From the Guidelines
Adrenaline (epinephrine) is the medication of choice for the initial treatment of anaphylaxis and should be administered promptly to prevent poor outcomes, including fatality. In anaphylaxis, it's administered as an intramuscular injection, typically 0.3-0.5 mg for adults or 0.15 mg for children using auto-injectors like EpiPen, with doses repeatable every 5-15 minutes if needed 1. For cardiac arrest, it's given intravenously at 1 mg every 3-5 minutes during resuscitation. In hospitals, epinephrine may be delivered as a continuous infusion for maintaining blood pressure in shock states or as a nebulized solution for severe respiratory conditions. Epinephrine works by binding to adrenergic receptors throughout the body, causing blood vessel constriction (increasing blood pressure), bronchial dilation (improving breathing), increased heart rate and contractility, and suppression of inflammatory mediator release.
Some key points to consider:
- Delayed epinephrine administration in anaphylaxis is associated with an increased risk of hospitalization and poor outcomes, including hypoxic-ischemic encephalopathy and death 1.
- Antihistamines and glucocorticoids are often used as adjunctive therapy for anaphylaxis, but they should not be administered before, or in place of, epinephrine 1.
- Patients with known severe allergies should always carry prescribed epinephrine auto-injectors and know how to use them promptly 1.
- Proper storage of the epinephrine, away from extremes of temperature and direct sunlight to protect the drug from degradation, is also important 1.
Overall, the use of adrenaline (epinephrine) is critical in the treatment of anaphylaxis, and its prompt administration can help prevent poor outcomes and save lives 1.
From the FDA Drug Label
Adrenalin® is a non-selective alpha and beta adrenergic agonist indicated for: Emergency treatment of allergic reactions (Type 1), including anaphylaxis Epinephrine acts on both alpha and beta-adrenergic receptors. Through its action on alpha-adrenergic receptors, epinephrine lessens the vasodilation and increased vascular permeability that occurs during anaphylaxis, which can lead to loss of intravascular fluid volume and hypotension Through its action on beta-adrenergic receptors, epinephrine causes bronchial smooth muscle relaxation and helps alleviate bronchospasm, wheezing and dyspnea that may occur during anaphylaxis
The role of adrenaline (epinephrine) in medical treatment is to act as a non-selective alpha and beta adrenergic agonist for the emergency treatment of allergic reactions (Type 1), including anaphylaxis. It works by:
- Lessening vasodilation and increased vascular permeability through alpha-adrenergic receptors
- Causing bronchial smooth muscle relaxation through beta-adrenergic receptors to alleviate bronchospasm, wheezing, and dyspnea Adrenaline (epinephrine) is administered intramuscularly or subcutaneously for the treatment of anaphylaxis 2, 2.
From the Research
Role of Adrenaline in Medical Treatment
The role of adrenaline (epinephrine) in medical treatment is multifaceted, particularly in the context of anaphylaxis, a severe, life-threatening allergic reaction. Adrenaline is considered the mainstay of acute pharmacotherapy for anaphylaxis due to its rapid onset of action and effectiveness in alleviating symptoms [ 3 ].
Administration and Dosage
The method of choice for administering adrenaline in non-intensive care settings is via intramuscular injection using an autoinjector [ 3 ]. The recommended dose is 300-600 µg for adults and 10 µg/kg for children, with the option to repeat the dose every 10-15 minutes if necessary [ 3 ].
Benefits and Risks
While adrenaline is highly effective, its use is not without risks. Serious adverse effects, including hypertension, ventricular arrhythmias, myocardial infarction, and pulmonary edema, can occur, especially with intravenous administration [ 4 ]. However, studies suggest that when administered correctly, such as through intramuscular injection, the risk of severe side effects is lower [ 3 , 5 ].
Indications and Availability
Adrenaline is indicated for the treatment of anaphylaxis and is available in various formulations, including autoinjectors like EpiPen and Ana-guard [ 6 , 7 ]. The choice of formulation may depend on factors such as patient age, weight, and the severity of the allergic reaction.
Education and Practice
Patient education on the proper use of adrenaline autoinjectors is crucial, as is practice in their administration to ensure competence in emergency situations [ 3 , 6 ]. Healthcare providers should also be aware of the benefits and risks associated with adrenaline use to make informed decisions in the treatment of anaphylaxis.
Key Points
- Adrenaline is the first-line treatment for anaphylaxis.
- Intramuscular injection via an autoinjector is the preferred method of administration.
- The risk of serious side effects is lower with correct administration.
- Patient education and practice in the use of autoinjectors are essential.
- Adrenaline formulations vary, and selection should be based on patient-specific factors.