Allercy and Asthma Health
The Official Publication of AAN - MA

When in Doubt, Use It! Epinephrine Can Save a Life in an Emergency


By Sarah M. Varekojis, PhD, RRT

Severe allergic reactions are scary and, when they occur, potentially life-threatening.

Severe allergic reactions, also called anaphylaxis, are the result of exposure to allergens or triggers. Common allergens and triggers include pollen, grass, dust mites, mold, weeds, insect stings, food, latex, and medications.

While anyone who has experienced an allergic reaction in the past is at risk for future severe allergic reactions, they are more likely to occur in people with allergies to insect stings, food, latex, and medications. After exposure to one of these allergens or triggers, the affected person’s immune system has an exaggerated reaction toward a substance that is normally harmless (like food or latex) or normally produces only a mild reaction (like an insect sting).

Know the symptoms

Anaphylaxis often starts with severe itching of the eyes or face, and very quickly (within minutes) progresses into one or more of the following:

  • Trouble breathing
  • Becoming hoarse or a tightness in the throat
  • Wheezing (a whistling sound while breathing)
  • Swelling in or around the face, eyes, ears, mouth, hands, and/or feet
  • Hives or flushing of the skin
  • Nausea, vomiting, diarrhea, abdominal cramping
  • Feeling dizzy or fainting

If anaphylaxis is not recognized and treated rapidly, the reaction can progress to low blood pressure, high heart rate, and eventually, to unconsciousness and cardiac arrest.

First line of defense

In August 2015, the American College of Allergy, Asthma, and Immunology released a report regarding the emergency care of anaphylaxis. One of the goals of the report was to ensure appropriate and prompt treatment of anaphylaxis by allergists and emergency room physicians. But the message delivered by the expert panel is also important for patients and families to hear.

Epinephrine (also commonly called adrenaline) is a drug that will reverse or prevent the swelling that occurs in the airway that leads to difficulty breathing, and will reverse or prevent the decrease in blood pressure that occurs with anaphylaxis. The expert panel concluded that epinephrine is the first line of defense in treating anaphylaxis, and that other treatments like corticosteroids and antihistamines should only be used after the patient has been given epinephrine, mostly because epinephrine works much faster than the other medications.

They clearly stated that the consequences of using epinephrine when it may not be necessary are much less significant than not using it when it could save a patient’s life.
The use of epinephrine rarely leads to dangerous side effects, making it safe to administer even if you only suspect you or a family member is having a severe allergic reaction.

The expert panel concluded, “There is no substitute for epinephrine as the most important tool for combatting anaphylaxis.”

Talk to your doctor

Patients and families need to remember that knowing and avoiding allergens and triggers is the foundation of preventing anaphylaxis. In addition, you need to be able to quickly identify the symptoms of anaphylaxis and be prepared to administer epinephrine at the first sign of symptoms.

Talk to your doctor to determine if you need to carry an automatic epinephrine injection device, and make sure family and friends are aware and prepared to help if necessary. A medical alert bracelet or necklace, or a card that identifies your allergens and triggers, is also recommended to assist medical personnel in your treatment. And it is important to call 911 for follow-up care after self-administration of epinephrine.

Dr. Sarah Varekojis is a member of the American Association for Respiratory Care from Columbus, OH, where she currently serves as an assistant professor and director of clinical education in the respiratory therapy program at Ohio State University.
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