Severe anaphylaxis calls for a different response. Ramesh recommended activating emergency medical services and administering a second dose of epinephrine in patients with significant hypotension, significant bronchospasm, or no response to the first dose. According to Ramesh, 80% of food-induced anaphylactic episodes resolve with 1 dose of epinephrine and 98% resolve with 2 doses, the rationale for prescribing a twin pack with every epinephrine prescription.<\/p>\n
Ramesh identified a second persistent misconception: routine reliance on antihistamines and corticosteroids as first-line management. He highlighted a guideline shift away from oral antihistamines and decongestants as primary treatment. Intranasal corticosteroids are now first-line therapy for most patients with moderate to severe allergic rhinitis, and the 2020 rhinitis update names them the preferred monotherapy for persistent disease.\u00b2<\/p>\n
Mild symptoms, such as a few hives or a single episode of emesis, can be managed appropriately with an antihistamine if they resolve. Any presentation beyond those symptoms warrants epinephrine as first-line therapy, with antihistamines and corticosteroids reserved as adjuncts, since data do not show these agents resolve anaphylaxis the way epinephrine does.<\/p>\n
Allergen Immunotherapy Underuse in Allergic Rhinitis<\/p>\n
Subcutaneous immunotherapy, commonly called allergy shots, has been in use since 1911, predating the discovery of penicillin. Ramesh noted more than 50 clinical trials each in allergic rhinitis and asthma support its efficacy across multiple allergens, and the therapy is considered standard of care for allergic rhinitis, asthma, and venom allergy.<\/p>\n
\u201cWe grossly underutilize subcutaneous immunotherapy,\u201d Ramesh said.<\/p>\n
The 2020 rhinitis practice parameter update includes recommendations for both subcutaneous and sublingual tablet immunotherapy in allergic rhinitis.\u00b2<\/p>\n
Sublingual immunotherapy offers a daily alternative, with the allergen placed under the tongue to dissolve and act through the oral mucosa. Ramesh explained both modalities work by shifting immune recognition of allergens from an allergic response to a nonallergic immune response.<\/p>\n
References<\/p>\n
Golden DBK, Wang J, Waserman S, et al. Anaphylaxis: a 2023 practice parameter update. Ann Allergy Asthma Immunol. 2024;132(2):124-176. doi:10.1016\/j.anai.2023.09.015<\/a>Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: a practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-767. doi:10.1016\/j.jaci.2020.07.007<\/a> <\/p>\n","protected":false},"excerpt":{"rendered":"Severe anaphylaxis calls for a different response. Ramesh recommended activating emergency medical services and administering a second dose…\n","protected":false},"author":2,"featured_media":646178,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[163,85,46],"class_list":["post-646177","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-health","tag-il","tag-israel"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/646177","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=646177"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/646177\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/646178"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=646177"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=646177"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=646177"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}