New York—When children began showing symptoms of anaphylaxis, parents often administer antihistamine medications in hopes of stemming the extreme allergic reaction. A new study explains why that is a bad idea.

The presentation at the American Academy of Pediatrics (AAP) 2019 National Conference and Exhibition in New Orleans argues that use of the drugs can delay emergency treatment, which can lead to far worse outcomes.

“Anyone experiencing symptoms of anaphylaxis, which can constrict airways and circulation, should seek medical care immediately and use an epinephrine auto-injector if they have been prescribed one,” said lead author Evan Wiley, MD, a pediatric resident at Jacobi Medical Center in New York.

Anaphylaxis can be rapidly fatal, but the prompt administration of epinephrine can prevent mortality, according to Dr. Wiley. He warns against the risky mistake of giving the child an antihistamine, however, and waiting to see if the reaction subsides, explaining, “While the use of antihistamines might help some allergic symptoms such as rash or itching, those medications will not prevent death from anaphylaxis. It is important for patients with anaphylaxis to seek immediate medical care, since the only proven lifesaving treatment is epinephrine, and any delay in receiving appropriate treatment can be fatal.”

Background information in the study estimated that 1.5 per 100,000 children are hospitalized for food-associated anaphylaxis in the United States each year. It notes that, while antihistamines relieve some anaphylaxis symptoms, they cannot prevent death.

Researchers sought to determine the association between home administration of antihistamines prior to hospital presentation and delayed seeking of care in children admitted with anaphylaxis. To do that, they conducted a retrospective chart review for patients admitted with a diagnosis of anaphylaxis to the pediatric hospital floor or admitted to an intensive-care unit at a community hospital from July 1, 2015, to January 15, 2019.

Included in the study were youths younger than age 21 years who had confirmed anaphylaxis symptoms. The primary exposure variable was antihistamine administration by a patient or caregiver prior to hospital presentation, while the primary outcome variable was any delay in immediately seeking care once the patient met criteria for anaphylaxis.

Ultimately, the study team identified 169 admissions with a diagnosis of anaphylaxis for patients ranging in age from 8 months to 20 years; 57% were male.

Results indicated that, in patients administered antihistamines (32 total), 72% delayed seeking care; of those not administered antihistamines (48 total) 25% delayed seeking care (P <.001). That meant administration of antihistamine was associated with 7.45 times increased odds of delay in seeking care (OR 7.45 [2.71, 20.50], P <.001),” according to the researchers.

“Home administration of antihistamines for anaphylaxis prior to hospital presentation was significantly associated with an increased odds of delay in immediately seeking care. Delayed presentation for anaphylaxis can delay epinephrine administration and increase mortality,” the authors write. “Future studies are needed to confirm this association, but the findings suggest the need to optimize patient education on the limited role of antihistamines for anaphylaxis and the need for immediate presentation to care at anaphylaxis onset.”

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