From the Guidelines
The recommended treatment for anaphylaxis is immediate administration of epinephrine (adrenaline) via intramuscular injection, typically using an auto-injector like EpiPen or Auvi-Q in the mid-outer thigh at a dose of 0.3mg for adults or 0.15mg for children, as supported by the most recent guidelines 1. This should be given as soon as anaphylaxis is suspected, without waiting for all symptoms to develop. After epinephrine administration, call emergency services (911) immediately. The patient should lie flat with legs elevated unless they are having breathing difficulties. Additional treatments include:
- Removing the trigger if possible
- Administering antihistamines (like diphenhydramine 25-50mg) and corticosteroids (like prednisone 40-60mg) as secondary medications, as noted in 1 and 1
- Using inhaled beta-agonists if bronchospasm is present, as suggested in 1 Epinephrine may need to be repeated every 5-15 minutes if symptoms persist, as indicated in 1. Epinephrine works rapidly by constricting blood vessels to increase blood pressure, relaxing airway muscles to improve breathing, and reducing hives and swelling. After the emergency, patients should be observed for 4-8 hours as biphasic reactions can occur, and they should be prescribed an epinephrine auto-injector to carry at all times, along with receiving education on trigger avoidance and anaphylaxis management, as recommended in 1 and 1.
From the FDA Drug Label
1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.
The recommended treatment for anaphylaxis is epinephrine (IM), as it is indicated for the emergency treatment of allergic reactions, including anaphylaxis 2.
- Key points:
- Epinephrine is the drug of choice for anaphylaxis treatment
- Administration route is intramuscular (IM)
- Adrenalin® is a available formulation for this treatment 2
From the Research
Anaphylaxis Treatment
The recommended treatment for anaphylaxis includes:
- Immediate administration of epinephrine (adrenaline) via intramuscular injection, with a recommended adult dose of 0.3-0.5 mg 3, 4
- Use of epinephrine auto-injectors for first-aid treatment in the community, with proper education on their use 3, 4
- Consideration of additional doses of epinephrine, as well as other treatments such as oxygen administration and intravenous fluids, for severe anaphylaxis 5, 6
Administration of Epinephrine
Key considerations for epinephrine administration include:
- Prompt injection of epinephrine after the onset of anaphylaxis symptoms, as delays can be fatal 3, 4
- Use of the intramuscular route, with the anterolateral aspect of the mid-thigh being the recommended injection site 3, 4
- Avoidance of subcutaneous or intravenous injection, due to potential delays in onset of action or increased risk of adverse effects 3
Additional Treatments
Other treatments that may be considered for anaphylaxis include:
- Antihistamines, which may have a beneficial effect in reducing the severity of anaphylaxis 7
- Corticosteroids, although their use in anaphylaxis should be revisited due to potential increased risk of adverse effects 7
- Oxygen administration and intravenous fluids, which may be necessary for severe anaphylaxis or shock 5, 6
Patient Education and Management
Important aspects of patient education and management include:
- Education on the proper use of epinephrine auto-injectors and recognition of anaphylaxis symptoms 3, 4
- Consideration of multiple epinephrine devices for patients with a history of anaphylaxis, particularly those who have required more than one dose of epinephrine to treat an allergic reaction 6
- Avoidance of allergen triggers and prompt activation of emergency medical services in the event of an anaphylaxis reaction 6