Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
The Myth: I should be afraid to use my EpiPen
As most people know, there has been a significant increase in allergies in America over the last several decades. Allergic reactions can be mild with only an itchy nose and mouth and sneezing. In some cases, however, they can be severe. Anaphylactic reactions with shortness of breath, loss of consciousness, and in some cases death may occur. There are roughly 150 deaths in America caused by food allergies and at least 50 deaths caused by stinging insects like bees, wasps, hornets, and yellow jackets per year. The good news is that there is very effective treatment for allergic reactions. The bad news is that severe anaphylactic reactions are frequently under-recognized and undertreated.
The primary goal of treating severe allergic reactions should be early recognition and early treatment with epinephrine, more commonly known as adrenaline. There is a popular myth that people should be afraid to use epinephrine/adrenaline because “the allergy is not that severe” or “it can cause heart attacks”. Epinephrine is considered a very safe medicine for most people and, the risk of harming oneself with epinephrine, is usually lower than the risk of letting a severe allergic reaction go without life-saving epinephrine treatment. Blaming epinephrine for deaths in treating allergic reactions is often not accurate as it is impossible to determine if the fatality was due to physiologic changes from the allergic reaction, or the effects of epinephrine.
Often people use antihistamines like Benadryl, Zyrtec, Claritin or Allegra before epinephrine which is usually not a good idea. Antihistamines only relieve mild allergy symptoms and there is no scientific evidence to show that antihistamines are effective in anaphylaxis. We also know from scientific studies that most fatal allergic reactions occur within 15-30 minutes after the exposure. Antihistamines can take 1-2 hours to really start working but epinephrine starts to work rapidly in approximately 3-10 minutes. We also know that the number one risk factor for deaths from allergic food reactions is delayed use of epinephrine.
This means that once anaphylaxis is recognized, rapid administration of epinephrine is the most important treatment that can be life-saving. When in doubt about the severity of an allergic reaction, presume it is severe and administer epinephrine as well. Clearly, epinephrine is the superior choice for treatment of severe anaphylactic reactions and people should not be afraid to use it.
The Verdict: The myth that you should be afraid to use your EpiPen is BUSTED!
Dr. Sean Lucas
Allergy Partners of Coastal Carolina