Benefits of Epinephrine for Anaphylaxis Outweigh Potential Harm—A Safety Review
David I. Bernstein, Michael S. Blaiss, Evan S. Dellon, Karen Rance
Abstract
Anaphylaxis is a potentially life-threatening allergic reaction that can progress quickly, and although fatal anaphylaxis is very rare, treatment should be given as soon as possible. The recommended first-line treatment for anaphylaxis is intramuscular (IM) epinephrine. Yet epinephrine for anaphylaxis is underused, which can have deleterious, or even tragic, consequences. Although fear of self-injection substantially affects adherence, hesitancy to use epinephrine for anaphylaxis may be linked to the common unsubstantiated perception that epinephrine is dangerous. Therefore, the objective of this narrative review is to describe the safety of epinephrine when administered for the treatment of anaphylaxis. Cardiovascular adverse events (AEs) are the greatest safety concern with epinephrine because of its known effects on cardiac output and vasoconstriction. Cardiovascular events and overdose are significantly more likely to occur with accidental intravenous bolus administration than IM administration. Although serious AEs have been reported with IM epinephrine, and there are potential risk factors for cardiovascular AEs for some patients, there are no absolute contraindications for its use in a life-threatening situation. Appropriately dosed and administered epinephrine should engender no fear of use for anaphylaxis. The potential harm of delaying or withholding epinephrine treatment for anaphylaxis far outweighs the potential risk of AEs.