What is the proper treatment and dosage of epinephrine (adrenaline) for anaphylaxis in cases of allergic reactions?

From the Guidelines

Epinephrine should be administered promptly as a 0.3-0.5 mg intramuscular injection in the mid-outer thigh for adults, or 0.15 mg for children weighing less than 30 kg, for the treatment of anaphylaxis. The preferred formulation is a 1:1000 (1 mg/mL) solution 1. If symptoms persist, the dose can be repeated every 5-15 minutes as needed. Auto-injectors like EpiPen come in two standard doses: 0.3 mg for adults and children over 30 kg, and 0.15 mg for children 15-30 kg. The intramuscular route is preferred because it provides rapid absorption and reliable blood levels.

Key Considerations

• Epinephrine is the cornerstone of anaphylaxis management but continues to be underutilized 1.
• The clinical criteria proposed by the National Institute of Allergy and Infectious Diseases (NIAID) continue to provide a helpful framework in approaching patients with acute allergic symptoms 1.
• Risk factors for severe anaphylaxis include cardiovascular disease, asthma, older age, and additional coexisting, comorbid conditions 1.
• After administering epinephrine, the patient should be placed in a supine position with legs elevated (unless breathing is compromised), and emergency medical services should be called immediately.

Administration and Dosage

• The recommended dose is 0.01 mg/kg, up to 0.3 mg in children, and 0.3 to 0.5 mg in adults, depending on the severity of the reaction 1.
• Epinephrine can be delivered through a variety of routes, including IM, IV, and endotracheal or intraosseous 1.
• The therapeutic actions of epinephrine include increased vasoconstriction, increased inotropy and chronotropy, and bronchodilation 1.

Patient Education and Management

• Patients with known severe allergies should carry epinephrine auto-injectors at all times and know how to use them properly.
• Effective care for individuals at risk of anaphylaxis requires a comprehensive management approach involving families, allergic children, schools, camps, and other youth organizations 1.
• Risk reduction entails confirmation of the trigger, discussion of avoidance of the relevant allergen, a written individualized emergency anaphylaxis action plan, and education of supervising adults with regard to recognition and treatment of anaphylaxis 1.

From the FDA Drug Label

Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary

The proper treatment and dosage of epinephrine for anaphylaxis in cases of allergic reactions is:

• Intramuscular or subcutaneous injection into the anterolateral aspect of the thigh
• Dosage for adults and children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) every 5 to 10 minutes as necessary
• Dosage for children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), every 5 to 10 minutes as necessary 2

From the Research

Proper Treatment and Dosage of Epinephrine for Anaphylaxis

• The proper treatment for anaphylaxis involves the prompt administration of epinephrine, with a recommended dosage of 0.3 to 0.5 mL of 1:1000 dilution intramuscularly for adults and 0.01 mg/kg for children, given in the lateral thigh 3.
• A "1-2-3" approach to anaphylaxis treatment is suggested, which includes:
  • Promptly administering a first dose of intramuscular epinephrine with proper positioning
  • Activating emergency medical services if immediate symptom resolution does not occur
  • Considering a second dose of intramuscular epinephrine with consideration of oxygen administration and intravenous fluid if initial epinephrine response is not adequate
  • Considering a third intramuscular epinephrine dose together with consideration of intravenous fluid support and oxygen for continued lack of appropriate response 4

Importance of Prompt Epinephrine Administration

• Delayed epinephrine administration is a risk factor for fatal anaphylaxis 5
• Epinephrine should be administered promptly once anaphylaxis is suspected, to minimize morbidity and mortality 6
• Patients at risk for anaphylaxis should carry 2 epinephrine autoinjectors and be taught and able to demonstrate how to use them 6

Epinephrine Autoinjectors and Availability

• Epinephrine autoinjectors need to be affordable, readily available, and easy for patients with allergies to carry and use 6
• The ideal means for storing and delivering epinephrine in prehospital and hospital environments warrants further study, to determine how to best balance efficiency, safety, and costs 6

Prehospital Treatment with Epinephrine

• Prehospital epinephrine use is associated with a lower likelihood of uncontrolled reactions, receipt of intravenous fluids in the emergency department, and hospital admission 5
• Patients treated with prehospital epinephrine were less likely to have uncontrolled reactions and to be admitted after the reaction 5