line treatment for any anaphylaxis episode-regardless of severity-is intramuscular injection of epinephrine into the anterolateral thigh; delaying its administration increases the potential for morbidity and mortality. When a reaction appears as "possible anaphylaxis," it is generally better to err on the side of caution and administer epinephrine."
Thanks for posting, Mac!
I can't really understand what the plan should be from this. We need a plan for "dummies". For example, my son ate a contaminated chocolate bar. His stomach didn't feel good. He said his throat felt a bit funny for a few minutes. It cleared with Benadryl as we sat outside the ER. Should I have given him the epi? I still don't know. I guess it was technically 2 symptoms but there was no visible sign of anything, no vomiting, no breathing difficulty. Sadly, I know I hold back because 1) a needle is traumatic and 2) it would have meant hours in a strange ER and a huge medical bill for nothing. If it was as easy to pop as a benadryl I would have done it in a heartbeat.
I would bet that 99% of people wouldn't use the epi in that situation, but I had it in my hand outside an ER. I had a parent tell me the other day that their son didn't have a serious peanut allergy like my son...he's not anaphylactic. But their son has had his throat swell up just from being at a baseball game near peanut shells?!?!?! This is the attitude most people have. It would be really nice if there was a clear guideline on when epinephrine is called for that was well-distributed to non-medical personnel.
I hear you, brownie. I've been there with myself a few times. If I had to Epi for queasiness and skin itches, even the slightest combination of either, I'd be Epi-ing myself for 'minor' reactions I get from touching things, being in a house where they ate nuts recently, or simply rubbing my eyes. Granted, I remove myself from those situations as soon as symptoms present and closely monitor, giving Benadryl in 30 minutes if symptoms don't progress beyond stage 1. Now, should I be using Epi every time and spending hours in the ER frequently or doing like you did, which is what I normally do when I haven't directly ingested anything? I wish they were clear symptoms = Epi but anaphylaxis symptoms are on a sliding scale and it's impossible to draw a line of where to Epi.
My GP reprimands me every time I tell her I took Benadryl because she thinks those minor reactions are Epi-worthy with two (very mild) symptoms, so maybe we need to change our way of thinking? Tough call.
Honestly, though...
how would you have any kind of life other than being locked inside a bubble or homebound if that were how one were to approach things?
I have regrets about not using Epi when I should have.
I do.
But not over the grade 1 symptom combos. Nor over stuff that seems to have been likely CONTACT reactivity. That just doesn't have the "danger" feel that inhalation or ingestion stuff does.
Well put, CM. I agree 100%. (Even with the regrets... it happens.)