Help….my face is swelling!



New Guidelines Detail Hereditary Angioedema Management in Women

Angioedema is a BIG problem in emergency rooms across the country and Tulsa is no exception!  Most treatment protocols use antihistamines (Benadryl) along with steroids. aughhh! 

 .  She has some very common frustrations with this condition.  The REASON antihistamines & prednisone often don’t work with angioedema is because the mediator is bradykinin, not histamine! 

An international panel of gynecologists and geneticists has issued practical guidelines for managing women with hereditary angioedema caused by C1 inhibitor deficiency, or HAE-C1-INH.The condition affects between one in 10,000 and one in 50,000 individuals, and estrogen is known to worsen the course of the disease.But little information has been published on how to manage gynecologic/obstetric events in women with HAE-C1-INH, the panel writes in its report, published in the Journal of Allergy and Clinical Immunology.

Effective acute treatments include plasma-derived human C1 inhibitor concentrate (pdhC1INH), icatibant acetate, ecallantide, and recombinant human C1 inhibitor (rhC1INH), the doses of which are the same during pregnancy. PdhC1INH is recommended as first-line therapy in pregnancy.

Short-term prophylaxis (before invasive medical, surgical, or dental procedures or other events that could precipitate edematous attacks) can be provided by pdhC1INH, attenuated androgens, tranexamic acid, and fresh frozen plasma, but pdhC1INH is the treatment of choice during pregnancy.

The same drugs can be used for long-term prophylaxis, but attenuated androgens are contraindicated during pregnancy and tranexamic acid during pregnancy is medically indicated only when pdgC1INH is unavailable, Dr. Teresa Caballero from Hospital La Paz Health Research Institute in Madrid and colleagues note.

Because of the contribution of estrogen to worsening of HAE symptoms, its use for contraception and menopause should be avoided.

For similar reasons, antiestrogens like tamoxifen that may have some agonistic effects on estrogen receptors should be avoided in breast cancer patients. If possible, attenuated androgens should also be avoided as prophylaxis in these women.

The guidelines also address special features of HAE-C1-INH treatment in female patients, such as genetic counseling, infertility, abortion, lactation, and endometrial cancer.


J Allergy Clin Immunol 2011.

#angioedema, #benadryl, #c1-inhibitor, #hae, #hereditary-angioedema, #pregnancy

Here’s a book on food allergies!

The ultimate Family--should be a TV show!

My transcriptionists are not only good at what they do, but when they hear me talk as much as I do, it’s almost family. 

I am reading a book called, Don’t Kill the Birthday Girl by Sandra Beasley, and I thought of you.

  • It’s a memoir about the author’s life with food allergies, what it was like growing up with allergies, etc. She has a variety of food allergies along with environmental allergies. 
  • It’s not very long but it seemed like a book parents who have kids with allergies or individuals suffering from allergies in general would really be able to relate to. Good advice Stephanie!
  • The author is really honest about what it’s like living with allergies but she’s humorous about it at the same time.
  • The one thing that shocked me is that when the author was a teenager she thought about overdosing on Benadryl because she was tired of living with allergies.  Don’t kid yourself, the quality of life in patients with allergy isn’t very good….much worse than heart disease or even diabetes.
  • I think this book could help people with allergies, so they don’t feel alone. I don’t feel alone but I know I’m the only one in my family with allergies and none of them get what an allergic reaction is really like so I’m really enjoying this book.

Stephanie, thanks for the suggestion and I’m sure many of our readers will also enjoy the book. You’ll have to ask her permission to “friend”, but here’s her link—>profile.php?id=1192230038&sk=photos

Here’s the link from Amazon about further information on the book:  Book on Allergies from Amazon

#allergies, #allergy, #benadryl, #conditions-and-diseases, #food, #food-allergy

Allergic to Antihistamines—really!


This is from Gary Stadtmauer, MD’s blog. 

How many times have we heard patients say they are “allergic” to drugs like antihistamines and corticosteroids?  Hypersenstivities to medications used to treat allergic diseases are fortunately uncommon. 

This is Dr. Stadtmauer’s experience with “allergy” to Benadryl….check the references below–it’s legit! 

“I have seen a couple of cases of drug exanthem from antihistamines but never immediate hypersensitivity…until now.  I recently saw a young woman who has had recurrent urticaria/angioedema of immediate onset due to Benadryl.  She had no associated symptoms.  Scratch testing to Benadryl 5mg/ml was negative but ID was positive at 0.5 mg/ml (W/F of 4/10) and 5 mg/ml (W/F o 5/10).  See image below.

One could question whether this is an IgE-mediated event.  Perhaps it is or perhaps in the occasional patient the antihistamine acts as an agonist, binding to the receptor instead of blocking it thereby triggering histamine release.  Anaphylactic shock caused by a challenge with 12.5 mg oral diphenhydramine has been reported and the authors of this case suggest the mechanism was IgE-mediated.

Benadryl Skin TestSo what?  Never say never when a patient comes in with a bizarre drug allergy or states that are allergic to Benadryl….you might be surprised!

Citations re:  Antihistamine Allergy
1. Barranco P, López-Serrano MC, Moreno-Ancillo A. Anaphylactic
reaction due to diphenhydramine. Allergy. 1998; 53: 814.
2. Weidinger S, Mempel M, Ollert M, Elser I, Rakoski J, Köhn FM,
Ring J. Anaphylaxis to mizolastine. J Allergy Clin Immunol.
2004; 114:979-81.
3. Rodríguez del Río P, González-Gutierrez ML, Sánchez-López J,
Núñez-Acevedo B, Bartolomé Álvarez JM, Martínez-Cócera C.
Urticaria caused by antihistamines: report of 5 cases. J Investig
Allergol Clin Immunol. 2009; 19 (4): 317-20.
4. Gonzalo-Garijo MA, Jiménez-Ferrera G, Bobadilla-González P,
Cordobés-Durán C. Hypersensitivity reaction to mizolastine:
study of cross reactions. J Investig Allergol Clin Immunol. 2006;
16 (6): 391-3.
5. Demoly P, Messaad D, Benahmed S, Sahla H, Bousquet J.
Hypersensitivity to H1-antihistamines. Allergy. 2000; 55: 679-80.
6. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez
J, Brockow K, Pichler WJ, Demoly P for EDNA and the EAACI
interest group on drug hypersentitivity. Drug provocation
testing in the diagnosis of drug hypersensitivity reactions:
general considerations. Allergy. 2003; 58: 854-63.

#allergies, #allergy, #anaphylaxis, #benadryl, #drug-allergy-2, #histamine-antagonist, #immunoglobulin-e, #the-journal-of-allergy-and-clinical-immunology