Antihistamines have little impact on the respiratory and cardiovascular parts of anaphylaxis. Maybe it delayed progression a wee bit so maybe it was of help in this case (or not) but the use of antihistamines instead of using the EpiPen (AuviQue, what have you) is too common and is clearly associated with delay of seeking care, potentially increase risk of worse outcomes.
Administration of antihistamine was associated with 7.45 times increased odds of delay in seeking care (OR 7.45 [2.71, 20.50], p<0.001). Discussion: Home administration of antihistamines for anaphylaxis prior to hospital presentation was significantly associated with an increased odds of delay in immediately seeking care. Delayed presentation for anaphylaxis can delay epinephrine administration and increase mortality.
Because not everyone here is a medical expert, it is worth discussing the basics.
Most allergic reactions involve release of histamine from mast cells mediated by allergen specific IgE immunoglobulins. Since antihistamines help stabilize mast cells, they are more useful given earlier, before exposure and before the mast cells release all their histamine.
Skin signs of allergy like hives, rash, wheals, itching or puffiness can often be treated just by antihistamines if there are no other signs of a severe allergy and things do not get worse with time. Steroids (strong anti inflammatories like prednisone) are stronger than antihistamines and epinephrine (same thing as adrenaline) is much stronger.
Severe allergy, or anaphylaxis, can be life threatening. Anaphylactic shock is a drop in blood pressure where organs are not receiving enough oxygen. Signs of severe allergy can include:
swelling around the lips, face, neck or tongue
wheezing, severe cough, difficulty breathing
low blood pressure
severe nausea or vomiting
fast heart rate or breathing to compensate for low pressures or oxygen levels
Most stings and food allergies just cause skin symptoms. Anything more should prompt consideration of giving epi, calling an ambulance and seeking medical help. The trigger may or may not be obvious. The allergy can be “new” in the sense that previous exposures caused no or mild symptoms. You should carry an Epi-Pen if you have had a severe allergy. A Ventolin (Albuterol, Salbutamol) inhaler can help with wheezing and breathing difficulties.
Is the description by the OP, hours of stomach pain after eating food they’re allergic to a serious allergy and apt to increase in severity?
Hours long stomach distress worries me.
Seems like alot.
I certainly would avoid my allergens if it were me. Total avoidance and maybe get the shots that help you in the long run(do they do allergy shots anymore?)
Hi Beck. No need to worry about my intestines. The allergen is almonds. It developed in my 20s (loved Almond Joys in my childhood), and it took me several years to figure out the connection. Once understood, it was usually simple to avoid, but I still stumbled every couple years. Which was no fun — four hours of farting n’ belching (no big deal) and severe cramps/gas pains. Which hurt, but didn’t last beyond those hours and never, over the decades, became any worse.
In my 50s I got the bright idea of trying Benedryl and, wondrous day, traded 4 hours of misery for a sweet 2 hour nap. A complete short circuit.
However, you can feel free to worry about my wife. A couple of times a sting made her forearm one-third larger. Her doc thinks oral antihistamines are adequate protection, no need for a pen. I’m doubtful. She hasn’t had a bee sting in 12 years.
I’m not eager to make specific conclusions but general principles I’ll riff on.
As a general rule serious anaphylaxis is rapidly progressing. It can start with GI symptoms, and first episode can be that alone, but subsequent ones are more likely to … be more.
And not all food reactions are allergic in origin.
The OP seems fine with less than rigidly strict avoidance and antihistamines.
In short, no likely not a serious risk of progression.
Sting reactions? Large local is still local and not a serious risk. The big flag for serious future risk is having a reaction not adjacent to the sting (discontinuous).
Any thoughts on the new nasal inhaler for epinephrine, Neffy? A bystander might be much more likely to administer a nasal spray than use an epi pen. I could see carrying both as Neffy hasn’t been/can’t be ethically tested on anaphylaxis.
I haven’t heard much about it yet honestly. I’d be … apprehensive. Especially for the circumstance of someone not in condition to self administer … in that case they may be panicking and I am imagining spraying something up a nostril of a panicked person, especially a child, as harder than jabbing the pen into the thigh.
Hey, @Seanette — Isn’t that the drug that Buddy is on, the one that brought him back from severe anemia, but which we are now hoping to get him off of because of the behavior issues that we suspect it of causing in him?
…. The key differences between prednisolone and prednisone are as follows:
…* Prednisolone is the active form of prednisone. Once prednisone is converted to prednisolone, this active form of the drug act on the immune system to lower the body’s inflammatory response….
And
… As mentioned above, prednisolone & prednisone are in the same class of medication. Prednisone is converted by the liver to the active metabolite prednisolone. Therefore, the effectiveness of prednisone in a person is dependent on liver function. Studies have shown that in people with impaired hepatic function (liver disease), the blood level of the medication can vary if they take prednisone because such people may not be able to convert prednisone reliably to the active form of prednisolone. Therefore, prednisolone may be preferred in people with impaired liver function. In patients with normal liver function, both prednisone and prednisolone are equally effective.…
From BuzzRx, dated April 2023.
Sounds like Buddy’s vet chose the prednisolone out of some consideration for his liver function or a factor specific to cats compared to people.
And yes, steroids can sure do wacky, weird and disconcerting things to people’s moods and personalities, so Buddy is not surprising there either. The vet will probably taper him off carefully and gradually, like they do people. Don’t be surprised if that blunts Buddy’s appetite.
