Preventing and Treating Allergic Reactions:

How I Treat Reactions

Updated 12/2017:  I’ve edited this a bit to be more generalized because my specific methods have had to change due to my MCAS and G6PDD. 

Obviously I do my best to make safe decisions and not react. That’s what this blog is all about. But there are circumstances out of my control pretty often, especially since I have dangerous reactions to airborne corn, and honestly yeah, I do just screw up. My diet is pretty limited right now so I *have* to try new things. I am usually very careful and when a food fails I only deal with a very mild reaction before I call it quits, but sometimes I mess up, and sometimes the food is SO corny that trying only small amount causes a major reaction.

Here are some general things to try if you do react. This is loosely based on The Mastocytosis Society protocol, which even though it is for mast cell disease, can easily be applied to “regular” allergic reactions as well.

Note that all of my medications need to be compounded. This is due to corn derivatives found in many premade medications. Manufacturers and pharmacies may say that these derivatives cannot cause a corn reaction because the “proteins have been processed out”, but it has been demonstrated by those with corn allergies over and over that they DO react to these derivatives. Further, cross contamination during manufacture can cause an issue for the most sensitive even if the ingredients themselves are not sourced from corn. Add in multiple sensitivities, and you will probably have a very hard time with most excipients and inactive ingredients in medications. Here’s more info on how to find out the inactive ingredients in your meds.

The “magic formula” for treating reactions is:

  • An H1 antihistamine.  First generation antihistamines such as benadryl, or hydroxyzine would be the best bet for a strong reaction or a reaction involving neurological or mood changes, since these cross the blood-brainb arrier.  Typical is 25-50 mg for both. The max dose for hydroxyzine is higher than benadryl, but benadryl has some qualities that make it the prime choice for a reaction if it can be tolerated. More information on getting corn-free benadryl. Second generation antihistamines such as ceterizine (zyrtec), levocetirizine (xyzal), fexofenadine (allegra) may be a good choice for a less strong reaction
  • An H2 inhibitor, such as ranitidine (zantac) or famotidine (pepcid). This increases the effectiveness of the H1.
  • A mast cell stabillizer, such as cromolyn sodium or quercetin.  This *may* help prevent rebound reactions.
  • A steroid, such as methylprednisolone, prednisone, or dexmethasone. These should be used rarely and sparingly as side effects such as Addison’s disease and Cushing’s syndrome are a very real risk with steroid use.

Important: If you are having an anaphylactic reaction, simply taking these meds is not enough.  No antihistamine will stop anaphylaxis once it starts. The only thing that treats anaphylaxis is epinephrine. It is common hospital practice to adminster benadryl and “wait and see,” but this is NOT the correct treatment and can and has led to deaths.

If you are in doubt, epi. If you epi, always go to the hospital. 

Mayo Clinic Article on how to treat anaphylaxis


Manitoba, Canada public health department info in treating anaphylaxis

A Simple handout on how to recognize and treat anaphylaxis

An overview of the effects of anaphylaxis on the body

Rebound Reactions

When you have an allergic reaction, your body is flooded with histamines which run around creating inflammation all over your body. The actual symptoms of the reactions are due to your various cells’ response to the histamine. Antihistamines like benadryl simply block the receptors on your various cells that would notice and respond to the histamine. That means that when they wear off, if there is still histamine in your system, your cells will start responding again. This is known as a rebound.

I don’t have any scientific evidence of this, but it seems logical that a mast cell stabilizer may help to reduce the chance of a rebound reaction. Mast cell stabilizers actually help prevent the release of histamine in the first place, which *should* help prevent rebound reactions as the antihistamines wear off. I have noticed that it helps me.

Detoxing

After a reaction it will usually take me at least a day to recover, sometimes up to 10 days if it was a bad one. If I had to epi and go to the ER, I could be toxxed out for *weeks*. My tongue will burn every time I eat something and I will just feel like I’m mild-to-medium reacting constantly, or about to react. I call it “feeling full-buckety.” There’s no real cure for this other than time and lots of water, but there are a few things I do to help move the toxins out of my system faster.

How I Detox After A Reaction

  •  Bentonite clay baths or foot soaks in clay from Living Clay Company. I have only tried the pure bentonite clay (sold as the “detox clay powder”) and not any other products. I am on their mailing list and wait until they have free shipping promotions and then order large quantities at a time. I rarely have time for a full bath but I find that the foot soaks are 80% as effective as a full bath and easy to do often.
  • Bentonite Clay taken internally, with LOTS of water, to help absorb toxins/allergens and move them through the system faster.  I find this works better than activated charcoal at detoxing after a reaction, but I am mentioning both options.
  • Activated Charcoal, taken internally, for the same purpose as the bentonite clay. Again, lots of water to flush it through your system!  I am no longer recommending a specific brand of activated charcoal because the manufacturers keep changing what they do. You’ll need to do some research and find something that works for you.
  • Epsom salt baths and foot soaks- I am sulfur sensitive so I don’t do this anymore but it does help many. Dr Teal’s  unscented epsom salts are available at Kroger, Costco, Target, and on Amazon, and are safe for most.

A Note on Prevention

As i mentioned, antihistamines block the receptors that stimulate your mast cells to release histamines. Therefore blocking those receptors does not reduce the histamines already in your system, nor does it stop the inflammatory processes already happening from histamines that have already found a cell to stimulate. Thus it is better used to *prevent* reactions. Obviously avoiding triggers is the best bet, but something else I do is to take both antihistamines and mast cell stabilizers in advance when I know I am going into a dicey situation. Now, I don’t mean that I take antihistamines and then eat something bad. That’s stupid and dangerous. I just mean that if I think I am going somewhere where I could have an airborne exposure, (like Costco on a weekend when all the food samples are out)  or if I am in a situation where small children will be climbing all over me and possibly trying to stick hands and objects in my mouth, I take some appropriate precautions.

Before I go in to a potentially allergenic situation, I take:

  • 5 mg levocetrizine (xyzal)
  • 150mg zantac

I can still take up to 100mg of hydroxyzine on top of this. (It’s very sedating so I stick with 50mg or less typically). I avoid benadryl due to g6pdd one could also take up to 50mg of benadryl as well.

A Note on Zantac: Antacids to treat allergic reactions??!

When I have gone to the ER for an allergic reaction, they have given me two intravenous injections: Benadryl (diphenhydramine), and Zantac (ranitidine). The first time I got an injection of Zantac, I was totally confused. Isn’t that a medication for acid reflux?

Well, yes it is, but the mechanism by which it does that is by blocking (antagonizing) histamine receptors.  Compare to proton pump inhibitors such as Prilosec (omeprazole).  Prilosec actually stops the production of stomach acid, while Zantac stops the signals for gastric acid secretion *and* allergic reactions from being noticed.

H1 and H2 blockers taken together are significantly more effective in treating an allergic reaction than either one taken on their own. 

Because of this, a number of folks with anaphylactic food allergies take a daily preventative H1 and H2 blocker.  I’m one of them. I don’t hope to be on this kind of medication for the rest of my life. For one thing, H2 blockers have a number of effects on vitamin and mineral absorption over the long timer, including interfering with absorption of vitamin B12. Also, taking drugs just masks symptoms, and I’d much rather find the cause of the problem and heal. But I’m totally okay with doing it right now to reduce the possibility of a life-threatening reaction.

Daily Medications- when you can’t avoid your allergens

I encourage you to avoid all of the allergens you can avoid. But if you can’t, such as if your allergens are in the air, it may be wise to take medication daily to help reduce the possibility of a severe/anaphylactic reaction from an unexpected exposure.

Typical daily allergy meds are:

  • A non-drowsy H1 antihistamine such as levocetirizine (xyzal), cetirizine (zyrtec), fexofenadine (allegra), or loratadine (claritin). In many cases, you can actually safely take more than the label recommended amount of these meds. Check with your pharmacist.
  • An h2 antihistamine such as ranitidine (zantac) or famotidine (pepcid).
  • A mast cell stabilizer such as quercetin, nettle, or cromolyn sodium.

The only pharmaceutical medication I currently use daily is a prescription mast cell stabilizer, antihistamine, and leukotrine inhibiter called ketotifen fumarate. It helps me so much that I’ve quit taking the cromolyn and don’t need any other daily antihistamines. Ketotifen does have some side effects, including sedation and weight gain, so it is not a first choice medication for me for those reasons. However it has really allowed me  more freedom to exist in the world without fearing for my life from a reaction to what someone else decides to eat or wear.

During heavy environmental allergy season, I also take:

  • 10mg levocetirizine (xyzal), compounded in a gelatin capsule daily.
  • 150mg ranitidine, compounded in a gelatin capsule, no filler, twice daily

If I am traveling or know I will be exposed to a lot of triggers, I go ahead and take a prophylactic hydroxyzine in the morning and at night. The hydroxyzine is compounded and I take 25mg at the same time as the ranitidine, morning and night.  More if needed. More on what I do when I travel.

About getting Xyzal compounded.

Treating Allergic Reactions: Corn-free Benadryl

The go-to drug for treating a severe allergic reaction is diphenhydramine, the active ingredient in Benadryl.  Unfortunately, there is no corn-free version of this drug available off the shelf. Benadryl dye-free liquigels contain sorbitol from corn. Benadryl children’s liquid formula contains glycerin and sucrose from corn. Many generic store-brand versions of Benadryl, such as Wal-dryl, contain corn starch.  All of these are derivatives that would send me to the hospital, especially if I were already reacting when I took them.

The only way to get truly corn-free Benadryl at this time is to get it made specially for you by a compounding pharmacy. This isn’t a post on how to do that, but there is a very nice blog post on getting medications compounded on the News For Corn Avoiders blog. Here are my additional notes on compounding medications and here is some advice on finding a compounding pharmacy.

Another possibility, though it requires a prescription, would be to get a prescription for an injectable version of Benadryl, and then drink it.This is an off-label usage but I am told it works just fine and will be relatively corn free. (It is in water though so if you react to some waters it may not be 100% safe for you.) Always check ingredients. There are probably several versions of the injectable Benadryl and all of them may not be corn free.

When I got my first Benadryl prescription compounded, I spent 30 minutes on the phone with the pharmacist deciding on ingredients used in my prescription. The pharmacist assured me that the microcrystalline cellulose they used for a filler in capsules was corn free. It was not. I got $50 worth of pills I reacted to worse than the corny off the shelf meds, and they wouldn’t take them back or give me my money back. I had very very recently gotten much more sensitive to corn products at that time, and was reacting constantly so feeling very sick and muddled while trying to hold down a full time job, and just did not have the mental energy to get it done right. I just gave up on getting medications compounded.

But I had to have something for reactions. Fortunately, I was still able to take one version of over the counter Benadryl and have it do more good than harm. While I am not *the most* sensitive corn allergic person in the world, I am pretty sensitive, and my reactions are pretty dramatic. However there are some derivatives I react to less than others.

This stuff has *lots* of corn ingredients, but for me the derivatives are ones that don’t cause huge reactions:

Alka-Seltzer Plus Allergy. Active ingredient: diphenhydramine hcl 25mg. Inactive ingredients:  croscarmellose sodium, D&C red #27 aluminum lake, dibasic calcium phosphate dihydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, talc, titanium dioxide.

I also found this”sleep aid” which is actually benadryl- the inactive ingredient, diphenhydramine, and the dosage, 25mg, is the same ingredient and dosage as benadryl.

Walgreens Sleep II Nightime Sleep Aid. Active ingredient: diphenhydramine hcl 25mg. Inactive Ingredients: Croscarmellose Sodium, Dicalcium Phosphate, FD&C Blue #1 Aluminum Lake, Magnesium Stearate, Microcrystalline Cellulose, Silicon Dioxide, Stearic Acid


Both of these products still have  a number of ingredients that could be (and often are) from corn. I’ve bolded them. They are definitely *not* corn free. It is the same drug as Benadryl, just a different brand. When I was VERY desperate, I was able to take them for reactions and they helped more than they harmed. I would definitely feel some reaction right when I took them, but once they kicked in the antihistamine effect would overtake the reaction. 

Getting compounded Benadryl made a world of difference though- it works faster and leaves me feeling much less hung over. A good portion of the effectiveness of the drug was previously being spent on counteracting the corn in the pills themselves.

But if you are ever in a very bad spot, you may find that there are some versions of the drug off the shelf that you can tolerate enough to help you out when you are reacting severely.

Note that which version will work best for you will depend heavily on what derivatives bug you. The liquigels contain sorbitol, so are a bad choice for me as sorbitol in toothpaste sent me to the ER once. Granted the quantity in the liquigels is probably small but I just skipped it because of the toothpaste reaction. Others may do better with that tiny amount of sorbitol versus the inactive ingredients in the product pictured above. Please choose carefully, use good sense, and consult your physician.

For those that are allergic to benadryl (this does happen), another option is hydroxyzine hcl (atarax) or hydroxyzine pamoate (vistaril). Atarax is more commonly prescribed for allergies, Vistaril is more commonly prescriped for anxiety. Both forms help both allergy and anxiety. They also are comparably as strong of antihistamines as benadryl. They do tend to sedate more then benadryl, but not everyone experiences this.  Hydroxyzine is prescription only. You would need to either get it compounded or identify a brand and manufacturer that does not contain corn, or does not contain *much* corn. You can use these instructions for finding the inactive ingredients of medications to try to identify something that might be safe.