Epinephrine in anaphylaxis: doubt no more

Purpose of review The purpose of this manuscript is to review the literature in support of epinephrine (adrenaline) as first line of therapy of anaphylaxis, not H-1 antihistamines or corticosteroids. Recent findings The purpose of this review is to assess that epinephrine has a quick onset of activity and rapidly antagonizes multiple mediators that are active in anaphylaxis. Epinephrine has maximal pharmacodynamic effect within 10 min of intramuscular administration into the thigh. As epinephrine has a narrow therapeutic window, prefilled epinephrine auto-injectors are available. There are weight-appropriate doses of epinephrine available with auto-injectors that are prefilled with 0.15, 0.30 and 0.50 mg. In addition, needle lengths vary from 1.17 to 2.50 cm. Different doses and needle lengths are available for paediatric and adult patients, especially obese patients to ensure intramuscular delivery in the thigh. Failure to administer epinephrine promptly has resulted in fatalities. Education about anaphylaxis and prompt treatment are critical for patients and their caregivers.