Backcountry Allergy Management: Adios Benadryl

Benadryl is a backcountry allergy management mainstay in wilderness first aid kits. June canoe trips in Algonquin Park include a healthy dose of blackflies; a nightly Benadryl help ensure a good sleep while reducing the itching for the next day.  

However, research over the past decade has motivated the Canadian Society of Allergy and Clinical Immunology to encourage the use of newer (2nd generation) antihistamines.  In light of these recommendations, we’ve said goodbye to Benadryl in our Raven Medical clinical guidelines, and welcomed Reactine as our go-to antihistamine. 

Antihistamines And Backcountry Allergy Management

Antihistamines are the second line of medication for a serious anaphylactic reaction.  Epinephrine is the first medication and the real life-saver when it comes to anaphylaxis.  In the case of an anaphylactic reaction, antihistamines help manage the symptoms of the reaction.

Where antihistamines really shine are with patients exhibiting a mild to moderate reaction. In those cases, antihistamines reduce skin-based symptoms – local swelling, and hives (urticaria). 

Unfortunately, Benadryl has unsavoury side effects.

Benadryl is one of the original antihistamines, and it does its job really well.  Unfortunately, is also has two unsavoury side effects.  

  • It makes the patient sleepy
  • It can have life threatening effects if taken in large quantities

Both of these side effects are not present in newer antihistamines.  This is way the allergist society now recommends second generation antihistamines for general use.

A New Medication For Allergies

Reactine (cetrziine) has been around since the 1980s, so its not really that new. However, research over the past few years has demonstrated distinct advantages over Benadryl.  

  • Reactine is longer acting: one dose will work for 24 hours.  This simplifies managing the patient—one pill a day and that’s it.  
  • Reactine has a quicker onset: faster acting medication is always good when dealing with an allergy.  
  • Reactine does not have the same side effects as Benadryl.  It does not make the patient sleepy, and does not have the same overdose effects.

It makes sense to say goodbye to Benadryl and move on to Reactine for backcountry allergy management.  Benadryl still works, and is still used by paramedics and hospitals, so there is no reason to ban it from all wilderness medical kits, but it does make sense to start incorporating Reactine into wilderness practices.  

Raven Medical has updated its clinical guidelines to reflect the move to Reactine, and has started teaching Reactine as the antihistamine of choice.