Antihistamines only delay emergency treatment for anaphylaxis

NEW ORLEANS — Giving antihistamines to children who experience anaphylaxis only endangers their lives by delaying emergency treatment, researchers reported. Instead, children should be administered epinephrine and go straight to the ED.

Evan Wiley, MD, a pediatric resident at Jacobi Medical Center in New York, and another colleague reviewed the medical records of children and young adults who were admitted to a community pediatric hospital between July 2015 and January 2019. They found that 72% of patients who first took antihistamines at home delayed seeking medical care compared with only 25% of those who did not take them. Patients who took antihistamines were more than seven times more likely to delay emergency treatment (OR = 7.45; 95% CI, 2.71-20.5), they said.

“The most basic thing that providers need to do is make sure we’re being really complete in our counseling,” Wiley told Infectious Diseases in Children. “My experience has been that a lot of providers are very good about talking about using the epinephrine injector, and they’re pretty good about talking about coming into the hospital, but I think it’s actually pretty rare for physicians to be explicit about antihistamines as being something that’s helpful for some symptoms like rash or itchiness, but not life-saving.”

The reasons why people give children antihistamines instead of epinephrine were not explored in Wiley’s study, but he said this is something he would like to research moving forward. He suggested that people may be uncomfortable injecting epinephrine, or they may be looking to avoid a trip to the ED, but only additional research could confirm those suspicions.

Reference:

Wiley E, et al. The association of antihistamine administration and delayed presentation for care in pediatric patients admitted with anaphylaxis. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.

Disclosure: Wiley reports no relevant financial disclosures.