When should epinephrine be administered in the treatment of anaphylaxis?
If anaphylaxis is suspected, administer epinephrine as soon as possible, contact emergency medical services, and transfer patients to a higher level of medical care.
What is epinephrine used for in the emergency department?
Epinephrine is indicated for the emergency treatment of allergic reactions (Type I), including anaphylaxis, which is defined as an acute, life-threatening allergic reaction. It can be triggered by insect stings or bites, foods, drugs, and other allergens, or it can be idiopathic or exercise-induced.
What is the role of antihistamines in the treatment of epinephrine toxicity?
Antihistamines [IM or intravenous (IV)] are adjunctive therapies and may be tried after epinephrine is administered to help control cutaneous and cardiovascular manifestations, such as itching, flushing, urticaria, angioedema, and nasal and eye symptoms, as well as prevent secondary reactions.
What is the maximum amount of epinephrine given per dose?
The maximum adult dose is 0.5 mg per dose. Epinephrine dose may be repeated approximately every 5-15 minutes if symptoms do not improve or if they return while waiting for EMS. The number and timing of epinephrine doses should be recorded and communicated to EMS.
What are the key words for allergy?
KEY WORDS: Allergy, Anaphylaxis, Epinephrine, Safety, Cardiovascular side effects. INTRODUCTION. The National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy Research & Education (FARE; formerly the Food Allergy and Anaphylaxis Network [FAAN]) define anaphylaxis as any serious allergic reaction that is rapid in onset ...
Do antihistamines work longer than epinephrine?
Antihistamines, such as diphenhydramine, have a longer ons et of action and longer time to peak activity compared with epinephrine.[19,20] The most compelling evidence against the use of H1 blockers as an initial therapy comes from studies looking at the onset of suppression of histamine-induced cutaneous flares.
Is epinephrine safe for anaphylaxis?
In general, these studies show that epinephrine is safe for patients with urgent medical needs for conditions other than anaphylaxis. Table 4. Safety of epinephrine given for conditions other than anaphylaxis. Open in a separate window.
Is epinephrine used in emergency medicine?
The authors prospectively decided that studies discussing the use of epinephrine in the emergency medicine setting for anaphylaxis, or other acute respiratory conditions (e.g., acute asthma, bronchiolitis, croup), with positive or negative results, would be considered for inclusion.
Is epinephrine safe for shock?
It is for these reasons that IM epinephrine is recommended as the treatment of choice for anaphylaxis. Epinephrine may be reserved for patients in shock only or because a clinician is concerned about its safety, when in fact it is indicated and needed to save a patient’s life.
Is epinephrine available in different doses?
Epinephrine is available in different doses and concentrations for delivery by different routes, and for different indications, including anaphylaxis and cardiac arrest. The differences, as well as inconsistent labeling of epinephrine vials, can lead to life-threatening medication errors (Table 1).
Why is epinephrine inappropriate?
Background: While epinephrine is the recommended first-line therapy for the reversal of anaphylaxis symptoms, inappropriate use persists because of misunderstandings about proper dosing and administration or misconceptions about its safety.
Is epinephrine safe for anaphylaxis?
Results: Epinephrine is safe for anaphylaxis when given at the correct dose by intramuscular injection. The majority of dosing errors and cardiovascular adverse reactions occur when epinephrine is given intravenously or incorrectly dosed.
Is it safe to inject epinephrine?
Conclusion: Epinephrine by intramuscular injection is a safe therapy for anaphylaxis but training may still be necessary in emergency care settings to minimize drug dosing and administration errors and to allay concerns about its safety.
Introduction
Anaphylaxis is defined as a serious, generalized allergic or hypersensitivity reaction that is rapid in onset and potentially fatal. Clinical presentation and severity can vary among patients and in the same patient from 1 anaphylactic episode to another. 1,–3 Epinephrine is the primary initial treatment of anaphylaxis.
Clinical Features of Anaphylaxis
Clinical criteria for anaphylaxis have been proposed and validated. 3,5 Anaphylaxis is highly likely when any 1 of the following 3 criteria is fulfilled:
Primary Role of Epinephrine
Epinephrine is the medication of choice for the first-aid treatment of anaphylaxis. Through vasoconstrictor effects, it prevents or decreases upper airway mucosal edema (laryngeal edema), hypotension, and shock. In addition, it has important bronchodilator effects and cardiac inotropic and chronotropic effects. 1,–4,19,–24
Epinephrine Administration and Dosing
Epinephrine can be life-saving when injected promptly by the intramuscular (IM) route in the mid-outer thigh (vastus lateralis muscle) as soon as anaphylaxis is recognized ( Table 1 ).
Safety of Epinephrine
Pharmacologic effects of epinephrine include transient pallor, tremor, anxiety, and palpitations, which, although perceived as adverse effects, are similar to the symptoms caused by increased endogenous epinephrine levels produced in the “fight or flight” response. These effects cannot be dissociated from the beneficial effects of epinephrine. 23
Dilemmas in Epinephrine Dosing
Only 2 premeasured, fixed doses of epinephrine, 0.15 mg and 0.3 mg, are currently available in EA formulations in the United States and Canada. 35 EA manufacturers advise prescribing the 0.15-mg dose for patients weighing 15 to 30 kg and the 0.3-mg dose for those weighing 30 kg and over.
Prescribing EAs
Most anaphylaxis deaths occur in community settings rather than in health care settings 1,16,–18; yet, some physicians fail to prescribe EAs for their patients at risk of anaphylaxis in the community.
What is the purpose of epinephrine?
Indication. Epinephrine is indicated for the emergency treatment of allergic reactions (Type I), including anaphylaxis, which is defined as an acute, life-threatening allergic reaction. It can be triggered by insect stings or bites, foods, drugs, and other allergens, or it can be idiopathic or exercise-induced.
How many ml is an Epipen injection?
EpiPen auto-injectors (epinephrine injections, 1:1000) are available as a 2-pack of 0.3 mL EpiPen auto-injectors and one trainer device. EpiPen Jr auto-injectors (epinephrine injections, USP, 1:2000) are available as a 2-pack of 0.3 mL EpiPen Jr auto-injectors and one trainer device.
What is the effect of epinephrine on the vascular system?
Through its action on alpha-adrenergic receptors, it reduces vasodilation and increases vascular permeability that occurs during ana phylaxis. Its action on beta-adrenergic receptors results in bronchial smooth muscle relaxation, which helps alleviate bronchospasm, wheezing, and dyspnea that may occur during anaphylaxis.
When was the first epinephrine injection invented?
The first epinephrine auto-injector was invented in the mid-1970s and approved in 1987. Yet, since Mylan purchased EpiPen in 2007, the product has increased in price by more than 400%, which has sparked public outrage and inquiries from Congress. Despite EpiPen having an 85% market share, there are still several other epinephrine formulations ...
Is epinephrine an autoinjector?
Epinephrine is highly effective for anaphylaxis. Although costly, the auto-injectors provide ease of use for patients and caregivers. Future generic formulations are expected to be released, which will help lower costs.
Does epinephrine help with anaphylaxis?
Epinephrine also reduces pruritus, urticaria, and angioedema and may relieve gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxer effects on the smooth muscle of the stomach, intestine, uterus, and bladder.
What is Personnel, medications, and supplies for assessing and managing anaphylaxis?
Personnel, medications, and supplies for assessing and managing anaphylaxis: This section has been expanded to indicate that trained personnel qualified to recognize and treat symptoms of anaphylaxis should be available at vaccination locations at all times. The recommendations for medications and supplies have also been updated.
What to do if you suspect anaphylaxis?
If anaphylaxis is suspected, take the following steps: Rapidly assess airway, breathing, circulation, and mentation (mental activity). Call for emergency medical services (EMS). Place the patient in a supine position (face up), with feet elevated, unless upper airway obstruction is present or the patient is vomiting.
What is emergency use authorization?
Under the Emergency Use Authorizations#N#external icon#N#for COVID-19 vaccines, appropriate medical treatment for severe allergic reactions must be immediately available in the event that an acute anaphylactic reaction occurs following administration of a COVID-19 vaccine. These interim considerations provide information on preparing for the initial assessment and management of anaphylaxis following COVID-19 vaccination.
Can anaphylaxis be recognized in long term care?
In addition, symptoms of anaphylaxis might be more difficult to recognize in people with communication difficulties, such as long-term care facility residents with cognitive impairment, those with neurologic disease, or those taking medications that can cause sedation.
Is anaphylaxis a life threatening reaction?
Anaphylaxis, an acute and potentially life-threatening allergic reaction , has been reported rarely following COVID-19 vaccination. These interim considerations provide recommendations on assessment and management of anaphylaxis following COVID-19 vaccination. Detailed information on CDC recommendations for vaccination, including contraindications and precautions to vaccination, can be found in the Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. Patients should be screened prior to receipt of each vaccine dose, and those with a contraindication should not be vaccinated. A COVID-19 prevaccination questionnaire#N#pdf icon#N#[6 pages] is available to assist with screening.
Is epinephrine contraindicated for anaphylaxis?
Because of the acute, life-threatening nature of anaphylaxis, there are no contraindications to epinephrine administration. Antihistamines (e.g., H1 or H2 antihistamines) and bronchodilators do not treat airway obstruction or hypotension and, thus, are not first-line treatments for anaphylaxis.