"Ask the Allergist": Dr. Ralph Strauss
“What is the role of Orapred in treating anaphylaxis?
Can it be used during an acute reaction if medical personnel are not available?”
As you know, the most important drug to treat anaphylaxis is epinephrine. This drug works within a few minutes to reverse the effects of anaphylaxis on blood vessels, mucous membranes, airway passages and chemical mediators that cause the reaction. Antihistamines such as Benadryl may help with some of the symptoms of itch, hives, and sneezing and have an average onset of action of 30 -40 minutes. Orapred is the brand name of a steroid medication called prednisolone. Many patients after they recover from the initial effects of anaphylaxis experience the release of a “second wave” of chemical mediators that can cause a recurrence of anaphylactic symptoms hours later. This is the reason that it is important to observe the patient for several hours in the ER or overnight if they experienced a serious anaphylactic reaction. Steroids are used to help prevent this second phase of anaphylaxis. Most doctors give a dose of steroids and may prescribe it for 1-3 days after the event but it does not play any role in the initial management of anaphylactic reactions.
Epinephrine is the medication to use to treat anaphylaxis and the case you recently sent me highlights that again. It should be used aggressively without delay. Benadryl or antihistamines are additional medications that help and can be used for a mild reaction – eg. hives only. Steroids are given once the patient is stabilized to prevent recurrent symptoms hours later and play NO role in the acute management of anaphylaxis based on current evidence.
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