Epinephrine in the Management of Anaphylaxis

Epinephrine is life-saving and the only first-line medication in the management of anaphylaxis. At therapeutic doses, it acts rapidly to reverse nearly all symptoms of anaphylaxis, and stabilize mast cells. The standard approved doses administered intramuscularly in the lateral thigh have a long track record for safe and effective use, but more information is needed on epinephrine pharmacokinetics and pharmacodynamics to ensure that current dosing strategies are optimal. Epinephrine should be administered promptly once anaphylaxis is suspected, to minimize morbidity and mortality. Providers on the front-line for managing patients with life-threatening allergic reactions need clear parameters and tools to guide the appropriate use of epinephrine, which take into account the potential evolution of symptoms and signs over time. All patients at risk for anaphylaxis should carry 2 epinephrine autoinjectors and be taught and able to demonstrate how to use them. Epinephrine autoinjectors need to be affordable, readily available, and easy for patients with allergies to carry and use. Furthermore, these devices should be available to meet the needs of all patients, from small infants through large or obese adults. 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.