Use of epinephrine in the treatment of anaphylaxis

Lieberman, Phil

doi:10.1097/00130832-200308000-00013

Cited by 57 publications

(24 citation statements)

References 45 publications

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“…Although caution is necessary and dosing errors need to be avoided, epinephrine is not contraindicated in the treatment of anaphylaxis in patients with known or suspected cardiovascular disease, or in middle-aged or elderly patients without any history of coronary artery disease who are at increased risk of ACS only because of their age 40,97. Through its beta-1 adrenergic effects, epinephrine actually increases coronary artery blood flow because of an increase in myocardial contractility and in the duration of diastole relative to systole 40. Concerns about the potential adverse cardiac effects of epinephrine therefore need to be weighed against concerns about the cardiac 8 of untreated anaphylaxis 39–41,46,47,97…”

Section: Management Of Anaphylaxis In a Healthcare Settingmentioning

confidence: 99%

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

Simons

Ardusso

Bilò

et al. 2011

World Allergy Organization Journal

847

1,095

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Abstract:The illustrated World Allergy Organization (WAO) Anaphylaxis Guidelines were created in response to absence of global guidelines for anaphylaxis. Uniquely, before they were developed, lack of worldwide availability of essentials for the diagnosis and treatment of anaphylaxis was documented. They incorporate contributions from more than 100 allergy/immunology specialists on 6 continents. Recommendations are based on the best evidence available, supported by references published to the end of December 2010. The Guidelines review patient risk factors for severe or fatal anaphylaxis, co-factors that amplify anaphylaxis, and anaphylaxis in vulnerable patients, including pregnant women, infants, the elderly, and those with cardiovascular disease. They focus on the supreme importance of making a prompt clinical diagnosis and on the basic initial treatment that is urgently needed and should be possible even in a low resource environment. This involves having a written emergency protocol and rehearsing it regularly; then, as soon as anaphylaxis is diagnosed, promptly and simultaneously calling for help, injecting epinephrine (adrenaline) intramuscularly, and placing the patient on the back or in a position of comfort with the lower extremities elevated. When indicated, additional critically important steps include administering supplemental oxygen and maintaining the airway, establishing intravenous access and giving fluid resuscitation, and initiating cardiopulmonary resuscitation with continuous chest compressions. Vital signs and cardiorespiratory status should be monitored frequently and regularly (preferably, continuously). The Guidelines briefly review management of anaphylaxis refractory to basic initial treatment. They also emphasize preparation of the patient for self-treatment of anaphylaxis recurrences in the community, confirmation of anaphylaxis triggers, and prevention of recurrences through trigger avoidance and immunomodulation. Novel strategies for dissemination and implementation are summarized. A global agenda for anaphylaxis research is proposed.

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Section: Management Of Anaphylaxis In a Healthcare Settingmentioning

confidence: 99%

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

Simons

Ardusso

Bilò

et al. 2011

World Allergy Organization Journal

847

1,095

View full text Add to dashboard Cite

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“…Local injection of epinephrine may also minimize further absorption of antigen from a sting or injection, but this has not been studied systematically. The β-adrenergic properties of epinephrine cause bronchodilation, increase myocardial output and contractility, and suppress further mediator release from mast cells and basophils[41,42]. Epinephrine administered in low concentrations (eg, 0.1 μg/kg) paradoxically can produce vasodilation, hypotension, and increased release of inflammatory mediators[39,43].…”

Section: Pharmacology Of Epinephrinementioning

confidence: 99%

“…Particularly vulnerable populations are those individuals at the extremes of age and those with hypertension, peripheral vascular disease, ischemic heart disease, or untreated hyperthyroidism (increased number of β-adrenergic receptors in the vasculature of these individuals render the myocardium more sensitive to β-adrenergic effects of epinephrine)[59]. Certain medications might also increase the risk of adverse events from drug interactions[13,18,42,59]. Some medications decrease the effectiveness of endogenous catecholamine stores or exogenously administered epinephrine (β-adrenergic blockers), interfere with intrinsic compensatory responses to hypotension (angiotensin-converting enzyme inhibitors and possibly angiotensin II receptor blockers), or impede epinephrine metabolism and lead to increased plasma and tissue concentrations (tricyclic antidepressants and monoamine oxidase inhibitors).…”

Section: Pharmacology Of Epinephrinementioning

confidence: 99%

Epinephrine

Kemp¹,

Lockey²,

Simons³

2008

World Allergy Organization Journal

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Anaphylaxis is an acute and potentially lethal multisystem allergic reaction. Most consensus guidelines for the past 30 years have held that epinephrine is the drug of choice and the first drug that should be administered in acute anaphylaxis. Some state that properly administered epinephrine has no absolute contraindication in this clinical setting. A committee of anaphylaxis experts assembled by the World Allergy Organization has examined the evidence from the medical literature concerning the appropriate use of epinephrine for anaphylaxis. The committee strongly believes that epinephrine is currently underused and often dosed suboptimally to treat anaphylaxis, is underprescribed for potential future self-administration, that most of the reasons proposed to withhold its clinical use are flawed, and that the therapeutic benefits of epinephrine exceed the risk when given in appropriate intramuscular doses.

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“…[17–20] Epinephrine is biologically active in the L-(−) configuration, while the D-(+) form is considered an impurity. L-(−) epinephrine is known to undergo racemization and degradation during storage, which results in a partial loss of effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Determination of the enantiomeric purity of epinephrine by HPLC with circular dichroism detection

Kirkpatrick

Yang

Trehy

2017

Journal of Liquid Chromatography & Related Technologies

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Several hundred drug substances approved by the U.S. Food and Drug Administration are chiral molecules. For the enantiomeric purity assessment, current practice is to develop separation techniques using chiral columns or mobile phase modifiers to separate enantiomers before detection. An alternative approach is to use currently accepted HPLC assay methods and use chiral-specific detectors to confirm whether the correct enantiomer is present. In this paper, adding a circular dichroism (CD) detector to an achiral HPLC method from the US Pharmacopeia (USP) is shown to be amenable for the determination of the enantiomeric purity of epinephrine, a substance used to treat anaphylaxis. This HPLC-UV-CD approach was able to detect the inactive D-(+) enantiomer at 1% of the total epinephrine composition. The linearity, accuracy, and precision of HPLC-UV-CD were evaluated and compared to analyses using a chiral HPLC method. Additionally, an epinephrine drug product was analyzed for assay (concentration) and enantiomeric purity. The results from achiral and chiral methods were identical within the experimental error. Overall, achiral chromatography performed using a USP method with CD detection may serve as a general means of determining chiral drug enantiomer purity and avoids the need for the development of additional chiral-specific methods for each individual drug.

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Use of epinephrine in the treatment of anaphylaxis

Cited by 57 publications

References 45 publications

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

Epinephrine

Determination of the enantiomeric purity of epinephrine by HPLC with circular dichroism detection

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