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Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes

International guidelines stipulate that intramuscular (IM) epinephrine (adrenaline) is the first-line treatment for anaphylaxis, with an established good safety profile. The availability of epinephrine autoinjectors (EAI) has greatly facilitated the lay administration of IM epinephrine in community...

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Autores principales: Dribin, Timothy E., Waserman, Susan, Turner, Paul J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259181/
https://www.ncbi.nlm.nih.gov/pubmed/36796511
http://dx.doi.org/10.1016/j.jaip.2023.02.002
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author Dribin, Timothy E.
Waserman, Susan
Turner, Paul J.
author_facet Dribin, Timothy E.
Waserman, Susan
Turner, Paul J.
author_sort Dribin, Timothy E.
collection PubMed
description International guidelines stipulate that intramuscular (IM) epinephrine (adrenaline) is the first-line treatment for anaphylaxis, with an established good safety profile. The availability of epinephrine autoinjectors (EAI) has greatly facilitated the lay administration of IM epinephrine in community settings. However, key areas of uncertainty remain around epinephrine usage. These include variations in prescribing EAI, what symptoms should prompt epinephrine administration, whether emergency medical services (EMS) need to be contacted after administration, and whether epinephrine administered via EAI reduces mortality from anaphylaxis or improves quality of life measures. We provide a balanced commentary on these issues. There is increasing recognition that a poor response to epinephrine, particularly after 2 doses, is a useful marker of severity and the need for urgent escalation. It is likely that patients who respond to a single epinephrine dose do not require EMS activation or emergency department transfer, but data are needed to demonstrate the safety of this approach. Lastly, patients at risk of anaphylaxis must be counseled against over-reliance on EAI alone.
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spelling pubmed-102591812023-06-12 Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes Dribin, Timothy E. Waserman, Susan Turner, Paul J. J Allergy Clin Immunol Pract Article International guidelines stipulate that intramuscular (IM) epinephrine (adrenaline) is the first-line treatment for anaphylaxis, with an established good safety profile. The availability of epinephrine autoinjectors (EAI) has greatly facilitated the lay administration of IM epinephrine in community settings. However, key areas of uncertainty remain around epinephrine usage. These include variations in prescribing EAI, what symptoms should prompt epinephrine administration, whether emergency medical services (EMS) need to be contacted after administration, and whether epinephrine administered via EAI reduces mortality from anaphylaxis or improves quality of life measures. We provide a balanced commentary on these issues. There is increasing recognition that a poor response to epinephrine, particularly after 2 doses, is a useful marker of severity and the need for urgent escalation. It is likely that patients who respond to a single epinephrine dose do not require EMS activation or emergency department transfer, but data are needed to demonstrate the safety of this approach. Lastly, patients at risk of anaphylaxis must be counseled against over-reliance on EAI alone. 2023-04 2023-02-14 /pmc/articles/PMC10259181/ /pubmed/36796511 http://dx.doi.org/10.1016/j.jaip.2023.02.002 Text en https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Article
Dribin, Timothy E.
Waserman, Susan
Turner, Paul J.
Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes
title Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes
title_full Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes
title_fullStr Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes
title_full_unstemmed Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes
title_short Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes
title_sort who needs epinephrine? anaphylaxis, autoinjectors, and parachutes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259181/
https://www.ncbi.nlm.nih.gov/pubmed/36796511
http://dx.doi.org/10.1016/j.jaip.2023.02.002
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