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Treatment of anaphylaxis - epinephrine or methylprednisolone? Options
 
Nydex
#1 Posted : 8/23/2019 12:53:55 PM

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Hello friends,

In preparations for my journey I am researching efficient methods of making sure I don't risk my life in the jungle. I've never been exposed to even one percent of the flora and fauna that is present in the Amazon rainforest, and I think it's of crucial importance to have a medicine in my backpack that will protect me from extreme allergic reactions that might occur when I get stung, bitten or generally exposed to some alegren I haven't encountered before.

The most widely recommended remedy for anaphylaxis is epinephrine. However my GP recommended that I go for methylprednisolone instead. A quick comparison between the two with the comparison tool of drugs.com shows that methylprednisolone reacts with many more substances and diseases than epinephrine.

In my case the cost of either is not a problem, because in Bulgarian pharmacies 1mg epinephrine vials go for as little as $0.10, and methylprednisolone for pretty much the same price. I would very much appreciate if someone that knows more on the subject helps me out with some info on which one should I choose, and why.

Thank you in advance! Love
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leratiomyces
#2 Posted : 8/24/2019 12:58:43 AM
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Allergic reactions are grouped into 4 classes.
Immediate hypersensitivity reactions is one of those classes. Anaphylaxis belongs in this class.
The correct treatment for genuine anaphylaxis is adrenaline 0.01mg/kg up to 0.5mg, followed by hospital admission.
It would be negligent to administer a steroid only for genuine anaphylaxis. The person would die.

Steroids and antihistamines are some of the treatments for other types of allergic reactions. But anaphylaxis is black and white.

If I was going into a jungle for an extended trip, I would have a collection of medications and medical supplies. Among them would be adrenaline, oral prednisone, sedating and non-sedating antihistamine, topical steroids, oral rehydration powder, and the list goes on.....

Hope that helps
 
Nydex
#3 Posted : 8/24/2019 8:36:06 AM

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leratiomyces wrote:
Allergic reactions are grouped into 4 classes.
Immediate hypersensitivity reactions is one of those classes. Anaphylaxis belongs in this class.
The correct treatment for genuine anaphylaxis is adrenaline 0.01mg/kg up to 0.5mg, followed by hospital admission.
It would be negligent to administer a steroid only for genuine anaphylaxis. The person would die.

Steroids and antihistamines are some of the treatments for other types of allergic reactions. But anaphylaxis is black and white.

If I was going into a jungle for an extended trip, I would have a collection of medications and medical supplies. Among them would be adrenaline, oral prednisone, sedating and non-sedating antihistamine, topical steroids, oral rehydration powder, and the list goes on.....

Hope that helps

That does help, thank you. So I'll definitely take epinephrine instead of methylprednisolone.

I have a big favor to ask you - can you please list all the medications that you would take with yourself if you were going to the jungle for say 2 years?

Thank you so much!
Break free from the chains of your beliefs. It is only then that you may find a moment of blissful stillness amidst the raging storm. Stay awhile and listen. The winds of truth shall fill your sails, and the oceans of hidden and long forgotten knowledge, ancient as the cosmos itself, will be yours to explore.
Quote:
O, supreme beings of the higher realms, allow me to venture into your dimensions. I come with love and with harmony. I bring no hatred and carry no malevolence in my soul. I come to learn and to grow. Show me your world and gift me some of your knowledge. Ask me, and I shall answer with honesty; hug me, and I shall hug you back; advise me, and I shall follow your wisdom. Heal me from my fear and give me insight. There is little I can offer back but my love and trust. O, supreme beings of the higher realms... I am yours.
 
leratiomyces
#4 Posted : 8/24/2019 12:52:52 PM
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That's a tough question to answer as there are so many variables that would weigh into the choices.
Variables such as, what's available locally? How much money do you want to spend? How comfortable you feel in using the medications? What activities will you be doing? What's the accommodation like? The list goes on....

And before you think about medications, I would be deciding whether I was going to get vaccinated against hep a, hep b, typhoid, yellow fever, Japanese encephalitis and rabies.

What's your plan for malaria?

Medications to consider. This list is over inclusive;
Amoxicillin, cephalexin, azithromycin, paracetamol, ibuprofen, codeine, loperamide, ondansetron, promethazine, loratadine, prednisone, adrenaline, salbutamol, topical steroid, oral rehydration tablets.
And depending on how much psychedelics you intend on taking, some diazepam and/or olanzapine might come in handy.
 
Tony6Strings
#5 Posted : 8/25/2019 1:21:29 PM

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You guys are not making a trip to the jungle sound like very much fun...
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corpus callosum
#6 Posted : 8/25/2019 2:24:35 PM

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To elaborate on leratiomyces contribution to the OPs query, true anaphylaxis is a serious and rapidly evolving allergic reaction (at a tissue level, dilation of blood vessels which become leaky) but the manifestations can vary from widespread hives to the more lethal picture which is in the mind of the OP, namely "anaphylactic shock" for which epinephrine is absolutely the treatment of choice.

The symptoms of anaphylaxis for our purposes can be thought of as existing on a spectrum and may start with tingling, flushing and itching, progressing to urticaria ("hives" ) which may be localised or widespread, and then on to the life-threatening features affecting the lungs (wheezing, tight chest, breathlessness), facial and laryngeal swelling (also adding to airway obstruction), hypotension, nausea, vomiting, diarrhoea (these largely represent gut edema), heart arrhythmias or even a heart attack (infarction).

For any of the life-threatening features epinephrine IM is firstline, largely to counteract the hypotension (but also to increase intracellular cAMP) but IV antihistamines and steroids would follow to deal with all the different components of the dysfunction at a cellular level. In the hospital setting the treatment would also include oxygen, BP monitoring, IV access and often IV fluids- luxuries not found in the jungle.

If ones reaction did not have features suggesting life was threatened then IM epinephrine would probably be overkill for simple hives (apparently its not pleasant!) and oral steroids and antihistamines would probably be sufficient.

Its important to note that the picture does not have to strictly follow the spectrum outlined and anaphylactic shock can rapidly develop within minutes without the preliminaries. I personally would like to have epinephrine, a steroid, an antihistamine and some salbutamol close by as mentioned in leratiomyces handy meds to have list.
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