Use of epinephrine in the treatment of anaphylaxis.

PURPOSE OF REVIEW: This paper is intended to review recent literature that impacts the use of epinephrine in the therapy of anaphylaxis.

RECENT FINDINGS: The most important recent finding regarding the administration of epinephrine is that the intramuscular route of administration is the route of choice for the treatment of anaphylaxis, and the lateral aspect of the thigh is the site of choice. In addition, recent research emphasizes the fact that epinephrine is grossly underused in the management of anaphylaxis, which accentuates the need for further education of both physician and patient in this regard.

SUMMARY: Several major themes have emerged from this review of the recent literature. The finding that the intramuscular route of administration for epinephrine is superior has now been recognized by the guidelines, and because the site of choice has been found to be the lateral aspect of the thigh, the needle used for injection must be long enough to penetrate the vastus lateralis muscle. The reasons for the underutilization of epinephrine in the treatment of anaphylaxis are also discussed. Other important findings include the fact that outdated EpiPens can usually be administered safely, and alternative routes of administration, which may be more acceptable to patients, may be on the horizon as a result of preliminary studies assessing the administration of sublingual epinephrine by wafer. Finally, it is now understood that epinephrine prescription data may be one of our best tools to study the epidemiology and incidence of anaphylactic episodes.