Eppi pens

[Southern Heritage]

Would having Zyrtec and/or Xyzal help?

Not a medical dude, exactly but try to think around corners a little.

Epi as a first line because its fast, of course.

They did tell me to keep Xyzal and just take it daily. Helps with general sinus/ stuffiness

 

[Southern Heritage]

do epi pens need a prescription or can any joe shmo get one? would like to add this to my backcountry first aid kit

Yes sir. Unless you’re in Canada. I’ve been told they are around $35.00. Fortunately my insurance covers mine and I get to use the tiny ones. Like neffy and aviQ vs the giant pens.

 

[Southern Heritage]

No matter what you use for a reaction, make sure whoever you are hunting with knows where it is in your pack, pocket or wherever you keep it. You may not be able to communicate effectively in an emergency. Them knowing where it is may save your life.

I am real good about doing this.

 

[fwafwow]

I am not allergic, and am unaware of any of my hunting buddies being allergic, but at one point I kept an Epi in my IFAK. At that time I got two for about $35 (IIRC that was my copay). I think there may be some challenge in keeping the Epi the right temperature. Does heat cause it to lose efficacy?

 

[Southern Heritage]

I am not allergic, and am unaware of any of my hunting buddies being allergic, but at one point I kept an Epi in my IFAK. At that time I got two for about $35 (IIRC that was my copay). I think there may be some challenge in keeping the Epi the right temperature. Does heat cause it to lose efficacy?

I live in Alabama and this last one I used was 3 years old. I have the floating around. Keep them in my tractors, boat, trucks etc. each year I get two new ones. Saying that this one lived In my side by side and worked just fine

 

[ericF]

Talk to your doctor and get a low dose 10 day course of Prednisone prescribed. Somewhere around 20mg-30mg per day that you can take into the Backcountry with you. The last thing you want to deal with is multiple reactions. At the first reaction you can use the epi-pen immediately and follow that up with the Prednisone. Alot of doctors prefer not to prescribe corticosteroid like Prednisone for long term use so you might need to explain that will only be used for emergencies.

I'm not a doctor, but I am someone that went into Anaphylaxis at the Immunologist office while doing allergy shots for seasonal allergies that exacerbated my asthma. Two shots of epinephrine, one shot of Benadryl, and one shot of Zantac at that visit. Followed up with a high dose shot of Prednisone. That initial Anaphylaxis has led to further issues (MCAS) over the last 10 years that are finally starting to calm down in the last couple years. As others have said, a daily dose of Zyrtec should also be the normal for you.

 

[Shooter Mike]

Talk to your doctor and get a low dose 10 day course of Prednisone prescribed. Somewhere around 20mg-30mg per day that you can take into the Backcountry with you. The last thing you want to deal with is multiple reactions. At the first reaction you can use the epi-pen immediately and follow that up with the Prednisone. Alot of doctors prefer not to prescribe corticosteroid like Prednisone for long term use so you might need to explain that will only be used for emergencies.

I'm not a doctor, but I am someone that went into Anaphylaxis at the Immunologist office while doing allergy shots for seasonal allergies that exacerbated my asthma. Two shots of epinephrine, one shot of Benadryl, and one shot of Zantac at that visit. Followed up with a high dose shot of Prednisone. That initial Anaphylaxis has led to further issues (MCAS) over the last 10 years that are finally starting to calm down in the last couple years. As others have said, a daily dose of Zyrtec should also be the normal for you.

This is inline with what I was going to suggest. The steroid will help work against the biphasic reaction that can sometimes occur with an allergic reaction - also works well in treating asthma attacks. Steroids reduce inflammation, and that's exactly what's occurring during anaphylaxis or an asthma attack.

If I had an allergy and was in the backcountry, after using the epi pen I would then take the Benadryl and then the 60mg PO Prednisone. The low dose 10-20mg daily isn't going to be as effective as single dose 60mg tablet when anaphylaxis is the concern. Prednisone has a half life of 3-4 hours, and eliminates in ~ 18 hours. The higher PO dose is what will be necessary for these situations. Half life is dose dependent, also.

The H1 blocker will be more effective in reversing systemic effects, whereas the H2 blocker will help remedy any associated GI distress as a result of the histamine reaction.

 

[isleofGough]

Epi pen or nasal epi (equivalent success) carrying three and get a prescription for a steroid if needed. Histamine blockers help itching but have little role in anaphylactic shock. Be aware that generic epi pens need to be held down for 10 seconds but Epi pen non generic give the med in 3 seconds.

 

[Shooter Mike]

Histamine blockers help itching but have little role in anaphylactic shock.

That's not entirely true. Histamine causes hypervascular permeability, which is the cause of much of the swelling. The third-spacing of fluids in tissue needs to be corrected, and that's where the H1 blockers (antihistamine) have their role in the treatment of an allergic reaction. The itiching is the result of Protein Kinsases and cytokines moving from the vasculature to the tissue. Swelling reduces blood flow. Hyperpermeability reduces vascular tone. H1 blockers play an important role.

 

[isleofGough]

Incorrect. Look it up.

 

[Shooter Mike]

Incorrect. Look it up.

Uh, I did. Perhaps you should. I know my craft, how about you?

 

[Shooter Mike]

Incorrect. Look it up.

Here ya go, maybe this will help stop you from giving dangerous and incorrect advice on the internet:

Histamine Induces Vascular Hyperpermeability by Increasing Blood Flow and Endothelial Barrier Disruption In Vivo - PMC

Histamine is a mediator of allergic inflammation released mainly from mast cells. Although histamine strongly increases vascular permeability, its precise mechanism under in vivo situation remains unknown. We here attempted to reveal how histamine ...

pmc.ncbi.nlm.nih.gov

 

[isleofGough]

Lots of well done actual studies do not support your conclusion. I've treated my share of anaphylactic shock. Some of the emt's use it with little evidence.

 

[Shooter Mike]

Lots of well done actual studies do not support your conclusion. I've treated my share of anaphylactic shock. Some of the emt's use it with little evidence.

Prove me wrong. I provided a reasonable resource to support my argument. And I've treated my fair share of anaphylactic shock patients too. There is a difference between observational research and anecdotes compared to scientific research.

 

[isleofGough]

Interesting no relevant mouse study

 

[isleofGough]

From uptodate:
Adjunctive agents — Epinephrine is first-line treatment for anaphylaxis, and there is no known equivalent substitute. Once epinephrine has been administered, adjunctive therapies may be given for residual symptoms. There is no direct evidence supporting the benefit of antihistamines or glucocorticoids in anaphylaxis, although they remain in common use, and they should not be considered part of first-line therapy. Patients treated with epinephrine generally do not need any additional adjunctive agents. If symptoms or signs persist, more epinephrine should be administered. When a patient's anaphylaxis manifestations have cleared after epinephrine but the patient continues to report itching or urticaria, an antihistamine may be helpful in relieving the symptom. Antihistamines do not relieve upper or lower airway obstruction or shock.

 

[Shooter Mike]

From uptodate:
Adjunctive agents — Epinephrine is first-line treatment for anaphylaxis, and there is no known equivalent substitute. Once epinephrine has been administered, adjunctive therapies may be given for residual symptoms. There is no direct evidence supporting the benefit of antihistamines or glucocorticoids in anaphylaxis, although they remain in common use, and they should not be considered part of first-line therapy. Patients treated with epinephrine generally do not need any additional adjunctive agents. If symptoms or signs persist, more epinephrine should be administered. When a patient's anaphylaxis manifestations have cleared after epinephrine but the patient continues to report itching or urticaria, an antihistamine may be helpful in relieving the symptom. Antihistamines do not relieve upper or lower airway obstruction or shock.

source? and that's focused on airway concerns. You should know there's more to anaphylaxis than that.

 

[Shooter Mike]

I am not allergic, and am unaware of any of my hunting buddies being allergic, but at one point I kept an Epi in my IFAK. At that time I got two for about $35 (IIRC that was my copay). I think there may be some challenge in keeping the Epi the right temperature. Does heat cause it to lose efficacy?

generally, medications should be kept between 60 and 85. Some new evidence has found that brief periods outside of those temperatures have not degraded efficacy. Expiration dates need to be considered. In cases of shortages, the FDA will extend some expiration dates. This should tell us that the efficacy, while it may be degraded may still be sufficient. At $35 for two (or even $100) ... I would not hesitate to replace anything nearing expiration, or if you fear it's had a lengthy exposure to temperatures outside of the recommended range. Epi-pens are life-saving devices, especially when you're in the backcountry. Tempt fate as little as possible.

 

[JoshOR]

My son is allergic. He gets venom shots monthly at our allergy clinic. It’s a slow build for a while but now his monthly shot regimen is roughly equal to 6 stings. It’s not cheap but our insurance pays a chunk and it’s worth our piece of mind. We carry epi-pens, Benadryl, and Zyrtec.

 

[Mangata]

No doubt Epi is needed for anaphylaxis.
Agree with the H1 & H2 blockers.
Prednisone 60 mg for five or six days would be my recommendation. OP mentions having recurrence of symptoms days later that most likely would not have occurred if on a course of steroids.