Anaphylaxis Treatment: Medication, Rehabilitation, and More
Anaphylaxis is a severe allergic reaction that causes symptoms like hives; swelling of the eyes, face, or tongue; and difficulty breathing. It requires immediate medical attention and emergency treatment.
The main treatment for anaphylaxis is epinephrine, usually given by injection. If you don’t have access to epinephrine, call 911 or seek emergency care immediately.
The most effective way to manage anaphylaxis is by early treatment with epinephrine, a medication that quickly stops symptoms and helps prevent allergic reactions from getting worse, says Akansha Ganju, MD, an allergist and immunologist based in Los Angeles. Don’t take an antihistamine or wait to see if your symptoms get better or worse.
“If someone is experiencing anaphylaxis, they should use epinephrine right away and call emergency services. This is especially critical for individuals at higher risk, such as those with asthma, heart conditions, or who require a second dose of epinephrine,” says Dr. Ganju.
Epinephrine is most commonly given by injection to the thigh with easy-to-use autoinjectors like EpiPen, EpiPen Jr, and Auvi-Q. These self-administered medications are usually prescribed by an allergist in advance and carried by people with anaphylaxis for emergency use.
In August 2024, an epinephrine nasal spray (Neffy) was approved in the United States as an alternative to epinephrine injection, and may be easier for some people to use than an auto-injector. But the nasal spray may not work as well for some people with certain nasal conditions, such as nasal polyps or a history of nasal surgery. Talk to your doctor about the potential risks and benefits of this treatment before trying it.
On rare occasions, some people with anaphylaxis experience a second reaction up to 12 hours after their first symptoms appear (known as a biphasic reaction). You may need another dose of epinephrine at this point, so it’s possible you’ll be kept in the hospital until the risk of this type of reaction has passed. There, you may receive one or more of these medications or interventions:
Epinephrine Continued doses of epinephrine may be needed to help stabilize your vital signs. These will most likely be given by injection.
Antihistamines These drugs work by blocking certain chemicals that your immune system produces in an anaphylactic reaction. They are given orally or by IV.
Corticosteroids These medications, such as cortisone, are also given by IV and reduce airway inflammation to make breathing easier.
Beta-Agonists Beta-agonist drugs like ventolin (Albuterol) can also help relax your airways.
Glucagon Glucagon may be used for cases of anaphylaxis that don’t respond to epinephrine.
Oxygen You may need supplemental oxygen to help you breathe.
In the long term, it may help to see an allergist or immunologist to receive immunotherapy, a series of allergy shots, for specific allergens like insect stings. Immunotherapy may help decrease your body’s allergic response and prevent severe reactions in the future.
Anaphylaxis Action Plan and Identification
If you’re at risk for anaphylaxis, it’s important to have an action plan in place. It should include written instructions about how to respond if you develop anaphylaxis in case you aren’t able to give yourself epinephrine and seek emergency care on your own. It could also help to wear a medical bracelet or carry a wallet card indicating that you’re at risk for anaphylaxis, which can help first responders and medical professionals diagnose and treat you more quickly in the event of an emergency.
Most people fully recover from anaphylaxis if treated promptly with epinephrine. “Using epinephrine early helps stop the reaction before it becomes more serious and harder to treat,” says Ganju.
But in rare situations, anaphylaxis can lead to complications like:
Low oxygen levels
Low blood pressure
Organ failure
Death
“If complications arise, such as difficulty breathing for an extended period, short-term rehabilitation may be recommended,” says Ganju. In rehab, you will work with physical and occupational therapies, among other services, to get your strength back and prepare to return home independently.
Experiencing anaphylaxis can be traumatic, and some people report a lower quality of life and increased mental health issues after an episode. One small study showed increased levels of stress, anxiety, and depression in participants after anaphylaxis, especially in women.
“An allergic reaction that requires epinephrine can be scary for both the person having the reaction and their caregiver,” says Ganju. Allergic reactions to food, in particular, can happen in everyday situations that can result in strong emotions.”
This can be especially true for someone who has had multiple severe reactions, and the toll can build up, says Ganju, who often refers patients to therapists who specialize in the unique needs of families impacted by food allergies.
Epinephrine is the first-line treatment for anaphylaxis, a severe allergic reaction.
Even after you take epinephrine, seek emergency medical care so that you can be stabilized and monitored for as long as needed.
In very rare cases or after repetitive episodes, you may also benefit from physical rehabilitation or mental health support.
If you feel unsure of what to do in case of anaphylaxis, ask your healthcare provider, who can help you create an action plan.
