What are the primary drug treatments for acute anaphylaxis?

Updated: May 16, 2018
  • Author: S Shahzad Mustafa, MD; Chief Editor: Michael A Kaliner, MD  more...
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The primary drug treatments for acute anaphylactic reactions are epinephrine and H1 antihistamines. According to the 2013 World Allergy Association update, [48] 2015 Joint Task Force anaphylaxis update, [47] and 2010 NIAID guidelines, [66] epinephrine is the drug of choice for life-threatening reactions. When the intravenous (IV) route is not indicated, the intramuscular (IM) route is preferable to the subcutaneous (SC) route due to more rapid and reliable absorption. The anterolateral thigh is the preferred site, in children and adults. There is evidence for better absorption at this site as compared to a deltoid IM injection or SC injection. A summary of pharmacological management recommendations is available in the Joint Task Force anaphylaxis update, [47] NIAID report, [66] or WAO report. [48]

Epinephrine is clearly effective for the most serious effects, and H1 -blockers are also effective; do not delay or defer their use in favor of other treatments. Inhaled beta agonists lack some of the adverse effects of epinephrine and are useful for cases of bronchospasm, but they may not have additional effects when optimal doses of epinephrine are used. Corticosteroids are potentially effective in preventing biphasic (ie, recurrent) reactions. Due to their delayed effect, corticosteroids are not first-line treatments.

H2 -blocking antihistamines theoretically are attractive agents for dermal and gastrointestinal (GI) manifestations, but evidence supporting their clinical effectiveness is less than that for H1 -blocking agents. Some evidence suggests that combining H1 and H2 blockers may be more effective than H1 blockers alone. Glucagon may be useful in treating refractory cardiovascular effects in patients taking beta-blockers.

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