Life-saving epinephrine underused during anaphylaxis outside of hospital, study finds

September 10, 2018, McGill University
Credit: McGill University

Fewer than half of adults and children experiencing food-induced anaphylaxis use their epinephrine autoinjector (EAI) before being treated at a hospital emergency room, according to a new Canadian study.

"It's a disappointing reality that epinephrine is seriously underused," says lead researcher Dr. Moshe Ben-Shoshan, a pediatric allergist and immunologist at the Research Institute of the McGill University Health Centre (RI-MUHC) and at the Montreal Children's Hospital, and an assistant professor of Pediatrics at McGill University.

"Our study found that only 41 percent of patients who had an epinephrine autoinjector with them during an anaphylactic reaction actually used it before arriving at the hospital. Given that death due to anaphylaxis can occur as rapidly as 30 minutes after exposure to food, it is crucial to use epinephrine promptly when available to reduce this risk."

Almost 600,000 Canadians will experience anaphylaxis in their lifetime. The potentially life-threatening reaction can occur within seconds or minutes of exposure to an allergen which may include food, medications, insect stings or substances such as latex.

The study, published in the Journal of Allergy and Clinical Immunology: In Practice, examined 483 cases of food-induced anaphylaxis treated at nine Canadian emergency departments between 2010 and 2017. The study is part of a larger national project and database called the Cross-Canada Anaphylaxis REgistry (C-CARE), which tracks the rates, triggers and management of anaphylaxis in different provinces and settings across Canada.

"We found that 53 percent of the patients in our study received antihistamines as a treatment, while 20 percent of patients did not receive any treatment at all before arriving at the hospital," says first-author Sofianne Gabrielli, an AllerGen trainee and a research associate at RI-MUHC. "It's surprising that epinephrine use during a severe allergic reaction is so low: there really is no downside to giving it—epinephrine is extremely safe and it can save your life."

Among the study's other findings:

  • Teenagers (13-19 years) possessing an EAI at the time of reaction were more likely to use it than younger children or adults over 20 years
  • Individuals with severe anaphylaxis were more likely to use an EAI than those with mild or moderate anaphylaxis
  • Alberta had the lowest percentage of EAI use among the five provinces represented in the study

"These results underscore the need for greater awareness and education for patients and their caregivers in assessing the signs and symptoms of anaphylaxis and the importance of using epinephrine to treat it", says Jennifer Gerdts, a study co-author and Executive Director of Food Allergy Canada—a non-profit charitable organization that educates, supports and advocates for Canadians with food allergies and those who care for them. "However, it's encouraging to see that teens—who, are considered a more high-risk group for allergic reactions—are more likely to use their EAI appropriately."

"The important takeaway from this study is that food-allergic individuals, as well as parents, the community, and healthcare professionals, need to recognize that should always be the first line of defense when treating and should not delay in administering an EAI."

Explore further: Increasing cases of anaphylaxis among children

More information: Sofianne Gabrielli et al. Teenagers and those with severe reactions are more likely to use their epinephrine autoinjector in cases of anaphylaxis in Canada, The Journal of Allergy and Clinical Immunology: In Practice (2018). DOI: 10.1016/j.jaip.2018.07.044

Related Stories

Increasing cases of anaphylaxis among children

April 21, 2016
Anaphylaxis, known to be a sudden and potentially life-threatening allergic reaction, seems to be increasing among children, according to a new study led by a team at the Research Institute of the McGill University Health ...

Half of kids who needed epinephrine didn't get it before trip to the emergency room

July 12, 2017
Anyone suffering a severe allergic reaction (anaphylaxis) should receive epinephrine as quickly as possible. A new study showed that even kids who were prescribed an epinephrine auto injector didn't receive the life-saving ...

Food-induced anaphylaxis common among children despite adult supervision

December 14, 2017
At least a third of reactions in children with food-induced anaphylaxis to a known allergen occur under adult supervision, according to a new study led by AllerGen researchers in Quebec, Ontario and Alberta.

Even if severe allergic reaction is in doubt, epinephrine should be used

August 6, 2015
There are times when emergency physicians can't be 100 percent sure a person is suffering from a severe allergic reaction, known as anaphylaxis, and may hesitate to use epinephrine. A new article says when in doubt - administer ...

Majority of US adults prescribed epinephrine report not using it in an emergency

June 21, 2018
The most effective, life-saving treatment for a severe allergic reaction (anaphylaxis) is epinephrine. Yet a new study shows in an emergency, 52 percent of adults with potentially life-threatening allergies didn't use the ...

US approves first generic competitor to Mylan's EpiPen

August 16, 2018
US regulators Thursday approved the first generic alternative for the EpiPen, a life-saving emergency allergy medicine, two years after soaring prices for the original version owned by Mylan stoked controversy.

Recommended for you

HIV vaccine protects non-human primates from infection

December 14, 2018
For more than 20 years, scientists at Scripps Research have chipped away at the challenges of designing an HIV vaccine. Now new research, published in Immunity, shows that their experimental vaccine strategy works in non-human ...

RNA processing and antiviral immunity

December 14, 2018
The RIG-I like receptors (RLRs) are intracellular enzyme sentries that detect viral infection and initiate a first line of antiviral defense. The cellular molecules that activate RLRs in vivo are not clear.

The 'greying' of T cells: Scientists pinpoint metabolic pathway behind age-related immunity loss

December 13, 2018
The elderly suffer more serious complications from infections and benefit less from vaccination than the general population. Scientists have long known that a weakened immune system is to blame but the exact mechanisms behind ...

Scientists create most accurate tool yet developed to predict asthma in young children

December 13, 2018
Scientists at Cincinnati Children's Hospital Medical Center have created and tested a decision tool that appears to be the most accurate, non-invasive method yet developed to predict asthma in young children.

New genetic study could lead to better treatment of severe asthma

December 12, 2018
The largest-ever genetic study of people with moderate-to-severe asthma has revealed new insights into the underlying causes of the disease which could help improve its diagnosis and treatment.

Researchers discover unique immune cell likely drives chronic inflammation

December 11, 2018
For the first time, researchers have identified that an immune cell subset called gamma delta T cells that may be causing and/or perpetuating the systemic inflammation found in normal aging in the general geriatric population ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.