title: Epinephrine (adrenaline) in the first-aid, out-of-hospital treatment of anaphylaxis.
abstract: Epinephrine (adrenaline), the initial treatment of choice for systemic anaphylaxis, is an alpha- and beta-adrenergic agonist with bidirectional, cyclic adenosine monophosphate-mediated pharmacological effects on target organs, and a narrow therapeutic index. In a recent study, 0.95% of a geographically-defined population was found to have had epinephrine dispensed for out-of-hospital use; dispensing rates within this population varied from 1.44% for individuals under age 17 years to 0.32% for those older than 65 years. Although epinephrine is widely available in the community, it is not necessarily given in a timely manner when anaphylaxis occurs. Individuals with anaphylaxis may fail to respond to first-aid treatment with epinephrine for a variety of reasons. These include: (1) delay in treatment (in an animal model, epinephrine injection at the nadir of shock fails to provide sustained haemodynamic recovery); (2) administration of epinephrine by sub-optimal routes such as subcutaneous injection or inhalation from a pressurized metered-dose inhaler instead of intramuscular injection; (3) administration of an inappropriately low epinephrine dose due to the limitations currently imposed by the availability of only two fixed-dose auto-injectors: EpiPen Jr 0.15 mg or EpiPen 0.3 mg; and (4) injection of 'outdated' epinephrine, with inadvertent administration of an inadequate dose. Additional fixed-dose formulations of epinephrine are needed to facilitate optimal first-aid dosing in patients of all ages and sizes.
authors.affiliation: Section of Allergy & Clinical Immunology, Department of Pediatrics & Child Health, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
mesh_terms: D000293:Adolescent; D000322:Adrenergic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000188:drug therapy* / Q000503:physiopathology; D000818:Animals; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D011307:Drug Prescriptions; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005392:First Aid; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy* / Q000503:physiopathology; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012646:Self Administration
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine