Update on epinephrine for the treatment of anaphylaxis

PURPOSE OF REVIEW: Epinephrine is the treatment of choice for anaphylaxis - a life-threatening and potentially fatal event. The purpose of this review is to highlight recent publications relevant to the management of anaphylaxis and identify potential barriers which prevent or delay appropriate administration of epinephrine. RECENT FINDINGS: Experts have moved towards a consensus on how to define anaphylaxis, which has a variable clinical presentation. A clear definition, across specialties, is necessary for more accurate determinations of prevalence, diagnosis and management. Epinephrine injected intramuscularly is the treatment of choice, but there remain gaps in physician knowledge despite increases in hospitalization rates for anaphylaxis. Epinephrine is also underused by parents, day-care centers and schools. Barriers to access for treatment exist in lower socioeconomic groups. Women appear to be at risk for suboptimal treatment when autoinjectors are used. Given these issues, other routes of administration of epinephrine have been explored. Epinephrine delivered via a sublingual route has been successful in animal studies. SUMMARY: Epinephrine is the primary therapy for anaphylaxis, yet studies show that it is underutilized. By addressing the contributory factors that have been identified, acute and long-term care of individuals with this potentially life-threatening disorder can be optimized.