A systematic review of epinephrine degradation with exposure to excessive heat or cold

Parish, Hannah G.; Bowser, C.; Morton, Jacquelyn R.; Brown, Julie C.

doi:10.1016/j.anai.2016.04.006

Cited by 28 publications

(10 citation statements)

References 20 publications

(34 reference statements)

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“…Preparing epinephrine in a box and attaching it to the wall of the ER in advance to be ready on demand was a rare practice. This agrees with recommendations of previous studies which reported that drawing epinephrine in a syringe and taping it to a wall in the ER is not preferred to avoid light exposure [23].…”

Section: Discussionsupporting

confidence: 92%

Pattern of use of epinephrine as anti-anaphylactic at a university hospital, Saudi Arabia

Murad¹,

Serry²

2018

biomedicalresearch

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Epinephrine is life-saving treatment of anaphylaxis. This study was conducted to identify pattern of use of epinephrine in treatment of anaphylaxis in the Emergency Department at King Abdulaziz University (KAU) Hospital, Jeddah. A 40 staff (10 physicians and 30 nurses) was asked to fill a structured and validated questionnaire about their use of epinephrine as an anti-anaphylactic treatment. The results showed that the most commonly used doses of epinephrine were 0.3 mg drawn from ampoules followed by use of auto-injectors (EpiPens). A single dose was enough for most patients. Intramuscular injection was the most common route. Epinephrine was kept mostly in the emergency trolley away from light and humidity. Keeping epinephrine in a box attached to the walls but protected from light was a rare practice. The time needed for delivery of epinephrine to patients was mostly 30-60 s, and there was no significant difference between physicians and nurses. In conclusion, the pattern of use of epinephrine as an anti-anaphylactic treatment at the KAU hospital is generally similar to the international reports. To our knowledge, there is very few data published in Saudi Arabia handling this issue, thus this study improves knowledge of the medical staff about proper use of epinephrine in anaphylaxis and opens gate for larger studies.

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Section: Discussionsupporting

confidence: 92%

Pattern of use of epinephrine as anti-anaphylactic at a university hospital, Saudi Arabia

Murad¹,

Serry²

2018

biomedicalresearch

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“…In contrast, some patients have reported that health care professionals have advised them to ignore the expiration dates and that EAIs are safe to use unless they are cloudy or discolored 19. However, significant degradation of epinephrine in an EAI can occur in the absence of discoloration or precipitation, indicating that appearance alone should not be used to determine whether an EAI is safe to use 74. Other experts have suggested that if an expired EAI is the only source of epinephrine available to treat an anaphylactic event, it may be used as the risk of using a suboptimal dose of epinephrine potentially outweighs the risk of using no epinephrine at all 69.…”

Section: Use Of Expired Epinephrinementioning

confidence: 99%

Update on the usage and safety of epinephrine auto-injectors, 2017

Posner

Camargo

2017

DHPS

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Anaphylaxis is a serious, potentially fatal allergic reaction. Guidelines recommend prompt intramuscular injections of epinephrine as the first-line therapy for anaphylaxis. Delayed epinephrine treatment may cause undesirable clinical outcomes, including death. In the community, epinephrine auto-injectors (EAIs) are commonly used to treat anaphylaxis. This literature review examines several recent concerns regarding the safety of EAIs that may prevent the timely administration of epinephrine. Reports of cardiovascular complications are linked with epinephrine administration, although recent studies suggest that these events are much more commonly associated with intravenous epinephrine rather than with EAIs. Recent studies have also highlighted accidental injections of EAIs in patients’ or caregivers’ fingers and lacerations associated with the use of EAI in children. However, the data suggest that both accidental injections and lacerations are rare and require limited medical intervention. In addition, patients may receive conflicting information on the safety and efficacy of using expired EAIs. Overall, it is believed that the benefits of using EAIs far outweigh the potential risks of not administering an EAI. Although legitimate safety concerns are associated with EAIs, adverse events are rare. Continued training of medical providers, caregivers, and patients may be beneficial to address these concerns and reduce EAI-associated injuries while ensuring that patients receive necessary medical care.

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“…Perish et al 31 published an informative and timely systematic review of epinephrine stability to extremes of hot and cold temperature, demonstrating that epinephrine in commercial devices is far more stable to moderate extremes of both hot and cold than often perceived, which may help to reassure nervous caregivers or allergic patients who fear their device may become inactivated in such situations. Redmond et al 32 describe an important aspect of food allergy awareness and managementdtrends in management occurring at summer camps.…”

Section: Systemic Allergic and Immune Disordersmentioning

confidence: 99%