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Do we know enough about epinephrine’s effectiveness?

Published online: March 29, 2018

In the event of a severe allergic reaction, namely anaphylaxis, the recommendations are clear: inject epinephrine without hesitation into the thigh muscle immediately. But do we know how epinephrine really helps in these situations? The independent Cochrane Collaboration, a network of trusted experts in tracking intervention studies, could not identify a single trial assessing the effectiveness of epinephrine in anaphylaxis.

In light of the vague scientific evidence for epinephrine in anaphylaxis emergency management, Grabenhenrich et al sought to find out how many first responders follow the guidelines and inject epinephrine. They analyzed data from the European Anaphylaxis Register from 10 countries over the past 10 years and published the results in a recent issue of The Journal of Allergy and Clinical Immunology: In Practice.

Grabenhenrich et al found that only one in four patients with a severe allergic reaction received epinephrine, despite being treated by a health professional, and only one in seven were given epinephrine when handled by a lay helper. They found that the numbers were somewhat increasing between 2007 and 2017 for professionals but not for lay respondents. The study could not identify a clear reason for the deficiency in injecting epinephrine for anaphylaxis. The treatment decision had nothing to do with the patient herself or himself (e.g., age) or the elicitor for the reaction, be it an insect sting, a drug, or a food allergen. Only patients with life-threatening symptoms, such as respiratory or cardiac arrest, were more likely to receive epinephrine, with still one in three not receiving the recommended drug.

Despite what the imperative, robust evidence implies, most first respondents refrain from giving epinephrine to anaphylaxis patients. With the far-reaching implications on individual health, ethics, and health economics, Grabenhenrich and colleagues call for joint efforts to lay the scientific foundations for an evidence-based anaphylaxis management strategy.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.