While trying to still absorb the tragic food allergy death of young Giovanni last week, I emailed allergists, Joshua Jacobs and Allyson Tevrizian of the Allergy and Asthma Medical Group of the Bay Area (San Francisco East Bay) with two questions. Of course, we don’t know the details of the Giovanni’s fatal food allergic reaction, but his mother made a comment on facebook about Benedryl® working in the past. I kept asking myself, did she carry an EpiPen® or Auvi-Q® or did she believe her son’s reactions would always be treated with Benedryl® ? This statement kept nagging me to the point I had to ask…
Question #1:
Last week a 14 year old boy died from a peanut reaction. His mother posted on facebook that Benedryl® had worked in the past. If it worked in the past, then why would it not work for every allergic reaction? How powerful is Benedryl during an allergic reaction?
Image of Dr. Allyson Tevrizian courtesy of Allergy and Asthma Medical Group of the Bay Area
Answer from Dr. Tevrizian… “Benedryl® is not first line treatment for an anaphylactic reaction. Injectable epinephrine is the only thing that if given promptly (within the first few minutes of symptom development), will reverse anaphylaxis. Benedryl® and other medications such as an albuterol inhaler do not treat the life threatening consequences of anaphylaxis. Benedryl® is also absorbed too slow to act immediately. Benedryl® will only decrease itching and rash rather than stop anaphylaxis”.
Image of Dr. Joshua Jacobs courtesy of Allergy and Asthma Medical Group of the Bay Area
Answer from Dr. Jacobs… “To reinforce what Dr. Tevrizian said; Benedryl® does not treat an allergic reaction. It only gives some symptom relief. Anaphylaxis is not uniformly fatal, so many people get away with an antihistamine and think that they have actually treated their anaphylaxis, when, in reality, it would have resolved on its own anyway. This reinforces the belief that Benedryl® treated their reaction. Epinephrine is the only medication that we know that has any significant effect on the outcome of anaphylaxis. Use epi first, ask questions later”!
Question #2:
Why do you think patients are not carrying or using epinephrine?
Answer from Dr. Tevrizian… “I believe people are not carrying epinephrine for a variety of reasons.
Number one: there is a general misunderstanding that Benedryl® will treat anaphylaxis just as well as epinephrine. This is not the case.
Number two: people are wary of epinephrine: it is a shot, it seems intense (anyone see Pulp Fiction?), it is more cumbersome to carry and maintain, and people are afraid they are going to cause harm by giving it. The reality is that epinephrine in the doses of an injectable device is quite safe. Any harm comes from not giving epinephrine-this has been proven time and time again when dealing with anaphylaxis.
Injectable epinephrine is by definition a shot and this can cause some anxiety. I recommend trying to have patients practice with a trainer device and then use an expired epinephrine device on an orange. People feel how it’s done and also see that the needle is not long and scary. I also have people practice with the trainer routinely so they get used to the drill. Regarding the care of the injectable epinephrine, there are a couple of different epinephrine devices to choose from and the patient can tailor that choice to his/her personal needs. There are also a number of fashionable accessories in which to put one’s injectable epinephrine if one desires. All things considered, while there is a little adjustment, the benefit and saving of a life are worth every minute!”
Thank you Dr. Jacobs and Dr. Tevrizian! It seems that the moral of this possibly life saving story is that Benedryl® is NOT going to stop anaphylaxis and all of us need to work with our physicians to determine the best epinephrine auto-injector for our lives, feel comfortable using it and learn when to use it. Oh, and you can be fashionable too while carrying your epinephrine on you at all time!
One of the hardest things I find about managing both life threatening food allergies and asthma is talking to others. I hate to be the one that might be perceived as demanding, pushing or for asking too much. What I now know, fourteen years later, is that honest, clear information presented with kindness works!..
I agree with this advice 100% Caroline, and thank you so much for publishing it. I too have my son only carry epinephrine (2 doses), to ensure there’s no hesitation as well. We illustrate and emphasize the slow and inadequate action of antihistamines repeatedly in our online anaphylaxis first aid course at epipentraining.com. If I may be so bold to mention it, taking the course is extremely valuable and takes one’s confidence to respond effectively far beyond injecting epinephrine into an orange. If any of your readers would like to take the course, they can use activation code EPICENTER to save 30%. I have never seen a case of allergic injury or death when the protocol taught in the course is followed, and that’s why I created it with Dr. Greenwald. Best ~ Elizabeth Goldenberg
Elizabeth, be bold! I am a BIG EPICENTER fan. Thanks for the discount for our readers!!!!
I had to use the Epi pen (UK) only two weeks ago on my son, who had eaten a brazil nut, he had eaten them a few times before with no reaction, but this time he had a reaction, he started by saying that he had tummy ache and felt ‘unwell’ so we gave him anti histimine ‘Benedryl’ then he became wheezy, so we gave him his ventolin inhaler, within minutes it was clearly obvious that these were not working, so we gave him the epi pen. First time ever, he is 7 years old and we have known about his multi allergies since he was a baby. Just so glad that all the information i have ever read, really kicked in. Knowledge is key.
Paula, thank you for sharing your story. What a perfect example of understanding the need for epinephrine. I’m even happier to hear that the story ended well. How disappointing though that another allergic was added to your son’s list! This is something that worries me. He is lucky to have a good mom like you in charge!
I was reading this saying, “Yes! Uh huh, yes, exactly!!” This is one of the most important points that bears repeating time and time again – EPINEPHRINE the first line of treatment!
It was Dr. Jacobs who made us remove Benedryl from our emergency bags. He feared I would go there first and I think he was probably right. Selena…can’t wait to see you next week!
My son would not take the Benedryl, because of the taste…he’s 4, and I think it would waste too much time trying to coax him into taking it. So, I don’t even carry it anymore. Our allergy doc has just told us to inject the epipen and that you will never go wrong doing that.
Atomic Mom, sounds like your son intuitively understood the best course of action! You said it perfectly, “you will never go wrong”. Have a great Monday!
I found two quotes especially useful which I haven’t heard put this way before:
1. “Benedryl® will only decrease itching and rash rather than stop anaphylaxis” – a good way to explain to others
2. “Anaphylaxis is not uniformly fatal, so many people get away with an antihistamine and think that they have actually treated their anaphylaxis, when, in reality, it would have resolved on its own anyway”
Thanks for posting this!
Kathryn,
Thanks to the good doctors for sharing with us! The second quote really resonated with me: Anaphylaxis is NOT uniformly fatal…. I think Benedryl has inadvertently created a false sense of solution. I keep wondering if Giovanni’s mom knew to carry an Epipen and had or did she believe the Benedryl would take care of everything? Just heart breaking either way! I’m grateful for Drs. Tevrizian and Jacobs for finding time to share information with us.
That is a great idea to not have the benedryl present! I have on our action plan to go epi; but it is true that I or another caregiver may go with that if it is present. This is such an informative and helpful post. Thank you!
This is awesome Caroline! I just shared it on another FB exchange. To add to this: Benedryl cures hives, epinephrine saves lives. And I just came up with this: Don’t be afraid to use epinephrine when your child has a reaction now so that they won’t become a teen who is afraid to use it later! And for the record, we don’t carry Benedryl for the same reason you don’t. Now here is a further medical question for you. Is Benedryl counter-indicated in anaphylaxis? For instance, if you give your toddler Benedryl during a reaction you won’t know if they are passing out from anaphylaxis or just really tired due to Benedryl. Been there done that. I do carry Claritin and Allergra and soon will be carrying Zyrtec for other reasons, but would probably give one of those if it seemed like my daughter could ingest it, realizing that in tablet form it would take a while to kick in. And further, does Benedryl have any pharmacological effect that could actually make anaphylaxis worse? There was some discussion of this a while back.
Kelly, EXCELLENT sharing!!! Thank you so much! I love your slogan: Benedryl cures lives, epinephrine saves lives. Also, I think you bring up a strong point: if our children see us hesitate of course they too will hesitate when they are teens. Thanks again for joining our discussion.
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