Adrenaline in the treatment of anaphylaxis: what is the evidence?

doi:10.1136/bmj.327.7427.1332

BMJ 2003;327:1332-1335 (6 December), doi:10.1136/bmj.327.7427.1332

Clinical review

Adrenaline in the treatment of anaphylaxis: what is the evidence?

Andrew P C McLean-Tooke, specialist registrar¹, Claire A Bethune, specialist registrar¹, Ann C Fay, consultant immunologist¹, Gavin P Spickett, consultant immunologist¹

¹ Regional Department of Immunology and Allergy, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

Correspondence to: A P C McLean-Tooke andrew.mclean-tooke@nuth.northy.nhs.uk

Adrenaline (epinephrine) is the recommended first line treatmentfor patients with anaphylaxis. This review discusses the safetyand efficacy of adrenaline in the treatment of anaphylaxis inthe light of currently available evidence. A pragmatic approachto use of adrenaline auto-injectors is suggested.

The first 150 words of the full text of this article appear below.

Introduction

Anaphylaxis is the clinical syndrome representing the most severesystemic allergic reactions. Mediator release results in smoothmuscle contraction, vasodilation, increased vascular permeability,and activation of vagal pathways, leading to the classic featuresof anaphylaxis, including urticaria and angioedema, bronchoconstrictionand hypotension. Owing to the nature of anaphylaxis there arefew controlled clinical trials, and therapeutic recommendationsare based on clinical observation and animal models. We lookat the current evidence for the use of adrenaline (epinephrine)in anaphylaxis, including its safety and route and timing ofadministration. We also discuss adrenaline auto-injectors andtheir role in patients with anaphylaxis.

Methods

We searched Medline using the key words adrenaline, anaphylaxis,epinephrine, and Epipen, and articles from the authors' personalcollection. When necessary we accessed cross references andrelated articles. Evidence has been graded, where possible (seebmj.com). Only studies with clinical outcomes have been classified(see table on bmj.com); those showing . . . [Full text of this article]

Anaphylaxis

Adrenaline

Auto-injectors

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