Indications for Adrenaline: Use by Patients and Emergency Departments
Pp. 330-363 (34)
Miguel A. Tejedor-Alonso, Maria V. Mugica-Garcia and Mar Moro-Moro
Experts agree that prompt use of intramuscular adrenaline is beneficial for
patients experiencing anaphylaxis. Adrenaline is administered using autoinjectors,
which are indicated in patients with a high risk of anaphylaxis, namely, those who have
already experienced anaphylactic reactions and have comorbid persistent asthma, those
who have reacted to trace amounts of allergen, those who have experienced mild
reactions to peanut or tree nut, those with mastocytosis and finally adolescents.
However, the frequency of administration of adrenaline by patients and physicians in
clinical settings is low. Autoinjectors are prescribed in less than 50% of cases;
availability and use by patients can be less than 75%. Administration of adrenaline in
emergency departments is also uncommon, in many cases less than 50%, although
many series show increased use of adrenaline when anaphylaxis is severe.
Our main objectives are to conduct a comprehensive review and update of the use of
epinephrine in anaphylaxis episodes (the first and recurrences) both by patients and by the
emergency services, after synthesizing the most accepted indications of epinephrine use in
anaphylaxis. All this information remains dispersed in the literature on anaphylaxis.
Adrenaline, auto-injectors, indications, emergency, prescription,
availability, administration, adherence, low.
Allergy Unit, Hospital Universitario Fundacion Alcorcón, Madrid, Avda Budapest 1, 28922 Alcorcón (Madrid), Spain.