Ok, so I’m no expert on this subject, but I can say that I’ve had enough hands on experience with all three to know the difference and the effect they have on the body. I continue to read articles and posts on social media where parents are concerned about giving their child Benadryl for anaphylaxis. Our daughter has certainly had her moments with anaphylaxis, and we have become well versed in the Epinephrine (Epi) routine, but don’t rule out the benefits of Benadryl and the correlation between them all.
When your child is having an anaphylactic reaction, Epi is ALWAYS the first line of defense for stopping the reaction. However, Benadryl should be your second line of defense to stop the release of histamine-which is what is causing the reaction in the first place. Let’s break this down and see if we can make it a bit clearer.
Once you have eaten an allergic food and your body begins to have a reaction, you should immediately be given the Epi injection to stop the reaction. However, histamine that was released into your body when you ingested the allergic food, is still there. Epi will have no effect on histamine except to bind (or cover) the mast cells so that histamine cannot penetrate them to continue the reaction. Benadryl-the Antihistamine-will be needed to prevent any further release of histamine. Once the Epi wears off (and it will in about 15-20 minutes [been there done that]) and there is still histamine in the body, the body will again go into anaphylaxis. To prevent this from recurring, you need to take Benadryl along with the Epi to prevent the body from continuing to release histamine (and it will until the allergic food has been digested).
Our daughter Nat was a year old when she had her first reaction to peanut.
My husband had decided to cook peanut butter cookies for the New Year Holiday that was approaching. We have two addictions in our house that we have no control over, his being peanut butter and mine being chocolate. Once the first batch was done, he sat down on the couch with a few cookies that we “taste tested” for quality control. Nat was standing between us on the floor in front of the couch and we began pinching our cookies and allowing her to “taste test” as well. There was no immediate sign of anaphylaxis, but just a small hive that I had noticed on her bottom lip. We knew she was sensitive to regular milk, but she’d never had a bad reaction. In our mind, we were thinking that it just may be the small amount of butter that was in the cookie dough. I gave her some benadryl and she was immediately fired from her “taste testing” position. Later that night (about 3-4 hours later), I’m lying in bed with her and she is scratching (more like digging) in the back of her head. I sit up, turn on the light and begin looking at her head. Noticing red splotches everywhere, I start a full body inspection to find that she is in severe distress. Her entire body is swollen and completely red. Not sure you can imagine this, but her skin was inflamed. I always describe it as if someone had taken a hive, stretched it out and slipped it over her head and covered her body. She looked like one huge hive. We immediately rushed her to the hospital. Once there, they begin working to stop the reaction. All the while, I’m in the corner with the doctor who is attempting to figure out what was causing the reaction. He begins by asking me to list everything she had eaten that day. I got to the peanut butter cookie, and it’s as if I could see the light bulb go off in his head. “That’s it!”, he exclaimed. I chimed in and told him that was more than 3 or 4 hours earlier. He even knew to ask me had she been given benadryl or any kind of antihistamine. I told him how her lip had gotten a hive on it and I’d given her a little benadryl and it went away. Again, he exclaimed, “That’s it!” He explained to me that the benadryl had stopped the release of histamine for a while, but once it wore off and was out of her system( and the peanut butter was still there) the reaction came back like a tornado. We were referred to an allergist, who did all the testing and confirmed her allergies to peanuts, eggs and milk.
Now, in telling that story, I just wanted to show that the Benadryl did prevent a terrible “immediate” reaction. However, had I not given Benadryl right away, I’m certain the reaction would have escalated and would have warranted Epi at that point, and after a few visits to the allergist, we learned that Epi IS the first line of defense. You need to stop anaphylaxis immediately, but you also should give Benadryl. Nat had so many reactions as a baby and toddler and we gave so much Benadryl, that we were afraid her body would become immune to it. Nevertheless, there were many times, we only gave Benadryl for those small reactions, and didn’t give Epi. And it worked! But….since then, we don’t hesitate to give her the Epi and followup with Benadryl.
Oh yes. Let me clarify why we were always quick to grab the Benadryl. My husband and I worked in EMS as an Intermediate and as a Paramedic. During that time of working with Emergency Medical Services, it was drilled to us that you always give Benadryl first. So that’s what we did on the back of an ambulance and that’s what we were use to. It just took time, a great deal of arguing with our allergist (who finally convinced us thank goodness) patience, and hands on experience to learn the correct line of defense in dealing with anaphylaxis. Perhaps her reactions back then could have cleared up a lot quicker had we immediately given Epi.
I know that may all seem to run together, but I just wanted to share our story and experience in what we have discovered and learned about the correlation between Benadryl, Epinephrine and Anaphylaxis. Even though I continue to read where parents are concerned about giving Benadryl, from our experience, we will continue to give Benadryl with Epi for all anaphylactic reactions.
“Our choice is our own.”