The slower the onset of the reaction, the less likely it will be anaphylactic.

Treatment:

• Give an antihistamines, such as diphenhydramine (e.g. Benadryl), which should take effect in 15-30 min.
  Liquid benadryl will take effect sooner or you can grind up pills.
• If patient shows signs and symptoms of anaphylaxis (swollen face, lips and tongue; difficulty swallowing; systemic hives; respiratory distress; inability to speak in more than one or two word clusters; signs and symptoms of shock) administer epinephrine:
  • Call 911
  • Administer epinephrine, a synthetic adrenalin, with an epipen®. See below.
• When the patient is again able to swallow, they should take an oral antihistamine.

- Primatine mist is an over the counter inhaler that has epinephrine in it. It also has a much longer shelf life.

EpiPen®

• An EpiPen® injects epinephrine a synthetic adrenalin.
• should be used only when your thinking "I cant breathe and I am going to die" or "I really need to go to the emergency room".
• 25-30% of the time a second severe reaction can occur within hours of the first. This is known as a biphasic reaction and requires a second dose of epinephrine.
  symptomatic patients should be observed for at least 3 - 6 hours after symptoms are controlled.
• Note: up to 90% of the epinephrine liquid stays in the auto-injector once it has been used.
• A dose may wear off after 10-20 minutes.
• A typical expiration range is between 12 and 16 months from time of purchase.
  Apparently most pharmacies receive their yearly EpiPen shipment in March.
  If, however, the only autoinjector available is an outdated one, it could be used as long as no discoloration or precipitates are apparent because the potential benefit of using it is greater than the potential risk of a suboptimal epinephrine dose or of no epinephrine treatment at all.
• Recommended storage temperature is 60 - 86° F; do not refrigerate.
• The EpiPen is designed to be injected into the outer mid-thigh only and can go thru clothes. (thigh area means take fist with thumb out,hold at side and press against leg naturally) press black knob against this area firmly. You will hear a snap..hold for 5-10 seconds..remove.
  You can rub the injection site for more rapid absorption.
• EpiPen Auto-Injectors should be used with extreme caution in people who have heart disease. Side effects of EpiPen Auto-Injectors may include fast or irregular heartbeat, nausea, and breathing difficulty. Certain side effects may be increased if EpiPen Auto-Injectors are used while taking tricyclic antidepressants or MAOIs.