Medical Question (Anaphylaxis and Diphenhydramine)

[Riot]

Medical scenario...

You're out in the field...someone gets stung by a bee and they're having a severe allergic reaction (anaphylaxis). You have diphenhydramine (aka Benadryl) on you in a pill form but your partner can't swallow anything...what do you do?

I ask because I wanted to know people's thoughts on this...if they have contingencies for anaphylaxis or if they've even thought of this scenario...I also wanted to know what you all thought about opening a granular capsule of diphenhydramine and dumping the pill in their eye. Google was no help in this matter...the Nurses I asked seemed to be flabbergasted and stated if I didn't have epinephrine (EPI-Pen) they would die if they reached anaphylaxis. However, I refuse to simply accept that and not think that their wouldn't be a chance of survival for anaphylaxis if you didn't have epinephrine.

We all know that dry, pill form medication will last much longer than liquid medication...so having lots of Benadryl in pill form is a must for people with allergies. Nevertheless, how would you administer it if their throat was too swallon to swallow? Mix it with Saline and inject it in them? Put it under their tounge? Do you all just suggest stocking up on a dozen EPI-Pens?

Your thoughts and suggestions are appreciated....

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[7SFCW4]

What about Benadryl in liquid form?

http://www.amazon.com/Diphenhydrami...id=1425225482&sr=8-2&keywords=benadryl+liquid

 

[Stepside2000]

I'm curious about this too. I have friends who have strong enough allergies that they may need an epi pen if they had a reaction, but they don't always carry one. I asked the last doctor I had if I could get a Rx for one since I have many friends who could need it and I'm usually the one most likely to have a first aid kit handy, and they said no since I had no immediate family(wife, kids, etc) who need it so he couldn't perscribe me one. I haven't asked my current doctor about it yet.

I would think if you ground it up and mixed with some water for them to try to drink it might work. If they are already far enough in anaphylaxis that they couldn't swallow a small amount of water, then I'm not sure Benadryl in any form would help enough unless your within a short drive to access to where an epi pen is(dr office or hospital).

 

[Riot]

What about Benadryl in liquid form?

http://www.amazon.com/Diphenhydrami...id=1425225482&sr=8-2&keywords=benadryl+liquid

After storing them for a few years I noticed that they don't keep very well...

 

[bolus]

There is no equivalent medication to epinephrine for anaphylaxis. If someone is out in the woods who has history of that severe of allergic reaction without an Epipen then they should not be out in the woods

Benedryl and other H1 antihistamines (H2 antihistamines for that matter), will NOT work for upper or lower airway swelling, hypotension or shock. You could give it IV in the field and it still wont help. They relieve itching and hives only.

If someone is in anaphylaxis and is unable to take a pill or talk they are basically F'd without an Epipen or an ambulance 2-3 minutes away.

I prescribe travel kits for my patients that are going on extended trips into the woods. Epipen, antibiotics, anti nausea and diarrhea stuff. A request for an Epipen from your doc even if there is no history of anaphylaxis should not be a problem for a doc to prescribe.

Stepside2000, sorry your doc would not prescribe one. He/She is just being a douche. There is no clinical concern with prescribing anyone an Epipen. It cant be abused. As long as someone has good instruction on how to use it. If your doc is that much of a tight butt, just lie and say a family member might need it.

 

[Riot]

There is no equivalent medication to epinephrine for anaphylaxis. If someone is out in the woods who has history of that severe of allergic reaction without an Epipen then they should not be out in the woods

Benedryl and other H1 antihistamines (H2 antihistamines for that matter), will NOT work for upper or lower airway swelling, hypotension or shock. You would give it u.the field and it still wont help. They relieve itching and hives on

If someone is in anaphylaxis and is unable to take a pill or talk they are basically F'd without an Epipen or an ambulance 2-3 minutes away.

I prescribe travel kits for my patients that are going on extended trips into the woods. Epipen, antibiotics, anti nausea and diarrhea stuff. A request for an Epipen from your doc even if there is no history of anaphylaxis should not be a problem for a doc to prescribe.

Stepside2000, sorry your doc would not prescribe one. He/She is just being a douche. There is no clinical concern with prescribing anyone an Epipen. It cant be abused. As long as someone has good instruction on how to use it. If your doc is that much of a tight butt, just lie and say a family member might need it.

Thank you for this...I did not know that Benadryl would not be effective for a severe allergic reaction...I think there may be some misconceptions out there, mainly from the book "Where There is No Doctor"

Severe allergic reaction and epinephrine (Adrenalin, p. 385)

allergic shock (p. 70) and, if possible, diphenhydramine (Benadryl, p. 386).

To prevent a serious reaction from an injection:

1. Use injections only when absolutely necessary.

2. Before injecting one of the medicines listed above, always have ready 2 ampules
of epinephrine (​

Adrenalin, p. 385) and an ampule of an antihistamine like promethazine​

(Phenergan, p. 385) or diphenhydramine (Benadryl, p. 386).

3. Before injecting, always ask if at any other time a similar injection caused itching or
other reactions. If the person says yes, do not use this medicine or any other medicine of
the same group, either injected or taken by mouth.

4. In very serious cases, like tetanus or snakebite, if there is a good chance that
the antitoxin might produce an allergic reaction (if the person suffers from allergies
or asthma or has had horse serum before), inject promethazine or diphenhydramine
15 minutes before giving the antitoxin: adults, 25 to 50 mg.; children, 10 to 25 mg.,
depending on their size (see p. 386).

5. After injecting any medicine, always stay with the person for 30 minutes to watch
for any of the following signs of ALLERGIC SHOCK:
• cool, moist, pale, gray skin (cold sweat)
• weak, rapid pulse or heartbeat
• difficulty breathing
• loss of consciousness

6. If these signs appear, immediately inject epinephrine (​

Adrenalin): adults, 1/2 ml.;​

children, 1/3 to 1/4 ml, depending on their size. Treat the person for SHOCK (see p. 77).​

Follow by giving an antihistamine in double the normal dose.

Some of the consesus even on SurvivalBlog.com was to simply give an individual diphenhydramine before giving them any medications they've never taken before in case they have an allergic reaction.

1. Antihistamines. Good for treating a variety of minor problems, antihistamines should also be used for life-threatening anaphylaxis, generally in combination with epinephrine (see #1 above). People are most aware of their value for treating colds and allergies, but all the OTC antihistamines can be used for treating hives and itching of other causes. The sedating antihistamines (diphenhydramine, doxylamine, and chlorpheniramine) are useful as sleep aids and are somewhat helpful for reducing anxiety. The non-sedating antihistamines (Claritin, Allegra, Zyrtec) are best if alertness is essential.

Bolus, if you are, indeed, a medical professional I will take your word over a few publications on the internet and get some EPI-Pens post-haste...I am just pointing out that there may be some mis-information out there so I do appreciate the response. I think it's best that I listen to you and the RN here at work that also made it clear that Benadryl won't save you for Anaphylaxis

 

[bolus]

Im a primary care doc, not an ER doc or someone who is an expert on wilderness medicine. So I dont treat it on a regular basis. Benedryl is used in conjunction with Epi most of the time though isnt a lot of data behind using it. Anaphylaxis is not easy to study because of how serious it is and how rapidly it progresses.

My point was to not expect benedryl to work when it is truly anaphylaxis. It is a great medication to have in a travel kit, but is not a substitute for Epi in that condition

The only problem with Epi is it has a shelf life so you do need to replace them when they go out of date.

 

[Riot]

The only problem with Epi is it has a shelf life so you do need to replace them when they go out of date.

Yeah...18 months...I wonder how long after the shelf life they'll still actually work, though.

 

[The Heretic]

This was a subject a couple of months ago on the survivalist boards - i.e., how long would an epi pen last? IIRC it was one year. That combined with the cost (hundreds of dollars) more or less convinced me that it was something that I would pass on for now even though I have one family member that *might* need one (she has other meds for those reactions too).

I did buy a bunch of generic Benadryl tabs, but my impression was that these are something that you use before someone starts showing a reaction, not after, and as others have said, if you are in dire need of an epi-pen then Benadryl won't help.

 

[bolus]

If you can get your doc to prescribe it then insurance will cover it at the pharmacy. The only problem is if the insurance requires a prior authorization where the doc has to prove that you had an event where you needed in the past. That depends on the insurance.

Epi itself is cheap, like $10 for a solution of 30 ml. Its the drug company that makes the autoinjector pen that holds 0.3 ml and charges $180 for it. That's 181,718% mark up for in syringe you use once for 33 cents of medication. F'ing drug companies.

 

[Stepside2000]

Thanks for the info bolus, I'll have to look into it with my current doctor. It was my last doctor I had a couple years ago that said no. But now I have the same primary as my wife and daughter. I just haven't thought to ask yet. Good info.

 

[johnny bob]

I ride a motorcycle with a small fairing that deflects wasps and bees into my neck usually resulting in a half golf ball size sting. Why dont I remove the fairing you ask. Ha it looks cool and does keep the wind pressure off my chest. For years I have carried Adolph's meat tenderizer or baking soda to make a paste with water and put it on the sting. It has worked ok but in preperation for this summer I order a product called Mitigator sting & bite treatment. It is for external use only. It is said to neutralize toxins and prevent blisters etc. I got it from Texas through EBAY. 10 packets for $16. I know my reactions are not as severe as those being discussed but just thought I mention the Mitigator as it is said to work for wasps, bees, chiggers, fleas, ticks, and mosquitos. We shall see.

 

[CoastRange57]

Im a primary care doc,

Would you happen to be on the west side Hillsboro area ?

 

[44mag2ndamend]

Epi itself is cheap, like $10 for a solution of 30 ml. Its the drug company that makes the autoinjector pen that holds 0.3 ml and charges $180 for it. That's 181,718% mark up for in syringe you use once for 33 cents of medication. F'ing drug companies.

FREAKING WOW!

No wonder doctors have a hard time treating their patients.

 

[boogerhook]

There is no equivalent medication to epinephrine for anaphylaxis. If someone is out in the woods who has history of that severe of allergic reaction without an Epipen then they should not be out in the woods

Benedryl and other H1 antihistamines (H2 antihistamines for that matter), will NOT work for upper or lower airway swelling, hypotension or shock. You could give it IV in the field and it still wont help. They relieve itching and hives only.

If someone is in anaphylaxis and is unable to take a pill or talk they are basically F'd without an Epipen or an ambulance 2-3 minutes away.

I prescribe travel kits for my patients that are going on extended trips into the woods. Epipen, antibiotics, anti nausea and diarrhea stuff. A request for an Epipen from your doc even if there is no history of anaphylaxis should not be a problem for a doc to prescribe.

Stepside2000, sorry your doc would not prescribe one. He/She is just being a douche. There is no clinical concern with prescribing anyone an Epipen. It cant be abused. As long as someone has good instruction on how to use it. If your doc is that much of a tight butt, just lie and say a family member might need it.

I have prophylactic prescriptions of epinephrine for both my children, and we take them with us on hikes etc. Our pediatrician had no problems prescribing them. That said, a person with high blood pressure and other vascular issues could suffer a heart attack or stroke if given without true anaphylaxis being present. In my neck of the woods they recently changed the EMS protocols from assist only to actively administering. In Europe we used to "hang"/position people upside down after allergic reactions to counter vascular dilation and keep blood flowing through the head - don't know how much of that is still considered good practice though ;-)

 

[balline36m3]

I have an allergy to bees and am prescribed an epi pen. I have not had any kind of reaction to wasp or hornet stings only honey bees. But I can tell you I am in very very bad shape in less than five minutes when I get stung by a bee. Luckily it has only happened three times since I was five(29 now). I have one for me and my son now just in case. I have used Benadryl for wasp stings and it helps a little but not with bee stings. I'll tell you you've never had a rush until you have been shot with an epi pen lol. Stuff lights your butt on fire and you can't calm down for a good three hours or so

 

[bolus]

I have prophylactic prescriptions of epinephrine for both my children, and we take them with us on hikes etc. Our pediatrician had no problems prescribing them. That said, a person with high blood pressure and other vascular issues could suffer a heart attack or stroke if given without true anaphylaxis being present. In my neck of the woods they recently changed the EMS protocols from assist only to actively administering. In Europe we used to "hang"/position people upside down after allergic reactions to counter vascular dilation and keep blood flowing through the head - don't know how much of that is still considered good practice though ;-)

There are definitely risks with using it and it should be last resort. Its too bad that so much of our behavior is shaped by risk of getting sued though.

 

[WAYNO]

So...A subject that's near and dear to me, also. I asked the Daktari if epinephrin-containing over the counter asthma inhalers could be used beneficially if an epi-pen was not available. Surprisingly, this Dr did not have an answer. So, what do you think?

WAYNO.

 

[bolus]

So...A subject that's near and dear to me, also. I asked the Daktari if epinephrin-containing over the counter asthma inhalers could be used beneficially if an epi-pen was not available. Surprisingly, this Dr did not have an answer. So, what do you think?

WAYNO.

I may be wrong but I thought the epi containing inhalers were all removed from over the counter a few years ago?

This is way beyond my expertise but some emergency medication treatments can be given via endotracheal tube when coding someone (emergency response to someone's heart stopping). But there is no clinical use for inhaled epinephrine during anaphylaxis (no doctor would do that in a hospital setting). I doubt it would do anything.

 

[WAYNO]

I may be wrong but I thought the epi containing inhalers were all removed from over the counter a few years ago?

This is way beyond my expertise but some emergency medication treatments can be given via endotracheal tube when coding someone (emergency response to someone's heart stopping). But there is no clinical use for inhaled epinephrine during anaphylaxis (no doctor would do that in a hospital setting). I doubt it would do anything.

Apparently, there is recently another OTC product, containing epinephrine, that is now safe for the ozone layer.

According to a press release from Nephron, its product, Asthmanefrin, was available in retail outlets beginning in late August. The inhaler contains 11.25 mg racepinephrine per 0.5 ml puff as an active ingredient. The solution is not made with CFCs or preservatives. It is available as a 10-vial starter kid that includes an atomizer and as a 30-vial refill kit. - See more at: http://www.pharmacytimes.com/news/New-OTC-Inhaler-on-Store-Shelves#sthash.PsQrHPUL.dpuf


WAYNO.