Epinephrine in anaphylaxis

Song, T. Ted; Lieberman, Phil

doi:10.1097/aci.0000000000000185

Cited by 21 publications

(11 citation statements)

References 29 publications

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“…In our study, the most common treatment modalities reported by our patients were antihistamines and corticosteroids; epinephrine was used in only 65.5% of the patients during the acute episode of anaphylaxis. This observation is in accordance with other studies in the literature [33-35]. Most of our patients failed to fulfill one of the fundamental recommendations for anaphylaxis follow-up: to carry an epinephrine auto-injector all the time.…”

Section: Discussionsupporting

confidence: 80%

“…Epinephrine is recommended as first-line treatment for anaphylaxis, and its no-use is related to a greater occurrence of fatal outcomes [33-35]. There are strong reasons for that recommendation, since epinephrine reaches its maximal pharmacological effect within 10 min of intramuscular administration into the thigh, while antihistamines and corticosteroids have a delayed peak of action, and may not prevent respiratory and/or cardiovascular arrest [33]. In our study, the most common treatment modalities reported by our patients were antihistamines and corticosteroids; epinephrine was used in only 65.5% of the patients during the acute episode of anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

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Serum Baseline Tryptase Level as a Marker for the Severity of Anaphylaxis

Aniceto

Dias

Melo

et al. 2019

Int Arch Allergy Immunol

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Background: Anaphylaxis is a severe and potentially fatal allergic disease or hypersensitivity reaction with variable clinical presentation. Biomarkers in anaphylaxis could be useful to improve diagnosis, to allow endotyping of patients, and to predict risk. Objective: To investigate the role of serum basal tryptase (sBT) levels in the management of patients with anaphylaxis. Methods: Patients with at least 1 episode of anaphylaxis were selected among those who attended the Allergy Clinics of the Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, Brazil, upon evaluation by allergy/immunology specialists of our medical staff. Demographic and clinical data were obtained using a structured questionnaire. sBT levels were determined using the ImmunoCAP Tryptase immunoassay. Results: 57 patients (56.1% female) with a median age of 35 years (range 7–87 years) participated in the study. sBT levels ranged from 2.57 to 21.19 ng/mL (mean 5.17 ng/mL), with no significant differences in patients with anaphylaxis due to different triggers. Mean levels were 4.93; 5.2; 5.41, and 5.24 ng/mL for patients who had anaphylaxis due to Hymenoptera venom (n = 17), foods (n = 13), drugs (n = 13), and idiopathic disease (n = 14), respectively. Significantly higher sBT levels were observed in patients with severe anaphylaxis (grade IV) than in patients with mild-moderate disease (grades II/III) (mean levels 6.61 vs. 4.71 ng/mL, respectively). Conclusion: High sBT levels may help to identify patients at increased risk of more severe anaphylaxis, prompting physicians to initiate immediate therapy to avoid further acute episodes.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Serum Baseline Tryptase Level as a Marker for the Severity of Anaphylaxis

Aniceto

Dias

Melo

et al. 2019

Int Arch Allergy Immunol

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“…Even though there is no evidence from prospective, randomized, or quasi-randomized trials on the effectiveness of adrenaline for the emergency management of anaphylaxis mainly due to practical and ethical reasons (31), there is a universal agreement that adrenaline is the mainstay of therapy to halt the progression of anaphylaxis and to reverse potentially lifethreatening cardiopulmonary manifestations (26,(31)(32)(33)(34)(35) (grade of recommendation C).…”

Section: Adrenalinementioning

confidence: 99%

“…When using AAI, patients weighing between 7.5 and 25 kg should receive a 0.15 mg dose while those at 25-30 kg should move to 0.3 mg (6,7,26). Even in infants, a 0.15 mg dose is suggested in community settings (62,63).…”

Section: Dosage Of Aai and Needle Lengthmentioning

confidence: 99%

Self‐medication of anaphylactic reactions due to Hymenoptera stings—an EAACI Task Force Consensus Statement

Bilò

Cichocka‐Jarosz

Pumphrey

et al. 2016

Allergy

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An anaphylactic reaction due to a Hymenoptera sting is a clinical emergency, and patients, their caregivers as well as all healthcare professionals should be familiar with its recognition and acute management. This consensus report has been prepared by a European expert panel of the EAACI Interest Group of Insect Venom Hypersensitivity. It is targeted at allergists, clinical immunologists, internal medicine specialists, pediatricians, general practitioners, emergency department doctors, and any other healthcare professional involved. The aim was to report the scientific evidence on self-medication of anaphylactic reactions due to Hymenoptera stings, to inform healthcare staff about appropriate patient selfmanagement of sting reactions, to propose indications for the prescription of an adrenaline auto-injector (AAI), and to discuss other forms of medication. Firstline treatment for Hymenoptera sting anaphylaxis is intramuscular adrenaline. Prescription of AAIs is mandatory in the case of venom-allergic patients who suffer from mast cell diseases or with an elevated baseline serum tryptase level and in untreated patients with a history of a systemic reaction involving at least two Abbreviations AAI, adrenaline auto-injector; ACE, angiotensin-converting enzyme; BST, baseline serum tryptase; EAACI, European Academy of Allergy and Clinical Immunology; ED, Emergency Department; GRADE, The Grading of Recommendations Assessment, Development and Evaluation; HVA, hymenoptera venom allergy; i.m., intramuscular; i.v., intravenous; ISA, insect sting anaphylaxis; s.c., subcutaneous; SAR, systemic allergic reaction; VIT, venom immunotherapy.Allergy 71 (2016) 931-943

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“…Despite these guidelines, the use of adrenaline is still suboptimal [4]. Different potential barriers to the use of adrenaline have been hypothesized and analyzed [5,6,7,8]. Nevertheless, therapeutic decisions in real life are still influenced by the fear of adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register

Cardona

Ferré-Ybarz²,

Guilarte³

et al. 2017

Int Arch Allergy Immunol

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Background: The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. Methods: Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. Results: 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. Conclusion: This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified.

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Epinephrine in anaphylaxis

Abstract: Failure to administer epinephrine promptly has resulted in fatalities. Education about anaphylaxis and prompt treatment are critical for patients and their caregivers.

Cited by 21 publications

References 29 publications

Serum Baseline Tryptase Level as a Marker for the Severity of Anaphylaxis

Serum Baseline Tryptase Level as a Marker for the Severity of Anaphylaxis

Self‐medication of anaphylactic reactions due to Hymenoptera stings—an EAACI Task Force Consensus Statement

Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register

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