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Sean G., M.D. - August 5, 2015 9:20 AM
the commentators mentioned essentially benadryl was the mainstay for allergic rxns and epi used much less commonly "only for the severe rxn".... That does not ring true with me. When pts present to the ER for allergic rxns most of the time it is because they are really uncomfortable from hives GI edema, or breathing issues...its rare I see someone with a minor local allergic rxn which is really the only rxn I avoid epi in. H1, H2 blockers and steroids do nothing for the rxns that have already occurred and the only thing that actually reverses the urticaria and edema causing the annoying sx is epi. So I use epi often, for all but the most benign allergic rxns. I use it IM when the rxn is just a bad one system dz, and reserve IV epi for the serious rxns. I think if I gave someone with severe urticaria just benadryl and steroids and sent them home an hour later still covered in hives they would be a bit dissatisfied.