If an allergist cannot identify a trigger, the condition isidiopathic anaphylaxis. Accessed June 27, 2021. Does albuterol help anaphylaxis. Journal of Allergy and Clinical Immunology. [ corrected] The following regimen is reasonable: 1:10,000 (100 mcg per mL) epinephrine at 1 mcg per minute, increased to 10 mcg per minute as needed. Epinephrine [ep-uh-NEF-rin] is the most important treatment available. Glucocorticoids for the treatment of anaphylaxis Anaphylaxis is a serious allergic reaction that is rapid in onset and may result in death. Skin testing itself carries a risk of fatal anaphylaxis and should be performed by experienced persons only. Govindapala D, Senarath US, Wijewardena D, Nakkawita D, Undugodage C. J Med Case Rep. 2022 Aug 26;16(1):327. doi: 10.1186/s13256-022-03528-y. Sicherer SH, Simmons, FE. By continuing to browse this site, you are agreeing to our use of cookies. Clipboard, Search History, and several other advanced features are temporarily unavailable. Training kits containing empty syringes are available for patient education. Li X, Ma Q, Yin J, Zheng Y, Chen R, Chen Y, Li T, Wang Y, Yang K, Zhang H, Tang Y, Chen Y, Dong H, Gu Q, Guo D, Hu X, Xie L, Li B, Li Y, Lin T, Liu F, Liu Z, Lyu L, Mei Q, Shao J, Xin H, Yang F, Yang H, Yang W, Yao X, Yu C, Zhan S, Zhang G, Wang M, Zhu Z, Zhou B, Gu J, Xian M, Lyu Y, Li Z, Zheng H, Cui C, Deng S, Huang C, Li L, Liu P, Men P, Shao C, Wang S, Ma X, Wang Q, Zhai S. Front Pharmacol. Nausea, vomiting, diarrhea, cramping abdominal pain, Bananas, beets, buckwheat, Chamomile tea, citrus fruits, cow's milk,* egg whites,* fish,* kiwis, mustard, pinto beans, potatoes, rice, seeds and nuts (peanuts, Brazil nuts, almonds, hazelnuts, pistachios, pine nuts, cashews, sesame seeds, cottonseeds, sunflower seeds, millet seeds),* shellfish*, Amphotericin B (Fungizone), cephalosporins, chloramphenicol (Chloroptic), ciprofloxacin (Cipro), nitrofurantoin (Furadantin), penicillins,* streptomycin, tetracycline, vancomycin (Vancocin), Aspirin and nonsteroidal anti-inflammatory drugs*, Allergy extracts, antilymphocyte and antithymocyte globulins, antitoxins, carboplatin (Paraplatin), corticotropin (H.P. Although isoproterenol may be able to overcome depression of myocardial contractility caused by beta blockers, it also may aggravate hypotension by inducing peripheral vasodilation and may induce cardiac arrhythmias and myocardial necrosis. Make sure school officials have a current autoinjector. Your provider might want to rule out other conditions. If severe hypotension is present, epinephrine may be given as a continuous intravenous infusion. 2022 Nov 28;13:1015529. doi: 10.3389/fimmu.2022.1015529. Mehr S, Liew WK, Tey D, Tang ML. Direct skin testing and radioallergosorbent testing (RAST) are available for some antigens, including heterologous sera, Hymenoptera venom, some foods, hormones, and penicillin. Recent findings: Advise patient to keep epinephrine self-injection kit and oral diphenhydramine (Benadryl) for future exposures. We teach the general public about asthma and allergic diseases. Asthma and Allergy Foundation of America. The Sakine IA * k1, Sule SOUND zmen Caglayan1, Suna Asilsoy2 Nevin Uzuner2 and zkan Karaman2 1Department of Pediatric Allergy and . Epinephrine is the drug of choice for acute reactions and the only medication shown to be lifesaving when administered promptly, but it is underutilized. Copyright 2003 by the American Academy of Family Physicians. Bethesda, MD 20894, Web Policies A more recent article on anaphylaxis is available. The .gov means its official. The patient also may take an antihistamine at the onset of symptoms. Change). Twinject [prescribing information]. As many as 25% of people who have an anaphylactic reaction will experience biphasic anaphylaxis, a recurrence in the hours following the beginning of the reaction, and will require further medical treatment, including additional epinephrine injections.9, Symptoms of anaphylaxis typically occur within 5 to 30 minutes of exposure. There was no consensus on whether corticosteroids reduce biphasic anaphylactic reactions. Oxygen administration is especially important in patients who have a history of cardiac or respiratory disease, inhaled b2-agonist use, and who have required multiple doses of epinephrine. Can an inhaler help with anaphylaxis. Two strengths are available: 0.3 mL of 1:1,000 epinephrine for adults, and 0.3 mL of 1:2,000 for children. 8600 Rockville Pike Anaphylaxis is common in children and has many differences across age groups. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Twinject Web site. Give hydrocortisone, 5 mg per kg, or approximately 250 mg intravenously (prednisone, 20 mg orally, can be given in mild cases). Lieberman P et al. BACKGROUND: We have previously shown that in patients with asthma a single dose of an inhaled glucocorticosteroid (ICS) acutely potentiates inhaled albuterol-induced airway vascular smooth muscle relaxation through a nongenomic action. Examination may reveal urticaria, angioedema, wheezing, or laryngeal edema. Antihistamines sometimes provide dramatic relief of symptoms. For a sensitive patient urgently requiring radiocontrast, 50 mg of oral prednisone 13 hours, seven hours, and one hour before contrast plus 50 mg of diphenhydramine one hour before the procedure dramatically reduce the rate of recurrent reaction.19 Some experts advocate the addition of 25 mg of ephedrine, and 300 mg of cimetidine orally one hour before the procedure.20 If the patient cannot take oral medications, 200 mg of hydrocortisone intravenously may replace prednisone in these regimens. Cardiovascular symptoms, which affect an estimated 33% of patients, include tachycardia, bradycardia, cardiac arrhythmias, angina, and hypotension.3,6 Other symptoms include syncope, dizziness, headache, rhinitis, substernal pain, pruritus, and seizure.3,6, Epinephrine is the drug of choice and primary therapy in the emergency management of anaphylaxis resulting from insect bites or stings, foods, drugs, latex, or other allergic triggers, and it should be administered immediately.3,12,13 In general, intramuscular (IM)injections in the thigh of 1:1000 solution of epinephrine are administered in doses of 0.3 to 0.5 mL for adults and 0.01 mg/kg for children.14-16 Many physicians may elect to repeat dosing 2 to 3 times at 10- to 15-minute intervals if needed, depending on response.15,16, Epinephrine is classified as a sympathomimetic drug that acts on both alpha and beta adrenergic receptors.12-14,16,17 Alpha-agonist effects include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability.12,13,15 Beta-agonist effects include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.12,13,15 The use of epinephrine for a life-threatening allergic reaction has no absolute contraindications.13,14, Patients with cardiovascular collapse or severe airway obstruction may be given epinephrine intravenously in a single dose of 3 to 5 mL of an epinephrine solution over 5 minutes, or by a continuous drip of 1 mg in 250-mL 5% dextrose in water for a concentration of 4 mcg/mL.11,15,16 This solution is infused at a rate of 1 to 4 mcg/min.16. 2013 May;52(5):451-61. A practice parameter update in 2015 by Lieberman et al includes an excellent discussion about the topic. These protocols include materials for educating teachers, office workers, and kitchen staff in the prevention and treatment of anaphylaxis. eCollection 2018. Some people have allergic reactions without any known exposure to common allergens. Allergy. National Library of Medicine. Gastrointestinal manifestations (e.g., nausea, vomiting, diarrhea, abdominal pain) and cardiovascular manifestations (e.g., dizziness, syncope, hypotension) affect about one third of patients. Glucocorticosteroids are often used in the management of anaphylaxis in an attempt to reduce the severity of the acute reaction and decrease the risk of biphasic/protracted reactions. The diagnosis and management of anaphylaxis: an updated practice parameter. Jacqueline A. Pongracic, MD, FAAAAI. Despite a detailed history, a cause remains elusive in many patients. Biphasic anaphylactic reactions in pediatrics. Biphasic anaphylactic reactions in pediatrics. Advise patient to wear or carry a medical alert bracelet, necklace, or keychain to warn emergency personnel of anaphylaxis risk. DOI: 10.1002/14651858.CD007596.pub3, Copyright 2023 The Cochrane Collaboration. 2021 Dec;8(4):251-254. doi: 10.15441/ceem.21.087. Your immune system tries to remove or isolate the trigger. Anaphylaxis: Confirming the diagnosis and determining the cause(s). Patients should be reminded to seek medical care regardless of response to self-treatment, so that they can access additional therapies, such as oxygen, intravenous (IV) fluids, corticosteroids, respiratory support, inotropic agents, albuterol, and histamine2 receptor antagonists (H2RAs).14,15 Furthermore, patients should be observed for biphasic reactions, which usually occur within 4 hours of the reaction.14,15, Adjunctive therapies include antihistamines, corticosteroids, and albuterol. It is commonly triggered by a food, insect sting, medication, or natural rubber latex. Our community is here for you 24/7. For the management of the primary anaphylactic reaction, children developing biphasic reactions were more likely to have received >1 dose of adrenaline (58% vs. 22%, P=0.01) and/or a fluid bolus (42% vs. 8%, P=0.01) than those experiencing uniphasic reactions. American Academy of Allergy Asthma & Immunology. Enfermedades de Inmunodeficiencia Primaria, AAAAI Diversity Equity and Inclusion Statement, Corticosteroids for treatment of anaphylaxis. An official website of the United States government. Anaphylaxis guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis. Using an autoinjector immediately can keep anaphylaxis from worsening and could save your life. 2022 Feb;42(1):65-76. doi: 10.1016/j.iac.2021.09.005. Anaphylaxis: Office Management and Prevention. Some patients have isolated abnormal tryptase or histamine levels without the other. Medicines, foods, insect stings and bites, and latex most often cause severe allergic reactions. Nebulized beta-adrenergic agents such as albuterol (Proventil) may be administered, and intravenous aminophylline may be considered. Ring J, Grosber M, Mhrenschlager M, Brockow K. Chem Immunol Allergy. itchy, watery eyes. It is commonly triggered by a food, insect sting, medication, or natural rubber latex. Review our cookies information for more details. Cutaneous manifestations of urticaria, itching, and angioedema assist in the diagnosis by suggesting an allergic reaction. Lung sounds. Darr CD. Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia. The dose may be repeated two or three times at 10 to 15 minutes intervals. Emergency department visits for food allergy in Taiwan: a retrospective study. The https:// ensures that you are connecting to the Management of anaphylaxis in schools presents distinct challenges. Clin Exp Emerg Med. Avoid prescribing beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, monoamine oxidase inhibitors, and some tricyclic antidepressants. 60th ed. Continuous hemodynamic monitoring is important. Anaphylaxis. Check the person's pulse and breathing and, if necessary, administer. There are several ways you can support AAFA in its mission to provide education and support to patients and families living with asthma and allergies. Family members and care-givers of young children should be trained to inject epinephrine. Prompt treatment of anaphylaxis is critical, with subcutaneous or intramuscular epinephrine and intravenous fluids remaining the mainstay of management. (LogOut/ NCI CPTC Antibody Characterization Program. A practical guide to anaphylaxis. If insect stings trigger an anaphylactic reaction, a series of allergy shots (immunotherapy) might reduce the body's allergic response and prevent a severe reaction in the future. Accessed January 29, 2009. Adults should be given approximately 50 percent of this dose initially. EpiPen Web site. 1235 South Clark Street Suite 305, Arlington, VA 22202 Phone: 1-800-7-ASTHMA (1-800-727-8462). 2013. Identifying and. Oral administration of glucocorticosteroids (eg, prednisone, 0.5 mg/kg) might be sufficient for less critical anaphylactic reactions. Glucocorticoids can treat this . Ann Emerg Med. Accessed Aug. 25, 2021. Why not use albuterol for anaphylaxis. Scratch and prick tests should precede intra-dermal testing to decrease the risk of an unexpected severe reaction. Anaphylaxis may include any combination of common signs and symptoms (Table 2).2 Cutaneous manifestations of anaphylaxis, including urticaria and angioedema, are by far the most common.3,4 The respiratory system is commonly involved, producing symptoms such as dyspnea, wheezing, and upper airway obstruction from edema. AAFA can connect you to all of the information and resources you need to help you learn more about asthma and allergic diseases. Do Corticosteroids Prevent Biphasic Anaphylaxis? Healthier Home Checklist: How to Improve Your Homes Asthma and Allergy Hot Spots, 7 Things You May Not Know About Ragweed Pollen Allergy. Food is the most common trigger in children, but insect venom and drugs are other typical causes. Pingback: Previous entries relevant to 02/23/18 MR | Pediatric Focus. Anaphylaxis must be treated right away to provide the best chance for improvement and prevent serious, potentially life-threatening complications. It should be released every five minutes for at least three minutes, and the total duration of tourniquet application should not exceed 30 minutes. Ann Allergy Asthma Immunol. The devices are available in 2 strengths0.15 mg for patients weighing between 33 and 66 lb, and 0.30 mg for those patients weighing >66 lb. 2020; doi:10.1016/j.jaci.2020.01.017. The average rate of corticosteroid use in emergency treatment was 67.99% (range 48% to 100%). Anaphylaxis: Emergency treatment. Managing nut-induced anaphylaxis: challenges and solutions. There is no established drug or dosage of choice; Table 510 lists several possible regimens. An estimated 40.9 million individuals in the United States have allergic sensitivities that put them at risk for anaphylaxis.5 Furthermore, because anaphylaxis is not a reportable disease, morbidity and mortality are likely to be underestimated. Latex allergy has become a significant problem since the widespread adoption of universal precautions against infection. A patient may underestimate the importance of a food antigen, or the antigen may be one of many ingredients in a complex product. Treat bronchospasm, preferably with a beta II agonist given intermittently or continuously; consider the use of aminophylline, 5.6 mg per kg, as an IV loading dose, given over 20 minutes, or to maintain a blood level of 8 to 15 mcg per mL. (LogOut/ Protocols for use in schools to manage children at risk of anaphylaxis are available through the Food Allergy Network. Occasionally, anaphylaxis can be confused with septic or other forms of shock, asthma, airway foreign body, panic attack, or other entities. coughing (crackles, stridor) Respiratory failure. American Academy of Pediatrics Web site. Pediatricians are in a unique position to assess and treat these patients chronically., There is also little evidence to either support or refute the use of corticosteroids, but their slow onset (4-6 hours) lends itself more to prevention of protracted or biphasic reactions than a benefit in the acute setting. No. Some experts advocate a short course of antihistamines with oral corticosteroids (e.g., 30 to 60 mg of prednisone).2,15. Supplemental oxygen may be administered. Regulation and directed inhibition of ECP production by human neutrophils. Youre not alone. Curr Opin Allergy Clin Immunol. AAFA is dedicated to improving the quality of life for people with asthma and allergic diseases. Sheikh A. Glucocorticosteroids for the treatment and prevention ofanaphylaxis. For patients with a history of idiopathic anaphylaxis or asthma, and patients who experience severe or prolonged anaphylaxis, consider the use of systemic glucocorticosteroids. Sicherer SH, Teuber S. Current approach to the diagnosis and management of adverse reactions to foods. We also searched the UK National Research Register and websites listing ongoing trials, and contacted international experts in anaphylaxis in an attempt to locate unpublished material. Would you like email updates of new search results? glucocorticosteroid vs albuterol for anaphylaxis. Some of the symptoms of a severe allergic reaction or a severe asthma attack may seem similar. Routine premedication with glucocorticosteroids in patients receiving iodinated contrast media, snake anti-venom therapy or allergen immunotherapy is unlikely to confer clinical benefit. Shaker MC, et al. Please enable it to take advantage of the complete set of features! Anaphylaxis can be protracted, lasting for more than 24 hours, or recur after initial resolution.5,6. Should steroids be used for anaphylaxis after the COVID-19 vaccine? 2018 Jun 28;10:117-121. doi: 10.2147/CCIDE.S159341. However, the evidence base in support of the use of steroids is unclear. You must seek medical care. Approximately 40 to 100 deaths per year in the United States result from insect stings, and up to 3 percent of the U.S. population may be sensitized.1,2 A history of systemic reaction to an insect sting and positive venom skin test confers a 50 to 60 percent risk of reaction to future stings.7. Place patient in recumbent position and elevate lower extremities. Previous entries relevant to 02/23/18 MR | Pediatric Focus. AAFA offers a variety of educational programs, resources and tools for patients, caregivers, and health professionals. At this point, the patient should be assessed for response to treatment. All rights reserved. Make a donation. The patient must be told to seek immediate professional help regardless of initial response to self-treatment. Intravenous access should be obtained for fluid resuscitation, because large volumes of fluids may be required to treat hypotension caused by increased vascular permeability and vasodilation. The dosage of glucagon is 1 to 5 mg (20-30 mcg/kg [maximum dose of 1 mg] in children) administered intravenously over 5 minutes and followed by an infusion (5-15 mcg/ min) titrated to clinical response. This will help you know what to do if you experience anaphylaxis. Epub 2014 Mar 17. Dopamine may be required to maintain blood pressure, and glucagon can be used in patients taking beta-blockers who have refractory anaphylaxis.15-17, All patients who have anaphylaxis should receive oxygen at 6 to 8 L/min. PMC National Library of Medicine ALLERGIC EMERGENCY If you think you are having anaphylaxis, use your self-injectable epinephrine and call 911. Anaphlaxis.com Web site. wheezing or. Practical Management of Patients with a History of Immediate Hypersensitivity to Common non-Beta-Lactam Drugs. corticosteroids, epinephrine, antihistamines). Systematic reviews of these prophylactic approaches undertaken in patients being investigated with iodinated contrast media and treated with snake anti-venom therapy have found routine prophylaxis to be of questionable value. Administer epinephrine 1:1,000 (weight-based) (adults: 0.01 mL per kg, up to a maximum of 0.2 to 0.5 mL every 10 to 15 minutes as needed; children: 0.01 mL per kg, up to a maximum dose of 0.2 to 0.5 mL) by SC or IM route and, if necessary, repeat every 15 minutes, up to two doses). Dosing for the pediatric population is 5 mg/kg/day in divided doses 3 to 4 times a day, not to exceed 300 mg/day.15, H2RAs, such as ranitidine and cimetidine, block the effects of released histamine at H2 receptors, therefore treating vasodilatation and possibly some cardiac effects, as well as glandular hypersecretion.15, Some research suggests that H2 blockers with H1 blockers have additive benefit over H1 blockers alone in treating anaphylaxis.6,15,16 Ranitidine is probably preferred over cimetidine in anaphylaxis, because of the risk for hypotension with rapidly infused cimetidine and the multiple, complex drug interactions associated with the drug.15 Cimetidine should not be administered to children with anaphylaxis, because dosages have not been established.15,16. Increase in the risk of gastric ulcers or gastritis. For children with concomitant asthma, inhaled 2-adrenergic agonists (eg, albuterol) can provide additional relief of lower respiratory tract symptoms but, like antihistamines and glucocorticoids, are not appropriate for use as the initial or only treatment in anaphylaxis. Epub 2022 May 6. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Both skin testing and RAST have imperfect sensitivity and specificity. Consider vasopressor infusion for hypotension refractory to volume replacement and epinephrine injections. Symptom onset varies widely but generally occurs within seconds or minutes of exposure. Inhaled beta agonists lack some of the adverse effects of epinephrine and are useful for cases of bronchospasm, but they may not have additional effects when optimal doses of epinephrine are used.. According to the practice parameter update and another recent review, the evidence that corticosteroids reduce or prevent biphasic reactions is weak. 3 de junho de 2022 . This device is a combined syringe and concealed needle that injects a single dose of medication when pressed against the thigh. Furthermore, patients should be given written information with suggested strategies for their own care. Prevention of future episodes is vital (Table 6). Created 7/31/13; reviewed 5/5/14 (no changes); updated 08/04/15. We advocate for federal and state legislation as well as regulatory actions that will help you. Epub 2019 Apr 26. An official website of the United States government. Alternatively, serum tryptase levels peak 60 to 90 minutes after onset of anaphylaxis and remain elevated for up to five hours. Finally, the patient should be advised to wear or carry a medical alert bracelet, necklace, or keychain to inform emergency personnel of the possibility of anaphylaxis. sharing sensitive information, make sure youre on a federal Ann Allergy Asthma Immunol 115(2015):341-84. Immediate Hypersensitivity Reactions Induced by COVID-19 Vaccines: Current Trends, Potential Mechanisms and Prevention Strategies. Clin Exp Allergy. Evaluation of Prehospital Management in a Canadian Emergency Department Anaphylaxis Cohort. The initial management of anaphylaxis includes a focused examination, procurement of a stable airway and intravenous access, and administration of epinephrine.2,10 [Evidence level C, consensus and expert opinion] Vital signs and level of consciousness should be documented. Before Clinical predictors for biphasic reactions in. 2009 Sep;39(9):1390-6. Some persons may react just by handling the culprit food. 2013 Jun;13(3):263-7. 2019 Sep-Oct;7(7):2232-2238.e3. Anaphylaxis [anna-fih-LACK-sis] is a serious allergic reaction that is rapid in onset and may cause death. We were unable to find any randomized controlled trials on this subject through our searches. If the diagnosis of anaphylaxis is not clear, laboratory evaluation can include plasma histamine levels, which rise as soon as five to 10 minutes after onset but remain elevated for only 30 to 60 minutes. HHS Vulnerability Disclosure, Help Philadelphia: Saunders; 2007:chap 188. Full-text for Childrens and Emory users. 2022 Mar 28;13:845689. doi: 10.3389/fphar.2022.845689. airway) Look for cardiac causes (JVD, pedal edema, ascites) Tachycardia, anxiety . Cochrane Database of Systematic Reviews 2012, Issue 4. 2020 Apr;145(4):1082-1123. doi: 10.1016/j.jaci.2020.01.017. Their benefit is not realized for six to 12 hours after administration, so their primary role may be in prevention of recurrent or protracted anaphylaxis. Anaphylaxis: Acute diagnosis. The Asthma and Allergy Foundation of America (AAFA), a not-for-profit organization founded in 1953, is the leading patient organization for people with asthma and allergies, and the oldest asthma and allergy patient group in the world. After reviewing the published evidence, the authors state that the use of corticosteroids has no role in the acute management of anaphylaxis. We therefore conducted a systematic review of the literature, searching key databases for high quality published and unpublished material on the use of steroids for the emergency treatment of anaphylaxis. When a concomitant -adrenergic blocking agent complicates treatment, consider glucagon infusion. baskin robbins icing on the cake ingredients; shane street outlaws crash 2020; is robert flores married; mafia 3 vargas chronological order; empty sac at 7 weeks success stories 2010;95:201-210. doi: 10.1159/000315953. However, it is limited to the same antigens that are available for skin testing. Approximately one third of anaphylactic episodes are triggered by foods such as shellfish, peanuts, eggs, fish, milk, and tree nuts (e.g., almonds, hazelnuts, walnuts, pecans); however, the true incidence is probably underestimated. The https:// ensures that you are connecting to the Written instructions should be given. glucocorticosteroid vs albuterol for anaphylaxis. Your provider might ask you questions about previous allergic reactions, including whether you've reacted to: Many conditions have signs and symptoms similar to those of anaphylaxis. Examples of common etiologies associated with anaphylaxis are listed in the Table. Federal government websites often end in .gov or .mil. Treat hypotension with IV fluids or colloid replacement, and consider use of a vasopressor such as dopamine (Intropin). You can connect with others who understand what it is like to live with asthma and allergies. 2017 Sep-Oct;5(5):1194-1205. doi: 10.1016/j.jaip.2017.05.022. Anaphylaxis: acute treatment and management. However, when gastrointestinal symptoms predominate or cardiopulmonary collapse makes obtaining a history impossible, anaphylaxis may be confused with other entities. Corticosteroids appear to reduce the length of hospital stay, but did not reduce revisits to the emergency department. At discharge, the patient should be told to return for any recurrent symptoms. During an anaphylactic attack, you can give yourself the drug using an autoinjector. Simultaneous H1 and H2 blockade may be superior to H1 blockade alone, so diphenhydramine (Benadryl), 1 to 2 mg per kg (maximum 50 mg) intravenously or intramuscularly, may be used in conjunction with ranitidine (Zantac), 1 mg per kg intravenously, or cimetidine (Tagamet), 4 mg per kg intravenously. Overall, aspirin accounts for an estimated 3 percent of anaphylactic reactions.8 Symptoms may start immediately or several hours after ingestion.