The Emperor has no symptoms: the risks of a blanket approach to using epinephrine auto-injectors for all allergic reactions

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Title: The Emperor has no symptoms: the risks of a blanket approach to using epinephrine auto-injectors for all allergic reactions
Authors: Turner, PJ
DunnGalvin, A
Hourihane, J
Item Type: Journal Article
Abstract: Fatal anaphylaxis in humans is rare and unpredictable. We note a trend to provide allergic individuals with care plans that recommend immediate use of epinephrine autoinjectors if allergen ingestion is suspected, even in the absence of any allergic symptoms, without any supporting evidence base. Instructions to use an autoinjector device, irrespective of reaction severity and especially when symptoms are actually absent, are likely to add to parental and patient anxiety. Of greater concern is the possibility of epinephrine being administered “too early” to treat initial, mild symptoms that then progress to severe anaphylaxis. It is not hard to visualize a scenario where one or both epinephrine autoinjectors have been deployed for mild symptoms, yet the reaction progresses to a severe reaction and no further epinephrine is available for administration. Epinephrine needs to be available as a rescue treatment for anaphylaxis, potentially buying valuable minutes while emergency medical services are activated to attend. Food-allergic individuals and their carers need to be provided with more constructive strategies and support than merely being told to “use your pen.”
Issue Date: 7-Jun-2016
Date of Acceptance: 6-May-2016
ISSN: 2213-2198
Publisher: Elsevier
Start Page: 1143
End Page: 1146
Journal / Book Title: Journal of Allergy and Clinical Immunology: In Practice
Volume: 4
Issue: 4
Copyright Statement: © 2016 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY license (
Sponsor/Funder: Medical Research Council (MRC)
National Institute for Health Research
Funder's Grant Number: MR/K010468/1
Keywords: Anaphylaxis
Emergency management
Food allergy
Publication Status: Accepted
Appears in Collections:Department of Medicine
Faculty of Medicine

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