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First-aid treatment of anaphylaxis to food: Focus on epinephrine

  • F.Estelle R Simons
    Correspondence
    Reprint requests: F. Estelle R. Simons, MD, FRCPC, Children's Hospital of Winnipeg, 820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9
    Affiliations
    From the Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health; and the Department of Immunology, National Training Program in Asthma and Allergy, University of Manitoba, Winnipeg, Manitoba, Canada
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      Abstract

      Avoiding food triggers for anaphylactic reactions (severe acute systemic allergic reactions) is easier said than done. Most episodes of anaphylaxis to food occur unexpectedly in the community in the absence of a health care professional. All individuals at risk should therefore have an emergency action plan in place. The cornerstone of first-aid treatment of anaphylaxis is epinephrine injected intramuscularly in the vastus lateralis muscle (lateral aspect of the thigh). In this review, we focus on epinephrine. We examine a therapeutic dilemma: the issue of epinephrine dose selection in an individual for whom no optimal fixed-dose auto-injector formulation exists, and a therapeutic controversy: the issue of epinephrine injection versus an oral H1-antihistamine in anaphylaxis episodes that appear to be mild. The pharmaceutical industry could address the first of these issues by providing a wider range of epinephrine fixed doses in easy-to-use auto-injectors, or by providing adjustable epinephrine doses in auto-injectors. The second issue could be addressed in part by development of alternative routes of epinephrine administration for the first-aid, out-of-hospital treatment of anaphylaxis.

      Keywords

      Abbreviations:

      tmax (Time to peak plasma concentration)
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      Linked Article

      • Correction
        Journal of Allergy and Clinical ImmunologyVol. 113Issue 6
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          With regard to the May 2004 article entitled “First-aid treatment of anaphylaxis to food: Focus on epinephrine” (2004;113:837-44): A serious dosage error appears in the section entitled “Epinephrine in the first-aid treatment of anaphylaxis.” On page 837, in the fifth line of the subsection entitled “Evidence base for epinephrine use in anaphylaxis,” the epinephrine dosage for children appears incorrectly as “a maximum of 0.3 mg/kg.” The correct maximum initial dose is 0.2 mg to 0.5 mg in adults; 0.01 mg/kg to a maximum of 0.3 mg in children.
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