Treating
anaphylaxis

Adrenaline

Adrenaline is the first-line treatment for severe allergic reactions to food, insect stings, medication, latex, exercise and other allergens.

Adrenaline acts fast and rapidly treats all of the most dangerous symptoms of anaphylaxis, including throat swelling, difficulty breathing and low blood pressure.1 It also helps alleviate itching, rash, swelling, gastrointestinal and genitourinary symptoms.2,3 It works most effectively if it is given within the first few minutes of a severe allergic reaction.1

Adrenaline MOA

ADRENALINE

Adrenaline MOA diagram

Smooth muscle contraction and increased vascular resistance

Smooth muscle contraction and inhibition of transmitter release

Increases cardiac contraction force and increases heart rate

Decreases mediator release and increase bronchodilation

Increased blood pressure and decreased mucosal oedema

Increased blood pressure and relief from shock. Decreased upper airway obstruction, wheezing, urticaria and angioedema

Adrenaline MOA diagram

Smooth muscle contraction and increased vascular resistance

Smooth muscle contraction and inhibition of transmitter release

Increases cardiac contraction force and increases heart rate

Decreases mediator release and increase bronchodilation

Increased blood pressure and decreased mucosal oedema

Increased blood pressure and relief from shock. Decreased upper airway obstruction, wheezing, urticaria and angioedema

Dosage and administration

The preferred route of administration of adrenaline for initial treatment of anaphylaxis is intramuscular.4

Adrenaline has a vasodilator effect in skeletal muscle, skeletal muscle is well vascularised; after intramuscular injection into the vastus lateralis (mid-anterolateral thigh), absorption is rapid and epinephrine reaches the central circulation rapidly; rapid absorption is important in anaphylaxis, in which the median times to cardiorespiratory arrest are reported as 5 minutes Iatrogenic, e.g. injected medication), 15 minutes (stinging insect venom), 30 minutes (food).1

Adrenaline auto-injectors are prescribed for self-administration and should be administered as soon as anaphylaxis is identified. It is possible that a biphasic reaction may occur, which is one of the reasons why guidelines state that patients should be prescribed 2 AAIs which they should carry at all times.6

EAACI anaphylaxis guidelines recommend the following doses of adrenaline for self-administration, to be given by intramuscular injection.5

  • - For adult and child body weight 25kg and above - 0.3mg
  • - For child body weight 7.5 kg- 25kg - 0.15mg

Side effects and precautions

Side effects associated with adrenaline's alpha and beta receptor activity may include palpitations, tachycardia, and hypertension as well as undesirable effects on the central nervous system, sweating, nausea and vomiting, respiratory difficulty, pallor, dizziness, weakness, tremor, headache, apprehension, nervousness and anxiety. Cardiac arrhythmias may follow administration of adrenaline.2,3

There is no known reason why anyone should not use EpiPen® during an allergic emergency.2,3

EpiPen is considered first aid treatment for anaphylaxis only. Patients should be advised to call 999, ask for an ambulance and say 'anaphylaxis' as soon as they experience symptoms.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Mylan by phone 0800 121 8267 or e-mail ukpharmacovigilance@mylan.com

References

  • Simons, F.E.R., 2011. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organization Journal4(2), pp.13-37.
  • EpiPen® (adrenaline) Auto-Injector 0.3mg SPC. Available at https://www.medicines.org.uk/emc/product/4289/smpcLast accessed: September 2020.
  • EpiPen® Jr (adrenaline) Auto-Injector 0.15mg SPC. Available at https://www.medicines.org.uk/emc/product/4290/smpc Last accessed: September 2020.
  • Resuscitation Council (UK) Guidelines. January 2008. Available at:
    https://www.resus.org.uk/anaphylaxis/emergency-treatment-of-anaphylactic-reactions/ Last accessed May 2020.
  • Muraro, A et al., 2014. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy, 69(8), pp.1026-1045.
  • MHRA guidelines- https://www.gov.uk/drug-safety-update/adrenaline-auto-injectors-updated-advice-after-european-review Last access September 2020.

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