What is the epinephrine (Epi) dose for an acute allergic reaction?

From the Guidelines

For an acute allergic reaction, the recommended epinephrine dose is 0.01 mg/kg of a 1:1000 solution, up to a maximum of 0.5 mg in adults and 0.3 mg in children, administered intramuscularly in the anterolateral thigh. This dose should be given immediately upon recognition of anaphylaxis, and can be repeated every 5-15 minutes if symptoms persist or worsen 1. The use of epinephrine auto-injectors, which come in fixed doses, can simplify the administration process. For children, the dose is typically 0.15 mg for those weighing less than 30 kg, while children over 30 kg should receive the adult dose. It is essential to note that antihistamines and glucocorticoids, although commonly used, have limited evidence supporting their role in anaphylaxis management, and epinephrine remains the cornerstone of treatment 1. After administering epinephrine, the patient should seek immediate medical attention, even if symptoms improve, due to the risk of biphasic reactions.

Some key points to consider when administering epinephrine for an acute allergic reaction include:

• The dose should be administered intramuscularly in the anterolateral thigh for optimal absorption and effect 1.
• The use of auto-injectors can simplify the administration process, but it is crucial to choose the correct dose based on the patient's weight 1.
• Repeat dosing may be necessary if symptoms persist or worsen, and patients should be closely monitored for signs of biphasic reactions 1.
• Epinephrine works by constricting blood vessels, relaxing airway muscles, and reducing hives and swelling, making it the first-line treatment for anaphylaxis due to its ability to address multiple symptoms simultaneously 1.

Overall, the prompt administration of epinephrine is critical in the management of acute allergic reactions, and healthcare providers should be familiar with the recommended dosing and administration guidelines to ensure optimal patient outcomes.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Anaphylaxis: 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 recommended epinephrine dose for an acute allergic reaction (anaphylaxis) is:

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

From the Research

Epi Dose for Acute Allergic Reaction

• The dose of epinephrine to be administered for an acute allergic reaction is 300-600 µg for an adult or 10 µg/kg for a child 3.
• Epinephrine should be administered intramuscularly, preferably using an autoinjector, in the lateral portion of the thigh 3, 4.
• The injection can be repeated every 10-15 minutes until there is a response 3.
• In cases of severe anaphylaxis, intravenous epinephrine may be used, along with fluid resuscitation 5.
• It is essential to note that the use of an autoinjector should be specially practiced in advance to ensure proper administration 3.

Administration and Treatment

• The treatment of allergic reactions should be guided by the severity of the reaction 4.
• Initially, an intramuscular epinephrine injection should be given if cutaneous, mucosal, and cardiovascular/respiratory symptoms occur 4.
• Additionally, the patient should receive intravenous antihistamines and corticosteroids 4.
• Airway obstruction must be recognized, and early intubation may be necessary 5.
• Patients should be monitored for a biphasic reaction (i.e., recurrence of anaphylaxis without reexposure to the allergen) for four to 12 hours, depending on risk factors for severe anaphylaxis 6.