How is epinephrine administered in the treatment of anaphylaxis?

Updated: May 16, 2018
  • Author: S Shahzad Mustafa, MD; Chief Editor: Michael A Kaliner, MD  more...
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Administer intramuscular (IM) epinephrine immediately. [37, 67] IM administration of epinephrine in the thigh (vastus lateralis) results in higher and more rapid maximum plasma concentrations of epinephrine than IM or subcutaneous (SC) administration in the arm (deltoid) of asymptomatic children and adults (see Medication). [49] However, similar studies comparing IM injections to SC injections in the thigh have not yet been done. Obesity or other conditions that enlarge the subcutaneous fat pad may prevent intramuscular access.

Remove the source of the antigen if possible (eg, remove stinger after honeybee sting or stop drug infusion). If anaphylaxis occurs after injection of allergen-specific subcutaneous immunotherapy (SCIT), a large local reaction often occurs. Place a tourniquet above the injection site and, after IM epinephrine is administered, inject up to 0.1 mL of epinephrine into the large local reaction site to slow absorption.

Racemic epinephrine via a nebulizer can be used to reduce laryngeal swelling, but it does not replace IM administration of epinephrine. Treat bronchospasm that has not responded to IM epinephrine with inhaled beta2 -adrenergic agonists such as albuterol.

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