The Role of Epinephrine in the Treatment of Anaphylaxis Anne K. Ellis, MD, and James H. Day, MD, FRCP(C) Address Beneficial Effects of Epinephrine Division of Allergy, Kingston General Hospital, 76 Stuart Street, in Anaphylaxis Kingston, ON K7L 2V7, Canada. Epinephrine is both an alpha (α) and a beta (β) adrener- E-mail:
[email protected] gic receptor agonist. Through α-adrenergic stimulation, Current Allergy and Asthma Reports 2003, 3:11–14 epinephrine increases peripheral vascular resistance, Current Science Inc. ISSN 1529-7322 Copyright © 2003 by Current Science Inc. improving blood pressure and coronary artery perfusion, reversing peripheral vasodilation, and decreasing angioedema and urticaria [5]. β-1 adrenergic stimulation Epinephrine is the cornerstone of anaphylaxis manage- has positive inotropic and chronotropic effects on the ment. Its administration should be immediate upon evi- myocardium, and β-2 adrenergic effects include bron- dence of the occurrence of anaphylaxis. Delays in chodilation [6]. β-adrenergic receptors also increase administration may be fatal. The most appropriate admin- intracellular cyclic adenosine monophosphate (cAMP) istration is 0.3 to 0.5 mL of 1:1000 dilution intramuscu- production in mast cells and basophils, which inhibits larly for adults and 0.01 mg/kg for children, given in the further inflammatory mediator release [7,8]. lateral thigh. Patients with known anaphylactic reactivity should be prescribed an epinephrine auto-injector to be carried at all times for treatment of potential recur- Dosage and Routes of Administration rences. Education of the patient or parent regarding the for Epinephrine proper use of this tool is paramount. Some discrepancy exists in the literature concerning the appropriate dosage of epinephrine for anaphylaxis.