Supplemental Drugs: Allergy Management, Herbals in Dental Health, Skeletal Muscle Relaxants
1 | Allergy Management
Ascertaining the nature of the allergic reaction as being minor (non-life threatening) versus major (life threatening) is the first step in allergy management. If the reactions are limited to the skin, such as rashes and hives, then it is considered minor and non-life threatening. If the symptoms involve the life threatening symptoms such as swelling of the tongue, wheezing and difficulty breathing, it is considered major allergic reaction.
Minor skin reactions are managed by administrations of antihistamine such as diphenhydramine (Benadryl) 25-50 mg (dosage depends on age) and by intramuscular (IM) injection of diphenhydramine in the deltoid muscle using a 50 mg/mL concentration (0.5-1.0 mL) in more severe reactions. As the histamines circulate in the blood for three days after the initial attack, the patients also should be taking oral diphenhydramine 25-50 mg (dosage depends on the age but usually 25 mg for children and 50 mg for adults) four times daily for 3 days, in addition to the diphenhydramine IM injection administered during the initial allergy attack.
Major allergy attacks are usually life threatening and require the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach described in the flowchart. A major allergy attack usually is an anaphylactic attack and typically, there is a rapid onset of signs and symptoms following allergen exposure. Early signs and symptoms include (For more on this topic, refer to Section 3: Emergency Drug Management.)
| Suggested Reading
• Becker DE. Drug allergies and implications for dental practice. Anesth Prog 2013;60(4):188-97.
• Nanavati RS, Kumar M, Modi TG, Kale H. Anaphylactic shock management in dental clinics: An overview. J Int Clin Dent Res Organ 2013;5(1):36-9.
• Panel NS. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010;126(6):S1-58. (www.ncbi.nlm.nih.gov/pmc/articles/PMC4241964)
Perform Primary Assessment
• Remove allergen
• Perform ABCDE assessment
– Airway: swelling, airway stridor, check for obstruction
– Breathing: rapid respiratory rate, cyanosis
– Circulation: low blood pressure, pallor