Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register

Abstract

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.

Anaphylaxis triggers in a large tertiary care hospital in Qatar: a retrospective study

“…Several studies from USA, UK, and Australia suggested that the incidence of anaphylaxis is on a gradual rise over the last two decades [7–14]. To estimate the incidence, prevalence, and triggers, scientists have used different methodologies including patients’ case reports [15–17], international medical coding systems [7–9, 18–24], hospital admission rates [11, 13, 25, 26], public surveys and epinephrine dispense records [10, 12, 21, 25, 27, 28]. These studies have demonstrated that distribution of anaphylaxis tends to fluctuate based on age, gender, race, geographical residence, and socioeconomic status of involved subjects.…”

Cardiac arrhythmia from epinephrine overdose in epidural test dose

“…Complications of epinephrine overdoses have been reported a number of times in the published literature and can include arrhythmia, hypertension, chest pain, tremor, anxiety, paleness, headache, peripheral vasoconstriction and nausea/vomiting. [67] Reported severe complications associated with iatrogenic epinephrine overdosages have included ventricular dysfunction, myocardial infarction, cardiac arrest, pulmonary edema and renal failure. [891011] Adverse events tend to be more severe in older patients that receive high doses of epinephrine via the intravenous routes.…”

“…[891011] Adverse events tend to be more severe in older patients that receive high doses of epinephrine via the intravenous routes. [712] Laboratory findings of excessive epinephrine dosing may include hyperglycemia, leukocytosis and hypokalemia. Treatment of epinephrine overdose is generally supportive in nature and targeted at specific symptom management.…”

Reconocimiento y manejo de la Anafilaxia en pediatría

“…Pero advertimos que en nuestros resultados el 18% eligió la vía intravenosa y 35% dosis superiores a las recomendadas. Cardona et al (34) describieron que la administración de la adrenalina intravenosa y la utilización de dosis mayores a las recomendadas se asociaron a mayor frecuencia de efectos adversos pero no observaron mayor morbimortalidad.…”