Common after hour emergency concerns and questions:
Shot reactions
Delayed allergy shot reactions (swelling or itching of injection site). Treat with Tylenol, ice, antihistamines or steroid cream.
Systemic or generalized reactions after allergy shots are rare. These reactions can be characterized by itchy eyes, nose, & throat, itching of the palms of the hands and soles of the feet, nasal congestion & repeated sneezing, light-headedness, faintness, nausea and vomiting, hives, any increased allergy symptoms, itchy skin, a flushed feeling, hacking cough, severe headaches, & abdominal discomfort. If you have any of these symptoms after leaving this clinic (especially breathing difficulties) go to the nearest emergency room (ER). If you have self-injectable epi on hand use as instructed and call 911 or go directly to ER.
Asthma:
Home treatments for wheeze, persistent cough, shortness of breath or chest tightness:
- Removal from known environmental triggers.
- Use rescue albuterol inhaler or nebulizer (inhalers include -ProAir, Ventolin, Proventil or Xopenex) every 20 minutes up to 3 times in an hour (if not improving call 911 or go directly to the ER for evaluation). Waiting too long to get emergency asthma treatment can be fatal.
- If oral prednisone is on hand, may use according per your asthma management plan for more severe symptoms.
- Keep your asthma action plan current to include your name, list and doses of all medications used, phone number of your family doctor and asthma specialist, name and phone number of closest emergency room/hospital and list of known asthma triggers. Bring your action plan to the emergency room.
- See more on asthma triggers & treatments here: https://www.carolinaasthma.com/blog/asthma-attacks-trigger-treatment
More Severe Asthma Flare/ Uncontrollable Cough
- Call 911 or go directly to the ER for the following symptoms: worsening breathlessness, difficulty talking or walking, chest tightness, rapid breathing, cough that won’t stop, wheezing during breathing in and out, anxiety, exhaustion, confusion, unconsciousness (passing out), not improving/ feeling better after using rescue inhaler, bluish lips or fingernails, and chest retractions (in children ribs may look sucked in).
Anaphylaxis:
Some allergic reactions can be severe or potentially life threatening. The most dangerous type of allergic reaction is called anaphylaxis. Refer to FARE anaphylaxis action plan in the link below: https://www.foodallergy.org/sites/default/files/2018-06/emergency-care-plan.pdf
If you think you may be having an anaphylactic reaction call 911 or get emergency help immediately. If you have epinephrine on hand (should keep 2 doses on hand at all times), do not hesitate to use epinephrine immediately at first sign of reaction and call 911 even if you are not sure it is allergy related.
Delayed skin test or patch test reactions:
- Take picture of test site with cell phone for future reference and call clinic for appointment next available day.\
Medication Refills:
(Consider after hours phone message including phone menu for instructions on after hour refills.)
- If need emergency albuterol or epinephrine call 911.
- If not emergency refills are required, please call the office the next available workday.
Hives:
Most hives respond to daily antihistamines but some severe episodes may require higher doses of over the counter non-sedating antihistamines such as Zyrtec (cetirizine), Claritin (loratadine), Allegra (fexofenadine) or Clarinex (desloratadine) up to 3-4 times a day and Benadryl at night. Skin itching can be treated with steroid creams applied to small areas sparingly until you can call for further advice the next day during office hours. Ice packs can also be helpful. If prednisone is on hand, start usual dose as instructed and call our office the next available day. If wheezing, throat symptoms, airway swelling or other signs of anaphylaxis are present use self-injectable epinephrine and call 911 or proceed directly to the ER.
Antibiotics:
Current office policy is to not prescribe antibiotics over the phone without an in-office evaluation to maximize patient care.
Allergy Skin Test Protocol
STOP all antihistamine type medications including both oral and nasal sprays 5 days prior to testing. Oral antihistamines include Zyrtec, Claritin, Clarinex, & Allegra. Nasal antihistamines include Astelin, Astepro (azelastine), Dymista, and Patanase (olopatadine). Benadryl (diphenhydramine) can be used up to 3 days prior to testing.
