Providers should not hesitate to use epinephrine for a patient with anaphylaxis, even if it is unconfirmed, according to a report published online ahead of print August 6 in the Annals of Allergy, Asthma, and Immunology.

Authored by a panel of allergists and emergency physicians chaired by Stanley Fineman, MD, the paper reviews scientific literature on anaphylaxis and provides recommendations on emergency anaphylaxis care. “Because epinephrine is the first line of defense in treating anaphylaxis, the panel agreed it should be used—even if a patient’s reaction may not meet all the established criteria,” Dr. Fineman said. “The consequences for not using epinephrine when it’s needed are much more severe than using it when it might not be necessary.” 


In addition, the group indicated that epinephrine should be used with patients who are at risk for an anaphylactic reaction based on a previous severe reaction or with patients who have had a known or suspected exposure to an allergic trigger with or without the development of symptoms. Antihistamines and corticosteroids were not recommended for use instead of epinephrine, because they do not offer rapid results. The group also recommended referral for a comprehensive follow-up with an allergist after treatment for anaphylaxis in an emergency department.