Q:

4/24/2013
Is it possible to have anaphylaxis to epinephrine? How many cases have been reported? What is the treatment, if it is true anaphylaxis to epinephrine? My patient is sure she has an allergy to epi and would not like to take any in case of true anaphylaxis. I will be sending her to allergist soon. Thank you so much!

A:

Thank you for your inquiry.

I am not aware of, and could not find in the literature, any documented case of anaphylaxis to epinephrine. Also I can recount my personal experience with a handful of patients who have presented with the same claim. In each instance, a graded challenge to this drug failed to produce any adverse response except those which were expected due to its pharmacologic activity.

A graded dose challenge is the only way one could evaluate a patient in this regard because skin tests would be invalid due to the vasoconstrictive effect of the drug, and there is no in vitro assay for specific IgE to epinephrine.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology