Epinephrine is the only drug that can halt and reverse the progression of anaphylaxis, a severe, life-threatening reaction to a food, insect venom, or substance.
It is common advice for individuals who are prescribed epinephrine auto-injectors to carry two with them at all times. This is because a single dose may be enough to stop an anaphylactic episode. But how often is that the case?
A study recently published in The Journal of Allergy and Clinical Immunology sought to answer just that question.
The researchers searched the Medline, Embase, and Cochrane databases for relevant studies reporting at least 10 anaphylaxis events due to food or venom from 1946 until January 2020. Eligible studies included those reporting more than 10 cases of anaphylaxis (by any definition) in individuals of all ages and in any country to minimize selection bias.
The study included both prospective and retrospective data, including data from food challenges conducted under medical supervision and patient surveys in which the categorization of anaphylaxis was evaluated by a health care professional.
After scrubbing the data, a total of 86 studies of 36,557 anaphylaxis events met the inclusion criteria.
The study authors concluded that about 10% of anaphylaxis reactions were treated with more than one dose of epinephrine, including when a healthcare professional decided to administer a subsequent dose.
A total of 11 studies reported the precise number of epinephrine doses administered. Overall, at least 3 doses were administered in 2.2% of anaphylaxis reactions or in 3.4% of reactions treated with epinephrine.