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Epinephrine is recognized as the immediate first-line anaphylaxis treatment but it is mostly underused. This is troubling considering how fatal anaphylaxis can be if there is delayed epinephrine administration.

What is anaphylaxis?

Anaphylaxis is an allergic reaction that can lead to death if not treated immediately which occurs due to exposure to an allergen from medication, food, insect sting, or any other trigger. The allergic reaction can occur at any time and can be triggered by allergens that one has experienced in the past. a mild reaction comprises of itching, hives, flushing, swelling of tongue or lips, and sometimes a combination of both.

Sometimes one can experience wheezing, trouble breathing, tightening or throat swelling, cough, shortness of breath, failing, nausea, and vomiting among others. Usually, the symptoms of anaphylaxis tend to vary from individual to individual and even episode to another. Anaphylaxis can be fatal and it is associated with concomitant asthma, adolescence, and failure to administer epinephrine immediately.

Epinephrine as a first-line treatment for anaphylaxis

Epinephrine should be administered promptly whenever there is an anaphylactic episode as a first-line treatment. It is a form of a hormone produced by adrenal glands and it works instantly to prevent progression as well as reverse anaphylaxis symptoms.  Any time you suspect that you are having an anaphylactic episode you should receive epinephrine immediately. Even when there is suspicion of having an allergic reaction always administer because the risk of having a severe reaction outweighs risks of inappropriate administration of epinephrine.

Usually, epinephrine will produce vasoconstrictor effects preventing or decreasing upper airway mucosal edema, shock, and hypotension. Also, it produces bronchodilator effects as well as chronotropic and cardiac inotropic effects. Most importantly antihistamines or glucocorticoids cannot be used as substitutes to epinephrine because they can only relive hives and itching but the life-threatening respiratory issues, shock, and hypotension will persist.

Sometimes antihistamines like cetirizine and diphenhydramine and glucocorticoids such as prednisone or a combination of both can be administered in some instances of anaphylaxis. It is important to note that antihistamines only relieve mild reactions within an hour but glucocorticoids can take longer to work thus not ideal for severe symptoms.