August 17, 2015
2 min read

Panel recommends epinephrine use even if severe allergic reaction is in doubt

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A panel of allergists and emergency physicians has recommended the use of epinephrine as a first-line defense against anaphylaxis, even if a patient is not showing signs of a severe allergic reaction.

A delay in epinephrine use could be hazardous and lead to even more severe anaphylaxis, according to the recommendations.

Stanley Fineman

Stanley M. Fineman

“Our emergency medicine colleagues told us that if patients don’t fit established guidelines for anaphylaxis, there may be a reluctance in the emergency room to treat with epinephrine,” Stanley M. Fineman, MD,  an adjunct associate professor in the department of pediatrics at Emory University School of Medicine, said in a press release. “Because epinephrine is the first line of defense in treating anaphylaxis, the panel agreed it should be used – even if a patient’s reaction may not meet all the established criteria. The consequences for not using epinephrine when it’s needed are much more severe than using it when it might not be necessary.”

The American College of Allergy, Asthma and Immunology in November 2014 gathered Fineman and colleagues to discuss current knowledge of anaphylaxis, and to recommend strategies to improve medical management of anaphylaxis.

Epinephrine should also be given to patients at risk for an anaphylactic reaction, whether they had a previous severe reaction or even if they had exposure to an allergic trigger without the development of anaphylaxis symptoms.

Anyone seen in the ED for anaphylaxis should be referred to an allergist to schedule a follow-up visit, according to the panel.

The panelists also recommended that antihistamines and glucocorticoids should never be used as a substitute to epinephrine, but rather should be used after epinephrine has already been administered.

“We want emergency medical personnel, as well as people who have had, or are at risk for having severe allergic reactions to know there is no substitute for epinephrine as the most important tool for combatting anaphylaxis,” panelist Paul J. Dowling, MD, director of allergy/immunology training program at Children's Mercy Hospitals and Clinics in Kansas City, said in the release. “Antihistamines and corticosteroids should not be given instead of epinephrine because they don’t work fast enough.” – by Ryan McDonald

Disclosure: The researchers report no relevant financial disclosures.