Q:

5/15/2014
Recently I have heard of allergists who add an "Epiwash" to the allergy vaccine presumably to reduce the risk of a reaction - local or otherwise. Is there any scientific validity to this practice and what are the risks and benefits if known?

A:

Answer:
Thank you for your inquiry.

I am not aware of any evidence in the literature, and could find none on a literature search, to document the efficacy of using an epinephrine wash when giving allergy injections. We have had a similar question posted to our website previously. For your convenience, I have copied this inquiry and response below for you as well.

Thank you again for your inquiry and we hope this response is helpful to you.

A “small dose of epinephrine” given simultaneously with an allergy injection
Question:
5/28/2013
Is it customary to give a "small" dose of epinephrine prophylactically at the same time as an allergy shot? The shots are for seasonal grasses, mold, etc. The patient has been getting localized swelling at the injection site several hours after and lasting for several days after the shots. The pt has also begun to develop a cough and "tickling" in the throat several hours after the shot and lasting for several days. The epinephrine is being given concurrently with the shot.

Answer:
To my knowledge, it is not customary to give a “small dose” of epinephrine prophylactically at the same time an allergy shot is given.

It should be kept in mind that low doses can cause paradoxical effects, resulting in vasodilation and enhanced mediator release from mast cells, thus potentially worsening an anaphylactic event (1-3).

Thank you again for your inquiry and we hope this response is helpful to you.

References:
1) Westfall TC, Westfall DP. Adrenergic agonists and antagonists. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman & Gilman's: The pharmacological basis of therapeutics, 11th ed. New York, New York: McGraw-Hill; 2006; pp. 237-247

2) Simons FER. First-aid treatment of anaphylaxis to food: focus on epinephrine. J Allergy Clin Immunol 2004; 113:837-844.

3) Current Opinion in Allergy and Clinical Immunology Epinephrine and its Use in Anaphylaxis: Current IssuesKeith J. Simons, F. Estelle R. Simons Curr Opin Allergy Clin Immunol 2010; 10(4):354-361.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology