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Prescribing epinephrine for anaphylaxis self-treatment

Scott H Sicherer, MD, FAAAAI
Section Editor
John M Kelso, MD
Deputy Editor
Anna M Feldweg, MD


Epinephrine is the drug of choice in the treatment of anaphylaxis and is available in many parts of the world in the form of epinephrine autoinjectors for self-treatment [1]. However, when prescribing these devices, clinicians must teach patients how and when to use them and dispel fears about adverse effects. Autoinjectors may be lifesaving for patients, but only if patients are willing and able to use these devices effectively.


Epinephrine is a sympathomimetic agent with multiple actions that can reverse the symptoms of anaphylaxis. (See "Anaphylaxis: Emergency treatment".)

Beneficial effects — Epinephrine acts as an agonist at alpha-1 receptors to mediate increased vasoconstriction, increased peripheral vascular resistance, and decreased mucosal edema. Agonist effects at beta-2 receptors result in bronchodilation and decreased mediator release from mast cells and basophils (table 1) [2,3].

Adverse effects — Even when injected properly, epinephrine is often associated with minor and transient adverse effects such as tremor, dizziness, palpitations, anxiety, restlessness, and headache (table 1) [3].

In contrast, serious adverse effects such as myocardial ischemia are rare after injection of a 0.3 mg dose in an adult or a 0.15 mg dose in a child. Such effects occur more commonly with epinephrine overdose, especially after intravenous administration. Reluctance to administer epinephrine due to fear of adverse cardiac effects should be countered by the awareness that myocardial ischemia and dysrhythmias can also occur in children and adults with anaphylaxis who have not received epinephrine treatment and in whom no cardiovascular disease can be found after the episode [4,5].

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Literature review current through: Nov 2017. | This topic last updated: Jul 23, 2017.
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