Adrenaline auto-injectors for preventing fatal anaphylaxis
Author(s)
Type
Journal Article
Abstract
Anaphylaxis affects up to 5% of people during their lifetime. Although anaphylaxis usually resolves without long-term physical consequences, it can result in anxiety and quality of life impairment. Rarely and unpredictably, community anaphylaxis can cause rapid physiological decompensation and death. Adrenaline (epinephrine) is the cornerstone of anaphylaxis treatment, and provision of adrenaline autoinjectors (AAI) has become a standard of care for people at risk of anaphylaxis in the community. In this article, we explore the effectiveness of AAIs for preventing fatal outcomes in anaphylaxis, using information drawn from animal and human in vivo studies and epidemiology. We find that data support the effectiveness of intravenous adrenaline infusions for reversing physiological features of anaphylaxis, typically at doses from 0.05 to 0.5 μg/kg/min for 1–2 h, or ~ 10 μg/kg total dose. Intramuscular injection of doses approximating 10 μg/kg in humans can result in similar peak plasma adrenaline levels to intravenous infusions, at 100–500 pg/mL. However, these levels are typically short-lived following intramuscular adrenaline, and pharmacokinetic and pharmacodynamic outcomes can be unpredictable. Epidemiological data do not support an association between increasing AAI prescriptions and reduced fatal anaphylaxis, although carriage and activation rates remain low. Taken together, these data suggest that current AAIs have little impact on rates of fatal anaphylaxis, perhaps due to a lack of sustained and sufficient plasma adrenaline concentration. Effects of AAI prescription on quality of life may be variable. There is a need to consider alternatives, which can safely deliver a sustained adrenaline infusion via an appropriate route.
Date Issued
2025-01-01
Date Acceptance
2024-08-28
Citation
Clinical and Experimental Allergy, 2025, 55 (1), pp.19-35
ISSN
0954-7894
Publisher
Wiley
Start Page
19
End Page
35
Journal / Book Title
Clinical and Experimental Allergy
Volume
55
Issue
1
Copyright Statement
© 2024 The Author(s). Clinical & Experimental Allergy published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39383344
Subjects
ALLERGIC REACTIONS
Allergy
anaphylaxis
ARGININE-VASOPRESSIN
CHILDREN
drug allergy
EPINEPHRINE ABSORPTION
food allergy
FOOD ALLERGY
HEMODYNAMIC RECOVERY
Immunology
Life Sciences & Biomedicine
NATIONAL INSTITUTE
pharmacology and pharmacogenomics
QUALITY-OF-LIFE
Science & Technology
TRENDS
UNITED-KINGDOM
venom and insect allergy
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2024-10-09