Modified Anaphylaxis Action Plan for COVID19 Pandemic

    Wednesday, 22 April 2020 18:01  Blog

Due to the COVID19 pandemic, people are trying to avoid going the Emergency Room unless it is absolutely necessary. New guidelines discuss whether it is absolutely necessary to go to the emergency room after an allergic reaction.

The treatment for severe allergic reactions (anaphylaxis) remains prompt use of injectable epinephrine (EpiPen, Auvi-Q, and generic epinephrine injectors). Typically, we recommend that after using epinephrine for an allergic reaction, you call 911 and go to the ER to get observed. I always try to explain that it is not the injection of the medication that requires the emergency room visit, but the allergic reaction itself. Anaphylaxis is a life-threatening event. One dose of epinephrine, given promptly, usually will resolve the symptoms. However, sometimes as the epinephrine wears off, the allergic reaction can return, and this is the reason for going to the ER.

Knowing that people are hesitant to potentially expose themselves to coronavirus, and that they do not want to over burden the healthcare system, new recommendations for the use of epinephrine in anaphylaxis have been developed for use during the pandemic.

If you are experiencing an allergic reaction, use your epinephrine as instructed. Then, if you are alone – call 911 (you want someone else to make sure that you are ok). If you have a family member or roommate available to watch you, then you can lay down with your feet elevated in a room near the front door of your house or apartment. Have your family member talk to you, keep you comfortable, and check on you. You can take an antihistamine now (preferably once that won’t make you sleepy), and if you have asthma, you can take your inhaler if you are feeling wheezy (NOTE: use your epinephrine FIRST, then use your other medications if you feel you need them). You should start to feel better within 5-10 minutes of using the epinephrine.  If you do not start to feel better, use your second injector and call 911. If you are feeling better after the first injection, continue close monitoring for 4-6 hours. If at any time, you feel that your symptoms are returning or worsening, use your second epinephrine injector and call 911. 

Some patients should always call 911 immediately after using the first dose of epinephrine. These include patients who:

  • Have had an allergic reaction in the past that required more than one dose of epinephrine
  • Have a history of very severe allergic reactions (For example, someone who needed to spend the night in the hospital after a reaction in the past)
  • Have poorly controlled asthma
  • Are too nervous to feel comfortable staying home after using epinephrine

To safely implement this, make sure that your epinephrine injectors are always available and are not expired. Make sure that you always carry two (2) epinephrine injectors together. If you have a reaction and only have one injector with you, call 911 immediately after use.

If you are unsure if this is the right plan for you, or your epinephrine injectors are expired, please call the office to discuss with the physicians. We are still seeing patients via “televisits” during the pandemic.