Johannes Ring1, Ludger Klimek, Margitta Worm. 1. Department of Dermatology and Allergology, Technical University Munich; Center for Rhinology and Allergology, Wiesbaden; Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin.
Abstract
BACKGROUND: Anaphylaxis is the most serious manifestation of an immediate allergic reaction and the most common emergency event in allergology. Adrenaline (epi- nephrine) is the mainstay of acute pharmacotherapy for this complication. Although epinephrine has been in use for more than a century, physicians and patients are often unsure and inadequately informed about its proper administration and dosing in everyday situations. METHODS: This review is based on pertinent publications from the period 1 January 2012 to 30 September 2017 that were retrieved, on the basis of the existing guide- lines of 2007 and 2014, by a PubMed search employing the keywords "anaphylaxis treatment," "allergic shock," "adrenaline," and "epinephrine," as well as on further ar- ticles from the literature. RESULTS: Adrenaline/epinephrine administration often eliminates all manifestations of anaphylaxis. The method of choice for administering it (except in intensive-care medicine) is by intramuscular injection with an autoinjector; this is mainly done to treat reactions of intermediate severity. The injection is given in the lateral portion of the thigh and can be repeated every 10-15 minutes until there is a response. The dose to be administered is 300-600 µg for an adult or 10 µg/kg for a child. The risk of a serious cardiac adverse effect is lower than with intravenous administration. There have not been any randomized controlled trials on the clinical efficacy of ephi- nephrine in emergency situations. The use of an autoinjector should be specially practiced in advance. CONCLUSION: The immediate treatment of patients with anaphylaxis is held to be ad- equate, yet major deficiencies remain in their further diagnostic evaluation, in the prescribing of emergency medications, and in patient education. Further research is needed on cardiovascular involvement in anaphylaxis and on potential new thera- peutic approaches.
BACKGROUND:Anaphylaxis is the most serious manifestation of an immediate allergic reaction and the most common emergency event in allergology. Adrenaline (epi- nephrine) is the mainstay of acute pharmacotherapy for this complication. Although epinephrine has been in use for more than a century, physicians and patients are often unsure and inadequately informed about its proper administration and dosing in everyday situations. METHODS: This review is based on pertinent publications from the period 1 January 2012 to 30 September 2017 that were retrieved, on the basis of the existing guide- lines of 2007 and 2014, by a PubMed search employing the keywords "anaphylaxis treatment," "allergic shock," "adrenaline," and "epinephrine," as well as on further ar- ticles from the literature. RESULTS:Adrenaline/epinephrine administration often eliminates all manifestations of anaphylaxis. The method of choice for administering it (except in intensive-care medicine) is by intramuscular injection with an autoinjector; this is mainly done to treat reactions of intermediate severity. The injection is given in the lateral portion of the thigh and can be repeated every 10-15 minutes until there is a response. The dose to be administered is 300-600 µg for an adult or 10 µg/kg for a child. The risk of a serious cardiac adverse effect is lower than with intravenous administration. There have not been any randomized controlled trials on the clinical efficacy of ephi- nephrine in emergency situations. The use of an autoinjector should be specially practiced in advance. CONCLUSION: The immediate treatment of patients with anaphylaxis is held to be ad- equate, yet major deficiencies remain in their further diagnostic evaluation, in the prescribing of emergency medications, and in patient education. Further research is needed on cardiovascular involvement in anaphylaxis and on potential new thera- peutic approaches.
Authors: M Worm; A Moneret-Vautrin; K Scherer; R Lang; M Fernandez-Rivas; V Cardona; M L Kowalski; M Jutel; I Poziomkowska-Gesicka; N G Papadopoulos; K Beyer; T Mustakov; G Christoff; M B Bilò; A Muraro; J O B Hourihane; L B Grabenhenrich Journal: Allergy Date: 2014-08-16 Impact factor: 13.146
Authors: M Worm; G Edenharter; F Ruëff; K Scherer; C Pföhler; V Mahler; R Treudler; R Lang; K Nemat; A Koehli; B Niggemann; S Hompes Journal: Allergy Date: 2012-02-16 Impact factor: 13.146
Authors: S S Panesar; S Javad; D de Silva; B I Nwaru; L Hickstein; A Muraro; G Roberts; M Worm; M B Bilò; V Cardona; A E J Dubois; A Dunn Galvin; P Eigenmann; M Fernandez-Rivas; S Halken; G Lack; B Niggemann; A F Santos; B J Vlieg-Boerstra; Z Q Zolkipli; A Sheikh Journal: Allergy Date: 2013-10-14 Impact factor: 13.146
Authors: Johannes Ring; Kirsten Beyer; Tilo Biedermann; Andreas Bircher; Matthias Fischer; Thomas Fuchs; Axel Heller; Florian Hoffmann; Isidor Huttegger; Thilo Jakob; Ludger Klimek; Matthias V Kopp; Claudia Kugler; Lars Lange; Oliver Pfaar; Ernst Rietschel; Franziska Rueff; Sabine Schnadt; Roland Seifert; Britta Stöcker; Regina Treudler; Christian Vogelberg; Thomas Werfel; Margitta Worm; Helmut Sitter; Knut Brockow Journal: Allergo J Int Date: 2021-01-28
Authors: Johannes Ring; Kirsten Beyer; Tilo Biedermann; Andreas Bircher; Matthias Fischer; Axel Heller; Isidor Huttegger; Thilo Jakob; Ludger Klimek; Matthias V Kopp; Claudia Kugler; Lars Lange; Oliver Pfaar; Ernst Rietschel; Franziska Rueff; Sabine Schnadt; Roland Seifert; Britta Stöcker; Regina Treudler; Christian Vogelberg; Thomas Werfel; Margitta Worm; Helmut Sitter; Knut Brockow Journal: Allergo J Date: 2021-02-12