Epinephrine Treatment for Severe Allergic Reactions Effective but Under-Utilized

Updated on December 27, 2018
Carola Finch profile image

Carola is a freelance writer who enjoys writing about health topics. She manages a website for people with disabilities.


The Definition Of Anaphylaxis

The American College of Allergy, Asthma, and Immunology defines anaphylaxis is a severe, life-threatening, and unpredictable allergic reaction. The leading cause of this reaction in the USA is food allergies. People may experience mild symptoms before a severe reaction occurs.

About Epinephrine

According to the US National Library of Medicine epinephrine is a drug mainly used to treat severe asthma attacks and severe allergic reactions to foods, insect bites or stings, or unknown substances. It is prescribed by doctors in the form of autoinjectors so that patients can give themselves a shot when needed. The medication is sold under different brand names. One of the most commonly known is the Epipen.

Immediate treatment is vital because anaphylaxis can be deadly if it is left untreated. Symptoms can appear suddenly and progress rapidly. Between 10 to 20 percent of severe reactions do not have skin symptoms. Some signs of a severe reaction are:

  • Constant coughing
  • Generalized hives
  • Rashes
  • Shortness of breath
  • Throat tightness
  • Trouble swallowing
  • Swelling on the skin with diarrhea, abdominal pain, and vomiting on various areas of the body
  • Weak pulse

Allergists say that it is better to use epinephrine right away because the benefits of the drug outweigh the possibility that the drug was not necessary.

Side Effects of Epinephrine

Side effects of the drug may include restlessness, anxiety, dizziness, and shakiness. On rare occasions, the drug can affect the heart by leading to abnormal heart rates or rhythm, or heart attacks. Other effects can be a dramatic blood pressure increase and fluid build-up in the lungs, anxiety, dizziness, restlessness, and shakiness. Patients with certain pre-existing health conditions may be at a higher risk for adverse effects and should consult with an allergist before using epinephrine.

Common Mistakes In Using Epinephrine

Mistakes made using epinephrine auto-injectors prescribed for severe allergic reactions has been associated with cases of fatal anaphylaxis. A study by AAI found that many people do not know how to use the autoinjector properly, but think that they do. The research found that only 16 percent of patients who were prescribed epinephrine used their auto-injector properly.

Not using the autoinjector correctly

The most common mistake is not holding the device in place for at least 10 seconds before triggering. Other errors are not placing the needle end on the thigh, and not pushing down with enough force to activate the injection.

Training issues

Some patients have not been instructed properly on how to use the autoinjectors. Others were trained on usage but did not understand what to do with the devices when a severe allergic reaction occurs. Others forget what they had been taught over time.

People delaying treatment

Parents and caregivers often avoid or delay the use of the drug. Sometimes they give children antihistamines, which are not an appropriate treatment for anaphylaxis. Antihistamines do not reduce airway swelling or raise low blood pressure.


Treatment is not applied when needed

Researchers at the ACAAI have studied patient records for children who are seen in the emergency department or urgent care for severe allergic reactions to understand how the drug is used. Fewer than half of the patients had received epinephrine before going to the hospital, even though 65 percent had a history of severe allergic reactions and 47 percent had a prescription for the drug. Children with a severe reaction at home were less likely to receive the drug than those who had anaphylaxis at school.

Only 50 percent of the kids were treated with epinephrine when an attack occured, including those who had received a dose before going to emergency. Children who were treated before their arrival where less likely to receive the drug. Only two-thirds of those with a prescription for the drug have it with them when a several allergic reaction occurs.

Epinephrine Use Recommendations

Allergists at the ACAAI say that people with severe allergies and the parents of children with allergies should know that epinephrine should always be the first line of defence to treat anaphylaxis.

  • Patients or parents of children with allergies should be trained on the proper use of their autoinjectors. Stakeholders should ask medical professionals questions about proper usage and refresh their knowledge, if needed.
  • Epinephrine should always be available for use by people with severe allergies. A second dosage should also be included and administered immediately if needed. This is particularly important for people who have had previous anaphylactic reactions because of allergies to foods such as crustacean shellfish, fish, peanuts, and tree nuts.
  • After epinephrine has been administered, 911 should be called. The dispatcher should be informed that the drug had been administered and be informed of the dosage.
  • Patients who are seen in emergency departments and urgent care for anaphylaxis should be referred to an allergist. Allergists can provide guidance and follow up care. They also can provide an emergency treatment plan that indicates how and when medications should be administered.


More Information

More information about the treatment of severe allergic reactions and asthma attacks is available at: AllergyAndAsthmaRelief.org. Many drug companies post videos on YouTube on the correct use of their autoinjector brands.


Epinephrine Auto-injector, American College of Allergy, Asthma, and Immunology
Epinephrine, U.S. National Library of Medicine

Study shows epinephrine auto-injectors and asthma inhalers used incorrectly, American College of Allergy, Asthma, and Immunology
Half of kids who needed epinephrine didn't get it before trip to the emergency room, American College of Allergy, Asthma, and Immunology

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2017 Carola Finch


Submit a Comment
  • docashp profile image


    2 years ago from india

    It is the drug of choice for anaphylactic reactions and is life saving in these circumstances.


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