Epinephrine May Be a Lifesaver

Epinephrine should be first step in treating severe allergic reactions, new guidelines say

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Epinephrine — sometimes called adrenalin — can save a life in the event of a severe allergic reaction. That's why new guidelines recommend epinephrine when a severe allergic reaction strikes.

These guidelines say epinephrine should be given as soon as the doctor detects an allergy attack.

Patients having an allergic reaction should always seek immediate medical care.

John Oppenheimer, MD, Fellow of the American Academy of Allergy, Asthma & Immunology (AAAAI) and one of the guideline authors, told dailyRx News what he recommends to anyone witnessing a severe allergic attack, or anaphylaxis.

"The first step is to call 911 and check ABCs (airway, breathing and circulation). Epinephrine is the drug of choice for anyone suffering from anaphylaxis. This diagnosis includes symptoms of cardiac or respiratory compromise, as well as a reaction that involves more than one organ, i.e. hives with vomiting," Dr. Oppenheimer said.

"Many consider antihistamines or steroids as first line therapy; however, as reinforced in this document, epinephrine is the true first line treatment. Studies have reinforced its early use, as delay may be associated with a late phase response or even death," he said.

Lead author Ronna L. Campbell, MD, PhD, an emergency department doctor with the Mayo Clinic in Rochester, MN, along with Dr. Oppenheimer and colleagues, developed new guidelines for managing patients who are having a severe allergy attack.

"Since emergency department physicians are often the first to see patients who are suffering from anaphylaxis, it's especially important that they not only correctly diagnose the problem, but understand that epinephrine should be administered as soon as possible," Dr. Campbell said in a press release. "In addition, following a severe, allergic reaction, patients should be referred to an allergist, as allergists provide the most comprehensive follow-up care and guidance."

The task force led by Dr. Campbell represents three organizations: the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

Almost anyone can have an allergic reaction. Foods and insect stings are common causes.

Allergy symptoms can progress rapidly to a severe allergic reaction condition called anaphylaxis — which can be deadly. Symptoms include a red face, shortness of breath and wheezing. Patients can also have nausea, hives or facial swelling.

Patients can also develop cardiac symptoms like very low blood pressure. Anyone with these symptoms should seek immediate medical care.

Epinephrine can decrease swelling, raise low blood pressure and relax the muscles around the airways, allowing the patient to breathe.

Dr. Campbell and team also recommended that patients who have had a severe allergic reaction should be referred to an allergist. Allergists are doctors who specialize in allergy management.

Guidelines are used to direct the care of patients with a specific condition. These guidelines are developed by a group of experts.

A strong recommendation — which the task force led by Dr. Campbell made for epinephrine — is supported by high-quality scientific evidence. The benefit of the action with this type of recommendation most often outweighs any risks.

The new guideline was published online Dec. 2 in Annals of Allergy, Asthma and Immunology.

The task force did not receive funding support. The authors disclosed no conflicts of interest.

Review Date: 
December 1, 2014
Last Updated:
December 3, 2014