What medicine should you take for food allergies in the United States?

If it is a severe food allergic reaction that causes laryngeal edema, difficulty breathing, or a drop in blood pressure, immediate injection of epinephrine is the first choice. No medicine can replace its first-aid role.； If it is just a mild allergic reaction such as rash or itchy lips, over-the-counter second-generation antihistamines are often used to relieve symptoms.

When I was studying in Boston two years ago, I saw a German exchange student from the same department mistakenly eat cookies mixed with chopped nuts. As soon as he said that his throat was tight and he couldn't speak, a friend who was traveling with him took out an Epipen and stabbed him directly on the outside of his thigh through his jeans. When 911 arrived, he was able to communicate normally with the medical staff. Later, the emergency doctor said that it was fortunate that he was given epinephrine before being sent to the hospital, otherwise he would have been at risk of suffocation ten minutes later. Many Chinese friends who have just arrived in the United States will confuse the priority of medication. They think that if they are allergic, they should take regular anti-allergic drugs first. When a severe allergic reaction occurs, antihistamines take more than 20 minutes to take effect and cannot suppress a rapidly progressing systemic allergic reaction. By the time the drug takes effect, the person may be unable to bear it. The FDA and the American Academy of Allergy, Asthma and Immunology (AAAAI) have repeatedly emphasized that epinephrine is the only first-choice emergency drug in severe allergic reactions, without exception.

If you accidentally come into contact with some allergens and only have itching around your mouth and a few hives on your arms and legs, but no other discomforts such as chest tightness or stomachache, just go to a CVS or Walgreens near your home and pick up a box of loratadine (trade name: Claritin) or cetirizine (trade name: Zyrtec). The symptoms will disappear in about half an hour after taking one tablet. The side effects are also mild, you will hardly feel sleepy, and it will not affect work or class at all. In the early years, many people loved to use Benadryl. It works ten minutes faster than second-generation antihistamines, but it makes you feel groggy for most of the day. Now, unless you have allergies and itching that makes you unable to sleep at night, few people choose this drug.

In recent years, there has been an oral desensitization drug targeting specific allergens. The most common one is Palforzia, the peanut allergy drug approved by the FDA in 2020. The principle is to eat a little purified peanut protein every day to slowly allow the body to adapt to the allergen. In the end, even if it is accidentally eaten, there will be no serious reaction. However, there is still a lot of disagreement in the allergy circle about this. An allergist I know who runs a private clinic in Chicago rarely prescribes it to children under 10 years old. He said that he had seen two cases of severe allergies caused by taking desensitization drugs before, and felt that the risks for young children are higher than the benefits. ； But there are also many parents who think the effect is good. I met a mother in a Chinese mother group in Seattle before. Her 7-year-old child was severely allergic to peanuts. She had to go to the emergency room if she touched any peanut-containing snacks. After a year and a half of oral desensitization, she only gets a small rash after accidentally eating cookies mixed with crushed peanuts, so she no longer has to go to the emergency room. Of course, she still carries two Epipens in her bag all year round, saying that she will always be careful.

By the way, if you have a food allergy, it is best to ask your family doctor to prescribe two epinephrine auto-injectors when you first arrive in the United States. Keep one in your carry-on bag and one in your regular office or home. Most commercial insurance in the United States can cover most of the expenses. It only costs a few dozen dollars out of pocket. It is more useful than anything else in case of emergency.