Q: My 4-year-old son is allergic to peanuts and tree nuts, and we recently learned he also has grass allergies. Our family doctor said to give him a daily antihistamine during grass-pollen season, but our allergist said not to, because it could mask symptoms of anaphylaxis. What should we do?
Dr. Sharma: Many children with food allergies also have hay fever and may benefit from a daily non-sedating antihistamine if the hay fever symptoms are bothersome. There is actually no evidence that taking a daily non-sedating antihistimine masks the symptoms of anaphylaxis.
The concern some allergists have regarding antihistamines is in cases where they are used inappropriately to treat severe allergic reactions, or anaphylaxis, instead of epinephrine.
Antihistamines should never be used alone or in place of epinephrine for the treatment of anaphylaxis.
While antihistamines might help treat symptoms of a mild allergic reaction, such as an itchy mouth, a few hives around the mouth or face, or mild itching, they do not relieve severe respiratory symptoms, gastrointestinal symptoms or shock.
Epinephrine is the only first-line treatment for anaphylaxis. Taking an antihistamine for severe allergic symptoms could result in a delay in administering epinephrine, and that delay increases the risk of a life-threatening reaction.
Work with your son’s allergist to develop a food allergy action plan tailored specifically to him. While an antihistamine might be appropriate to treat mild symptoms in some patients, it is important to continue monitoring to be sure the reaction does not progress to more severe symptoms of anaphylaxis.
Additionally, if there is a history of a prior severe allergic reaction, it is often advised to give epinephrine immediately, even for mild symptoms.
Dr. Sharma is an allergist, clinical researcher and assistant professor of pediatrics. He is Clinical Chief of the Division of Allergy and Immunology at Children’s National Health System in Washington, D.C. and Director of the Food Allergy Program. Questions submitted below will be considered for answer in the magazine.